Certified physiotherapist, Allen Hicks, of Evolution Physiotherapy, assesses Jamie's injury and devises a rehab plan to get him back on the course in eight weeks. An assessment was also done of Jamie's overall golf fitness and a simultaneous program has been put in place to use the down time to improve on weaker areas. Tracking of injury progress in left column. Tracking of overall golf fitness progress in right column.

Range of Motion: Painful arc with flexion and abduction; shoulder abduction limited to 140 degrees; horizontal adduction limited to ¾ range (olecranon at right eye).

Strength: Significant pain and weakness with shoulder abduction and mild pain and weakness with shoulder external rotation.

Accessory Movement Testing: Limited posterior glide of the glenohumeral joint.

Special tests: Positive impingement test (Neer and Hawkins-Kennedy); decreased scapular stability/strength.

Preliminary Diagnosis: Rotator cuff tear (supraspinatus portion); differential diagnosis: rotator cuff contusion/ impingement with possible calcification in supraspinatus muscle.

Rehab Plan: Increase shoulder range of motion, strengthen scapular stabilizers, strengthen rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis), improve posterior capsule mobility of gleno-humeral joint, return to playing golf.

Other Tests: Diagnostic ultrasound to examine rotator cuff muscles.

Excessive spine flexion in the set-up position. Correct spine posture to improve swing consistency and performance has been identified.

Limited range of motion: horizontal adduction of right shoulder (necessary in the swing follow-through motion). Stretching of the posterior capsule and posterior shoulder muscles has been implemented in the treatment plan.

Limited strength with horizontal adduction of left shoulder, which results in breakdown (excessive bending) of the left elbow during the backswing/takeaway motion; this will lead to decreased power, as well as less consistent ball contact.

Follow through position: does not transfer enough weight to forward leg.

Shoulder strengthening exercises for the rotator cuff muscles group have been progressed.

External rotation strength has improved in the neutral position and has been progressed to the overhead position (full backswing position).

Deep transverse frictioning has been commenced for the rotator cuff interval and the long head of the biceps tendon.

Jamie’s shoulder still exhibits sharp pain with sudden movements. The pain only occurs at specific shoulder angles. There is still significant pain and weakness of the supraspinatus (top portion of the rotator cuff muscle group) muscle, which would be expected if a tear exists in this muscle

This is a credit to Jamie’s compliance with performing the appropriate spinal rotation strengthening exercises. The measurements have improved from 41 cm to 38 cm with right rotation, and 41 to 39 cm with left rotation. A lower number indicates improved spine rotation.

Jamie still has right shoulder pain at the top of his backswing motion. He still has pain in his right shoulder with the follow-through motion, but this pain has decreased over the past 2 weeks.

Jamie’s spine posture/angle in the address positioning is improving, but does not feel natural yet.

Preventative warm-up and strengthening exercises have been initiated for Jamie’s wrists and elbows, to help prevent suffering from golfer’s or tennis elbow once he’s back playing golf.

Golfer’s who have shoulder weakness or who have suffered a previous shoulder injury (eg. an old shoulder separation from hockey, football, or rugby years ago) are more susceptible to having residual shoulder weakness, which can lead to developing tennis elbow.

Tennis elbow injuries are 6 times more common in golfers than golfers elbow. Tennis elbow refers to tendinopathy of the lateral elbow. Golfers elbow refers to tendinopathy of the medial elbow.

Over the past 2 weeks, Jamie’s shoulder range of motion has continued to improve. He no longer presents with a painful arc, but still has pain at the end of his full range of motion with flexion and abduction. Horizontal adduction motion is full and pain-free, but still feels tight at end range compared to the left side. Strengthening exercises have been progressed over the past 2 weeks. Quadrant scouring has been added to help deal with continued pain at specific angles and positions. Further scapular stability exercises have been initiated.

Jamie’s spine rotation strength has remained the same as 2 weeks ago - 38 cm with right rotation, and 39 cm with left rotation. This lack of change was expected, as Jamie indicated that work has interfered with his exercise program over the past 2 weeks. Jamie’s experience is typical of most clients that I see. The exercises result in improved changes when they are done regularly, but if they are not done regularly, no benefits are seen.

Jamie’s shoulder still exhibits sharp pain with sudden movements. As expected, this pain is due to a tear in the supraspinatus portion of the rotator cuff. Continued strengthening and stabilizing exercises for the surrounding musculature will continue to help alleviated stress on the injured area. Surgery for the supraspinatus tear may be warranted, pending a surgical consultation. In the meantime, the goal remains to get Jamie back golfing as soon as possible, in spite of the rotator cuff tear.

Hold for 10 seconds, repeat until fatigued (it won't take long!). The higher you lift the arms, the harder the exercise. You don't want it to produce any shoulder pain, just muscle fatigue.

An MRI has been ordered to help facilitate a surgeon referral. The MRI results should correlate closely with those of the diagnostic ultrasound, confirming the partial thickness rotator cuff tear.

Effective management of golf injuries requires an understanding of how the golf swing creates stress on the body and the Centre provides individual fitness programs to help golfers improve their health and performance. You do not need a physician referral and new patients are always welcome.

Click here for more about Allen Hicks and Evolution Physiotherapy.