Managing a male golfers low back and sacroiliac joint pain using manual therapy and therapeutic exercises to avoid surgery and continue scratch level play.

Abstract

Purpose: The purpose of this case study is to demonstrate a unique way of working with low handicap golfers looking to avoid surgery after two years of low back/sacroiliac pain (LBP/SIJP) and injury. This study used all-encompassing treatment sessions each time the patient was seen, including lengthening, strengthening and creating power with less stress on the LB/SIJ region. The treatment looked at decreasing muscle and structural imbalance and engaging all of the muscles when making a swing. Client description: Patient is a 71 year-old man with a 14 month “bad” back with history of pain. The pain was so debilitating that he went from daily play to a three time a week play. His play itself also decreased from a +2 handicap to a -4 handicap. The patient complains that he suffers from constant pain and has decreased all functional and recreational activities. Intervention: Patient was seen 2-3 times a week for eight and half months. There was a three-month stop when the patient returned north for the summer and was healing from an arm injury. The patient completed treatments targeted at maintaining a level pelvis, increasing mobility of the lumbar spine, and strength training all surrounding core, gluteal and lower extremity muscles. Muscles Energy Techniques (MET) were used to align his pelvis. Stabilization exercises and strengthening exercises that could be completed in the golf position were done in order to create proper length tension relationships as well as kinesthetic awareness of the body during the swing. Balance and proprioception was also worked on every session with a push/pull concept in order to decrease muscle imbalances and increase coordination from past months of pain and injury. Measures and Outcomes: All measurements and subjective and objective measures were covered over 8 months. After the second treatment patient's pain level and ability to move independently was improved significantly. IR and ER of the hips took the longest to achieve but this measurement directly affected the pelvis alignment and patient’s subjective comments on the ability to get through the ball during the swing. His pain and tone levels continued to go down throughout treatment and he is now without pain during and following play. Implications: “Once a bad back, always a bad back” appears to be a proper theme for athletes who wish to continue to play at the same level or better without surgery or medicine intervention. Patients who are willing to work on their body with manual and physical strength training can keep most symptoms in control and still have improvement in play. But it requires daily exercise and manual stretching. Pain was decreased and function was returned in about 25 days, but whenever the patient stopped his exercises and stretching (within the first 5 months of treatment), symptoms would return. He is now able to play and travel with less routine, but still needs at least 1 time a week for core strengthening and stretching. Golf mechanics have been resumed because there is a lack of pain and all the muscles that should be used are now turned on with the specific strength routine.