Titleist Performance Institute Case Study: Golfer with Previously Broken Jaw

It is critical to obtain a complete injury history when dealing with a new athlete. By "complete" I mean birth through present day. Conditions during child development can affect the way the body subsequently learns movement. Understanding the possible causes of the physical limitations observed in screening can help guide the appropriate corrections. Below I describe a brief case study in training a golfer whose movement limitations all share a common thread to an old high school injury.

Background

Played baseball in high school (right handed pitcher)

Age 30, Right handed golfer, Eight handicap, Played for 15 years with a few breaks

Originally noted no prior injuries…

Swing issues (according to his instructor):

1. Loses control of right elbow in backswing
2. Sways on backswing
3. Over-the-top downswing and hangs back through impact
4. Left-to-right ball flight (loses it too far right at times)

Titleist Performance Institute Screen Results (only limitations are noted below)
Pelvic Tilt Test: Limited anterior; Shake n bake
Pelvic Rotation Test: Limited bilateral mobility; lateral motion
Torso Rotation Test: Limited bilateral stability
Overhead Deep Squat Test: Both ankles dorsiflexion limited
Toe Touch Test: Limited toe touch bilateral
90/90 Test: L arm – less than spine angle (golf posture and neutral posture)
Single Leg Balance Test: 0-5 seconds bilateral
Lower Quarter: Right Internal less than 60 degrees
Bridge with Leg Extension Test: Glutes weak bilateral
Ankle Mobility – Limited eversion bilateral

Thought Process

Based on the screening results, my priorities were to improve the toe-touch pattern, achieve a right-to-left symmetry in the thoracic spine (re: the 90-90 test), correct the deep squat, and activate the glutes. We ultimately spent very little time on the single-leg-balance as his progress was rapid (single leg balance typically has a steep learning curve). He also made rapid progress with the pelvic tilting.

However, before we began training, he added, "Oh, by the way, I just remembered that I broke my jaw in high school." While this bit of information did not change the screening results, it did provide valuable context. For instance, he was extremely sensitive with foam rolling and using the tennis balls to massage the thoracic spine. Simply lying on the foam roller was uncomfortable. Likewise, his thoracic spine mobility was limited, especially when rotating to the left.

This player appeared to be a classic case of the body and brain evolving to protect something; in this case the jaw. Interestingly, he received virtually no rehab after the injury. The process was merely to immobilize the jaw, get rid of the splint, and then try not to get hurt again! Unfortunately, his golf game suffered for having never properly relearned how to use his thoracic spine. Without the ability to rotate freely from his thoracic spine, his body sought use of the flying right elbow to complete the backswing.

Based upon the way he shut down his breathing to grind through each corrective exercise, I felt more confident in the hypothesis of the jaw injury being a contributing factor. Additionally, his performance on the toe touch, deep squat, and deep squat ankle breakout provided additional evidence of a more global neuromuscular problem. Athletes with neck and jaw dysfunction often exhibit limitations along their entire posterior. We saw evidence of this phenomenon in his failed tests. The quality of these movements suffered as a result of the upper thoracic tension being transferred throughout the body.

The posterior chain as a single unit

Corrective Process and Conclusion

Understanding the source of dysfunction is crucial to resolving any problem. The neurological "guarding" this athlete used to stabilize his jaw deserved specialized attention beyond going through the exercises. Fortunately, if you can influence the underlying brain elements, you don’t need an entire library of exercises to make progress.  How you do the exercise is more important than what you choose.

Strength and power often improve simply by finding the right way to remove the emergency brake. With this player we observed improvements in the Titleist Performance Institute medicine ball testing, which measures power in three different planes. Ultimately, our off-course interventions must remove physical limitations so the golf professional has the best possible canvas with which to work when giving instruction.    

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