It is an all too common story in golf. Injury or overuse of the lumbar spine will result in a change in swing mechanics mediated by pain or physical impingement, or both.  Repeated treatments, whether conservative or surgical, only give temporary relief but the problem never really goes away. What if the lumbar spine is not the problem?

How many of you have walked into a clinic expecting to be treated for your lower back, to find yourself having manual therapy done on your thorax, and are then surprised to find the lower back pain lessen or disappear?

Does a pain-free thorax then equate to ideal mechanics in your spine?
 

The Thorax

The thorax is inclusive of the thoracic spine, the ribcage, chest plate and internal organs, forming 20% of our total body length. It often gets under or misreported as lower back pain in a lot of clinical data. It is in the thorax predominantly that most of the rotation of the spine occurs. Compensatory rotation of the lumbar spine, especially when combined with flexion (bending) such as during a golf swing, can make the lumbar discs increasingly vulnerable to injury. The lack of thoracic rotation is seldom due to stiffness but instead a lack of adequate neuromuscular control of the joints in the thorax.

Now consider the number of muscles that attach from your thorax to your pelvis, head/neck and shoulders, all of which are pivotal in transitioning force generation from the pelvis to the upper limb in the golf swing. Lower thorax issues will most often impair and alter the functional movements of the pelvis resulting in loss of stability, strength and movement. Similarly, a poor upper thorax will alter the ability to lift and rotate the shoulders, arms and head/neck.
 

The Body-Swing Connection 

The sequence of body segments during the downswing (in a right hander) follows first the pelvis translating and rotating to the left, then rotation of the thorax, then arms and club back toward the ball. Dysfunction in the thorax will prevent the optimal transition of segmental movement from your lower body into your upper body and club. This can result in any number of the compensatory swing faults commonly seen. This impaired swing is also less effective (shorter and less accurate shots) and may also lead to further injury and overuse of other body segments.

A simple test to determine whether or not your thorax is affected and contributing to the dysfunction is to sit on the edge of a chair, fold your arms across your chest and turn as far as you can with your upper body, without moving your backside off the chair. Compare this from left to right:

  • Is there one side tighter than the other?
  • Is there pain?
  • Are you actually moving your thorax versus turning your neck or side bending your trunk?

 

Treating a Dysfunctional Thorax

Treating the thorax may involve manual therapy by a physiotherapist to release fixated joints and muscles that are preventing optimal movement. The body is an incredibly interconnected unit and more than just the sum of all its parts. Often there may only be one or two primary areas creating this suboptimal movement, which is generally referred to as a 'driver' (or primary and secondary drivers where there is more than one).

Once the driver has been identified (this may not necessarily be the thorax but can be elsewhere in the body) and normal motion is restored to that area, it is important to then retrain the brain to make effective use of the increased range of movement and to regain neuromuscular control of that area. Knowing where and what your driver is can help you address the problem with greater efficiency. This is where communication between your golf coach, physiotherapist and fitness trainer is important.

"Knowing where and what your driver is can help you address the problem with greater efficiency"

Motor control exercises to correct the primary driver and facilitate new muscle patterns are important to prevent unwanted muscle tone and postures from returning. These can include simple movements where specific segmental muscles are cued with appropriate feedback (often tape, biofeedback and use of mirrors). Appropriate thoracic strengthening exercises and subsequent golf specific drills can then be added, being sure to maintain the correct cueing pattern throughout, until such a time that the correct movement becomes automatic.

Understanding where your driver is can be the key to effective management of any musculoskeletal condition.

Treating the thorax may not fix your golf swing but it will enhance your movement pattern and ability to sequence body parts. This in turn will optimise this fundamental component of a swing, which most teaching professionals can recognise, and that will then lead to improvements on the course.

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