Services » Physiotherapy Case Study - Tom

Background

Tom Naskrett is 55 years old and lives in Mallorca. He read about our services online and came to see us to see how we could help him.

He originally injured his elbow 30 years ago, resulting in open surgery. He made a reasonably good recovery from this and played golf for the next 13 years, but had to stop due to some discomfort. He resumed playing around five years ago, only to have increasingly severe problems over the last year with his elbow while playing golf. His main complaint was at impact, which gave him nasty pain at the elbow - sufficient for him to need a week to recover before considering playing again. A number of investigations had been carried out, but it was the impact position which was his real worry.

Assessment

An initial meeting with Tom highlighted several things, including:

• postural issues at address and with the swing as a whole. These included lack of thoracic extension (mid-back), rounded shoulders, chin 'poke', flexed lumbar spine and loss of thoracic rotation
• very good use of his hands, due to all of the above - hitting the ball was good!
• loss of full extension at the elbow with decreased turning the hand in and over and out (pronation and supination).

The moment we saw Tom swing with his setup, we knew we could help him. He was 'all arms', with no trunk movement or control, lack of flexibility and stability, thereby throwing all the stresses onto his arms and elbow.

The next important piece of advice was to see TGA for a 3D analysis of his technical movement and to undertake the full musculoskeletal analysis. The analysis threw up some important points.

Therapy

The analysis allowed TGC to identify and address the problem areas:

• Manual therapy enabled Tom to regain more extension from his right elbow
• Exercises were prescribed to build up the basic strength around the elbow
• Postural drills were developed both for golf setup and everyday use
• The initial programme included
  • Self-stretching of the elbow into extension, with response further enhanced by pre-heating. This was recommended daily and pre-golf
  • Pectoral stretches in a doorway
  • Shoulder blade stability exercises (scapulo-humeral) and with all functions
  • Mid-back exercises (thoracic spine for extension work) daily and with all functions
  • Postural exercises for the whole back, neck, shoulders and elbow - 'angel wings'.

We also recommended a good sports physio for Tom who could mobilise and manipulate his stiff thoracic spine and ribs, as well as deep soft tissue releases all over the body and especially around his shoulders and pelvis/lower back.

Future Development

Tom came to us with a specific problem that our tailored programme has been addressing. Looking to the future, his treatment and exercise programme would involve:

• specific soft tissue stretches and releases which connect the upper to lower limbs
• further local elbow work
• flexibility and stability work for the shoulder girdle, pelvis, hips and lower limbs
• a specific strength and conditioning programme, built around Tom's own daily/weekly schedule
• ongoing golf drills and exercises from TGA.

We've discussed our programme with Tom's golf professional who has interwoven it into his work in Mallorca and help review via the internet. We'll meet with Tom again when he next visits the UK to further assess his progress.