During the first phase of the backswing in a right-handed golfer, the left scapula should glide freely across the torso. Once the elastic barrier has been reached, the glenohumeral joint will activate to allow continued movement of the forward arm up the vertical plane. The thoracic spine will then complete the necessary rotation as the forward arm climbs to the set point at the top of the backswing. The sequence of motion during the backswing is scapulothoracic, glenohumeral, and finally torso (thoracic) rotation.
Do not be surprised at the limitation of your patient to push their forward arm up the vertical plane past "9 o'clock" on an imaginary clock face. The average tour professional can reach to "11 o'clock" without postural compromise. The biggest hitters on tour reach "12 o'clock."
It is important for your patient to keep their forward arm extended during the backswing. Bending the forward elbow is a compensatory reaction to lack of shoulder and torso flexibility. During the downswing, secondary to centrifugal force, the bent elbow will "snap" and hyperextend at impact.
Patients know they have to take a long backswing to generate power for distance, but 80 percent of them lack the necessary flexibility in the scapula and glenohumeral joint, so they compensate by bending the forward elbow. Bending and then hyperextending the elbow eventually will inflame the connective tissue of the joint, causing pain. In addition, the width of the arc will collapse, resulting in a significant loss of club-head speed.
Correction Protocol: To address swing mechanics, have your patient place a 10 inch strip of tape across the posterior aspect of the elbow joint (mid-humerus to mid-ulna) when they swing the club. If they bend at the elbow, the tape will pull the skin, providing immediate "biofeedback" that they are out of position. To address flexibility mechanics specific to golf, it may be prudent to refer the patient to a health care professional who specializes in this area.
