A frequent patient type that comes into my clinic is the senior golfer. Golf is an incredible sport that many are fortunate to play throughout the majority of their lift. While there is little impact in the game, the repetitive motion often is associated with hip or low back pain. While we do not advocate the idea of assessing and treating pathoanatomically, we do believe that motion is good for the human body. Golf is a sport that requires movement in at many joints throughout the body, and a restriction in one area may impact another.
A site of common dysfunctional motion in the senior population is the hip. With the propensity of low back pain in senior golfer patients, we must be sure to improve mobility both locally and far from the affected area. A frequent presentation of hip arthritis (even non-painful arthritis) is loss of hip IR ROM. With golf requiring rotation in both directions, each hip is required to move into both IR and ER at different parts of the swing. A loss of hip IR leads to increased strain in another part of the body during the swing (possibly the lumbar spine). While we can try and improve hip mobility into the restriction, we may have limited success. A potential fix for these patients is to adjust the hip position at the initial swing. For patients with loss of hip IR mobility (either with significant hip OA or retroversion), we can externally rotated the lower extremities slightly bilaterally before the swing begins. That way the hip can move into relative internal and external rotation throughout the swing.
Again, I cannot stress enough the importance of not automatically having your patients switch to this positioning. You patient may respond to some form of manual treatment, exercise, or other intervention to improve hip mobility; however, should they fail to respond, adapting the hips to an externally rotated position can permit some relative internal rotation mobility. We look for anyway we can help our patients reach their goals.
-Dr. Chris Fox, PT, DPT, OCS
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