PWB: Thoracolumbar Pain Stabilization Golf Instructor: Phase 4 (4-2-18)

Email Response
- The alternative of the ball rollout worked well
- The cross leg lower trunk rotation: What should I feel? Do I want my abs engaged?
  - This is the initiation of controlled rotation. You should feel pulling into the lateral hip and low back, sometimes into the shoulder as well. You do want your core engaged. Move very slowly through the motion so your core as to work to control the rotation and pull you back out of the position. You can gradually move deeper into the rotation but do so carefully. I want you to work on rotation but with control and moving slowly.
Daily Sequence
- 55) Abdominal Isometric at Counter/Desk VIDEO
  - We started to discuss this the first day I met you
  - This can be done frequently to off load the low back
  - This will be important because any exercise we do requires you get control here first
- 124) Double Leg Heel Raise VIDEO
  - THIS WILL ADD MOBILIZATION OF CALF WHILE MAINTAINING ABDOMINAL CONTROL
- 18.1) Hands Elevated CHILDS POSE Variation VIDEO
  - Mobilization for mid back and shoulder while engaging abdominal tension
    - NEW OPTION
      - 83.2) Ball Rollout Wall Block VIDEO
        
        LESS OF A STRETCH WITH MORE FOCUS ON ABDOMINAL ACTIVATION
      - OPTION 2
        
        MORE OF A STRETCH
        
        18) Puppy Pose Progression VIDEO
- 41.2) Cross Leg Lower Trunk Rotation Pec Stretch VIDEO
  - Slow and controlled motion
Strength Sequence
- THIS WEEK I WILL BREAK UP THE STRENGTH INTO 2 SEPARATE CIRCUITS
  - YOUR WEEKLY ROUTINE WOULD IDEALLY BE:
    - DAY 1: STRENGTH CIRCUIT #1 (2 SETS) + DAILY MOVEMENTS
    - DAY 2: DAILY MOVEMENTS
    - DAY 3: STRENGTH CIRCUIT #2 (2 SETS) + DAILY MOVEMENTS
    - DAY 4: DAILY MOVEMENTS
    - DAY 5: STRENGTH CIRCUIT #1 +#2 (1 SET OF EACH) + DAILY MOVEMENTS
    - DAY 6: DAILY MOVEMENTS
    - DAY 7: REST DAY/OPTIONAL DAILY MOVEMENTS
- CIRCUIT #1
  - 98) Hip Extension Over Table/Bed VIDEO
    - Since I reviewed the movement above the first day we met, I would like you to add this as well
    - make sure you do not have any pain in the low back
    - I am going to give you 2 options to try and you can decide which works best but they are the same concept…option 1 is above and option 2 is down below
    - Really try to keep the knee locked out completely straight as you lift the leg
    - Hold at the top for 5 sec
    - Lying over the edge of a bed or dining room table works well
      - 97) Quadruped with Physio Ball Hip Extension VIDEO
  - 56.1) Lying Down Weighted Pullover Feet Elevated VIDEO
    - Do this slowly to avoid tension in low back
    - Very light weight to start
  - 149) Upper Body Assisted Squat VIDEO
    - Hold on the squat for this week and try the progression below
    - We will bring back another variation of the squat next week
    - Slow and controlled
    - Stay in a range short of pain
  - NEW OPTION: START OF PHASE 1 AND THEN TRY PHASE 2 THE NEXT TIME THROUGH IF NO ISSUES WITH PHASE 1
    - Can use edge of couch or chair instead of ball
    - make sure you get good abdominal tension first and do not lift your hips too high
    - Let me know if you feel anything in your back with this one
    - PHASE 1: 113) Isometric Co-activation Abdominal/Glute Phase 1 VIDEO
    - PHASE 2:115) Double Leg Bridge Phase 3 VIDEO
- CIRCUIT #2
  - 66.1) Static Plank High to Low VIDEO
    - Goal is to hold 30-90sec
    - You will feel more in your abdominals as you progress to lower surfaces
    - If you are able to get to 90sec, progress to lower surface where is is a challenge to get 30-60sec
  - Palloff Press Variations
    - 86) Standing Press in Lunge and Terminal Stance VIDEO
      - BAND IS ANCHORED TO THE SIDE
      - IT IS TRYING TO PULL YOU SIDEWAYS AND YOU HAVE TO CREATE THE SAME STABILITY IN YOUR TRUNK TO RESIST ROTATION
      - YOU WANT YOUR FEET NARROW ENOUGH THAT YOU FEEL SLIGHTLY OFF BALANCE
      - TRY FOR 8-15 REPS EACH POSITION FOR A TOTAL OF 4
      - IF THIS IS NOT WORKING I HAVE SOME OTHER LATERAL STABILITY DRILLS WE CAN TRY
  - 8) Standing Thoracic Rotation with Band Around Knees VIDEO
    - THIS IS A DRILL IN A SMALL KNEE BEND TO WORK ON THE ROTATION REQUIRED FOR THE GOLF SWING
    - TRY FOR 30-90SEC IN A VERY SMALL KNEE BEND GOING THROUGH SLOW AND CONTROLLED ROTATION