The Clinical Coach: Addressing Shoulder Injuries in Golfers

, I am back with another Friday Clinical Coach segment!

And today’s segment was brought on by the surge of golfers with shoulder pain we’ve seen in the last couple of weeks.

Makes sense…

Many golf players go months without swinging a club, and expect their body to withstand high rotational forces through their body.

You’d think back pain would be the first injury we’d see, but shoulders it is.

So let’s dive into it.

What is… shoulder pain in golfers?

There are a few injuries golfers will experience throughout their career.

• low back

• neck

• knee

• shoulder

• hip

• elbow

With the bold ones being the most common injuries based on the biomechanics of the game.

If you are working with golf athletes who dabble in the sports a handful of times in the summer, you are more likely going to experience elbow, low back, and shoulder issues.

The higher the caliber of player, the more interesting the injury becomes. After all these are players who play golf year round and even during the winter maintain a decent level of swing practice as best as they can.

You can expect knee and hip injuries in your older golfers, as well as a lot of shoulder injuries.

Novice golfers tend to present more with elbow and back pain issues.

So why are we talking about the shoulder?

Because it’s not quite common to have 15-20 individual golf players come into your office with similar shoulder issues.

Most Common Shoulder Injuries

You should be aware of the most common shoulder injuries that will plague most golfers. These are not severe for the most part, but dependent on the age of the patient, may require a more thorough intervention.

These are:

• Supraspinatus tendinopathy/strain

• Infraspinatus tendinopathy/strain

• Teres Minor/Major Strain

• Proximal Bicep Tendinopathy

• AC Joint Compression

• GH arthritis

Most patients tend to simply try and ignore their shoulder pain, thinking it’s going to get better, until it doesn’t and they have continuously aggravated it for the last two weeks.

You’ll also start getting athletes who claim to be biohackers telling you they’ve been running BPC-157 or a cocktail of peptides to treat it, but it doesn’t get any better.

This is where understanding tissue adaptation comes in handy.

Assessing the Shoulder

As any good clinician your assessment should include the testing of:

• Supraspinatus

• Infraspinatus

• Subscapularis

• Teres Minor/Major

• Pec Major/Minor

• Deltoids

• Latissimus Dorsi

• Bicep Brachii

• Scapular motion

• GH Motion

• AC Joint

If you don’t test ER and IR of the GH joint at different angles. Start doing so. You’ll start noticing patients may not compensate at one angle, but may compensate at a slightly higher/lower angle. You can use this as an additional data point for progress.

Just don’t get too picky and try to assess every 5 degrees… that might be too much. Stick with 0-15-45-90-135-180. At least that’s what I have used and has worked great.

From the muscle assessment, we are looking for good muscle strength, non-painful movements of the shoulder, and non-painful muscles during all ranges of motion. Preferably we’d like to see pain during our passive assessments.

An excellent, and simple, exercise that I use to assess integrity of the shoulder is the pushup.

I like it for a few different reasons:

1. humbles patients when done right.

2. excellent rehab exercise to start pretty much every single patient.

3. easy to progress and regress

4. opens up the conversation about post-rehab

If you have the space, have your golfer bring their clubs with them.

If not, then have them record themselves hitting some balls in slow motion for their next visit. This should give you some insight on their technique.

If you are familiar with a golf swing, you’ll be able to dissect their swing no problem. If you aren’t familiar with a golf swing get a golf pro to take a look at the video (great networking) or find a golf course for chiropractors. The TPI certification would be a great start.

The 3-Phase Rehab Formula

You already know that I don’t believe there’s a one size fits all rehab program.

Sure there are overlaps in the formula, but seldomly should patients have the exact same program.

Last week I shared the 3-phase formula for ankle rehab.

That same formula can be applied to most shoulder injuries, and here’s how that would look like:

Phase 1: RESET

Goal: Reduce pain, swelling, and restore mobility

Priorities:

• Control swelling: compression, elevation, active movement

• Light weight-bearing as tolerated

Phase 2: REBUILD

Goal: Rebuild balance, control, and ankle-specific strength

Priorities:

Proprioception (awareness and balance)

Lateral and rotational stability

Phase 3: RELOAD

Goal: Prepare for return to running/hiking with full function and trust

Priorities:

Restore power, reactivity, and load tolerance

Simulate real-world terrain demands

Reinforce joint integrity under fatigue

The 3 Exercises Your Patients Need

If you thought I was going to say shoulder presses, you wouldn’t be wrong.

Shoulder pressing, whether it’s with DB’s or barbells, is one of the most underrated exercises for shoulder health.

The problem is 98% of people don’t know how to do it, and 90% of clinicians don’t know how to coach it. If they attempt it, they coach it like it’s a body building exercise, not a strength and conditioning exercise.

For that reason I have three different exercises that develop strong and resilient shoulders and can be adapted to any part of the rehab framework.

Exercise #1

• Dumbbell Lateral Raise through the scapular plane.

  • The movement is 30-45 degrees in front of the frontal plane.

  • Targeting the middle and posterior delt, as well as the rotator cuff muscles without creating an impingement.

  • I use this exercises as a conditioning tool first, and a strength exercise second. Typically starting with 3-4 sets of 20 reps.

  • The higher the reps, the lower the weight.

  • The lower the reps, the higher the weight.

Exercise #2

• Dead Hangs

  • Not an exercise commonly seen in shoulder programs, and a missed opportunity to develop resilient shoulders

  • This is an exercise you’ll have to progress your patient slowly, but you should aim for 1 consecutive minute of hanging without any pain.

  • Regressions: TRX incline hang, Inverted row hang (feet elevated), Inverted row hang (feet on the ground)

  • Progressions: Increase time. Increase weight, One arm?

Exercise #3

• One Arm Sandbag Throw

  • Or you could use a light weighted ball, or a sand disc.

  • Don’t go heavier than 5-10lbs'; there’s no need.

  • We use this to build coordination, speed and control of high velocity movements.

  • It can be an Overhead, Side, Pitch, Underhand, throw.

  • Usually introduced as a pattern to rebuild shoulder locomotion in phase 2 by braking it down in different components. Usually based on patient’s skill levels.

Anything else?

Yes.

Don’t overlook patients biomechanics when it comes to shoulder pain.

Telling your patient to “keep doing what they are doing” and just follow the treatment plan is detrimental to their perception of your expertise, and overall the trust they’ll place on you.

Doing what they are doing is most likely why they got injured. Therefore something needs to change.

Adding treatment to aggravated soft tissues is not going to improve things long term.

If you are not familiar with golf mechanics, that’s okay. It’s time you level up your skills and knowledge.

Clinical Pearls

Tissue remodeling, tissue capacity, and tissue adaptations only occur through adequate stressors. In those cases your best progressions or regressions are based on volume, load, intensity and frequency of the stimulus.

Every patient is unique.

Make sure you take the time to understand them.

Until our next issue!

In health and strength,

P.S. If you have questions or comments, feel free to respond to this email. I reply to all emails personally.

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