Restricted trunk rotation in a golfer SPORTS MASSAGE CASE STUDY: 2

SCENARIO.... A 20 year old golfer presents with restricted trunk rotation. An ideal range would be for the golfer to attain 90 degrees in both directions while sitting astride a chair. While some golfers are able to attain this range of movement, many don’t. Techniques used to help attain this ROM include static stretching and proprioceptive neuromuscular facilitation techniques such as contract/relax. After discussion with another colleague, this practitioner considered that massage to the abdominal wall might positively influence thoracic rotation.

SECTION 1 - PRACTITIONER’S NAME AND PATIENT’S DETAILS Practitioner’s name and clinic (if applicable), patient’s date of birth, name and address, sex, occupation, sport, event, position (where applicable), name and contact details of GP/team doctor.

SECTION 2 AND SECTION 3 - GENERAL HEALTH AND PRESENTATION Reason for visit: Restricted range of movement in trunk General health: Excellent, very fit. No known allergies Previous history: None Previous treatment: The golfer followed a mobility programme for several weeks to improve the range of motion and although improvement did occur this was mainly transitory (immediately after the stretching regimes) and any gains were relatively small. Medication: None Any surgery: None

SECTION 4 - ASSESSMENT Observation and movement: Assessment of the player’s thoracic region showed no costal or spinal abnormalities or irregularities. While sitting astride a chair to fix the pelvis and lower limb joints, the golfer’s range of thoracic rotation was measured as 65 degrees to the right and 70 degrees to the left. Palpation: Palpation of the abdominal wall did not cause pain or highlight any localised areas of tissue tension.

SECTION 5 - TREATMENT PLAN Aims and objectives: To investigate whether reducing abdominal tissue tension could improve trunk rotation. Treatment: The golfer lay in a supine position with hips and knees flexed over pillows and the feet flat on the bed. The mas- sage commenced with longitudinal strokes in a clockwise direc- tion, starting in the right inguinal fossa and working upwards to the lower right costal margin, across the abdomen to the left costal margin and downwards to the left inguinal fossa (hence fol- lowing the path of the colon). The initial strokes were applied very lightly using the pads of the fingers of one hand to ensure that the golfer did not experience any pain and hence tense the abdominal wall. This was particularly relevant as the hands passed inferior to the sternum. The hand did not pass over the bladder but was lifted off the abdomen and replaced over the left inguinal

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fossa. As the golfer did not complain of any discomfort and the practitioner did not feel any tissue tension or reflex muscle spasm, the depth of the strokes were very gradually increased by using the pads of the fingers of one hand, reinforced by the other hand, moving in circular movements with varying pressure following the same clock-wise direction around the abdomen. Deep kneading using both hands further warmed, loosened and softened tissues. Finally tissues were stroked using alternate hands moving from the outer borders of the abdominal cavity towards midline, still moving along the path of the colon before finishing with just two longitudinal strokes. Outcome: The total massage time was 10 minutes. The golfer sat up from the bed and once it had been ascertained that he did not feel light-headed, he repeated the original exercise sitting astride a chair. His thoracic rotation was measured as 75 degrees to the right and 80 degrees to the left and was improved even further by then adding contract/relax PNF techniques and static stretches.

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