This entry is part 1 of 7 in the series Shoulder Injuries

Golfers’ Shoulders – Injuries and Pain in Golf

In this series we are going to examine:

The most common golfers’ shoulders injuries experienced, and the anatomy and biomechanics of the shoulder, shoulder girdle, and upper back. We will also look at injury- inducing swing faults, fixes and prevention.

Then we will put the data from this course into action. As a result, you will understand the risks to your shoulders and what you can do to minimize them and prevent injuries. Ultimately this will lead to more consistency, better distance, lower scores, and less pain on and off the course.

The shoulders are an area that can give golfers a great deal of trouble. Shoulder injuries are prevalent in golfers, and there are some simple reasons why this happens. There are several muscles in the shoulder complex that are tied to the posture of the upper body. When imbalances develop in the chest, upper back and shoulder, upper cross syndrome, rotator cuff disorders, tightness in the chest, limited shoulder motion, and shoulder complex asymmetries to name just a few, are likely to occur.

There are many shoulder disorders that can exist for years and not let us know they are there. There are some that we know about right away. You may have a slight rotator cuff tear, or cartilage tear, or a bone spur in your shoulder, but that doesn’t mean that your shoulder will hurt or get in the way of golf. You could have arthritis, but it may not hurt. If we add the motion of the golf swing to poor torso mobility or scapular stability and or a degenerative processes or slight injury or deformity, the shoulder will give out and you will experience pain with your golf motion.

The golf swing requires large amounts of rotation in the shoulder joint. If rotation is limited or lacking, the shoulder will be stressed during the swing.

There are two key principles that we will take up in the biomechanics section of this course. They are the issues of required mobility in the thoracic spine and shoulder blade stability. When thoracic rotation is lacking, there will be excessive mobility in the shoulder blade. This can lead to instability and injury in the shoulder joint. In the coming weeks we are going to dissect the problem of shoulder injuries and pain. We will examine anatomical issues, biomechanical issues, and swing faults.

Here is an interesting fact for you to ponder…if you struggle with deceleration in your swing, you probably have a shoulder problem on your downswing side, whether it hurts or not. We will look closely at this challenge in the next few issues.

Please email me at [email protected] if you have any questions.

Here’s to your healthy shoulders and good golf.


This entry is part 2 of 7 in the series Shoulder Injuries

The Shoulder – Common Injuries in Golf

Shoulder injuries can be a real pain. There are many kinds of injuries. In this lesson we will take up a variety of shoulder dysfunctions and the injuries they cause. Shoulder injuries are interesting because they generally come from overuse or improper use and from poor stability/mobility patterns of the thoracic spine and shoulder girdle. When the thoracic spine (which is supposed to be mobile) becomes immobile this leads to excessive mobility of the shoulder blade. If this happens, the shoulder joint’s response is to create stability for the arm rather than allowing mobility of the arm. The result seems to be roll reversal in the thoracic spine, scapula, and shoulder that is the root of many shoulder problems.

Rotator cuff tendonitis is nothing more than inflammation of the tendons of the rotator cuff. This inflammation is generally caused by overuse or impingement. Most commonly this is the supraspinatus muscle. This muscle sits at the top of the shoulder blade on the back and runs directly through the sub-acromial space. Because of its position it is very susceptible to compression (impingement) between the humeral head and the acromion. Unchecked impingement can lead to tearing or shredding of the tendons of the rotator cuff muscles. This is a real problem for the golfer. If you tear these tendons you will be out of the game for about six months.


When the shoulder blade becomes unstable on the ribcage, due to thoracic spine rigidity, the muscles of the rotator cuff become over active. They “try” to create stability in the shoulder so that the arm can move. There is a rule in the body when it comes to muscles: a muscle cannot be a stabilizer and a mover at the same time. When a muscle that is a mover “tries” to act as a stabilizer it generally becomes irritated and inflamed and a tendonitis develops because it was not designed to act in this way.

If you want to prevent this type of shoulder injury you must have a mobile thoracic spine, stable shoulder blade, and mobile shoulder. This will stop shoulder injuries. It will also cure some golf maladies like “flying elbow,” “limited arc length” and deceleration and “flipping” of the club.


Bursitis is the inflammation of a bursa. This inflammation is caused by excessive irritation and poor mechanics of the structures that the bursae are guarding. Remember that a bursa is a fluid-filled sac. Its job is to cushion the ride of muscles and tendons as they glide over one another or over bones. If the mechanical pressures are too much, the bursa will become inflamed and cause pain and compensation of your swing motion. Once again it comes back to shoulder complex mechanics. Balanced mechanical function prevents injuries and promotes good motion in the golf swing.


Arthritis is a process of wearing out of the shoulder joint. Many attribute this disorder to aging, other injuries, and poor conditioning. All are correct. There is, however, another reason: improper use of the body part, in this case the shoulder. If there are muscle imbalances, shoulder girdle imbalances, or a limited range of motion in a shoulder or thoracic spine, the shoulder is put under great stress. An unbalanced shoulder girdle causes asymmetrical loading of the shoulder joint. It will, over time, lead to wearing out and change in shape of the shoulder joint.

Just because you are older, you do not have to have arthritis. With proper activity, including training that promotes symmetry in the shoulder girdle and the muscles of the trunk, arthritis can mostly be prevented. Just because your doctor tells you that you have a little arthritis, this does not mean it is the cause of your shoulder pain.


The bottom line is that self-diagnosis rarely works. If you have shoulder pain you could have any of these disorders. All of these disorders are aggravated by imbalances in the muscles of the shoulder girdle, thoracic spine and shoulder joint. Remedying these imbalances in most cases will reduce the strain on the structures of the shoulder complex and lead to less pain.

If you have questions about your situation, please send me an email at [email protected]. I will do my best to answer your them.

Here’s to your healthy shoulder and good golf.




This entry is part 3 of 7 in the series Shoulder Injuries

Shoulder Anatomy, How It Is Made Affects How It Works

Shoulder and Shoulder Complex Anatomy

Anatomy, how the body is built, is a key to understanding the role of the shoulder in the golf swing. In this segment we are going to study the anatomy of the shoulder girdle and the whole shoulder complex. There are many important structures and substructures in this area. The humerus, clavicle, scapula, ribs, and rotator cuff bones and muscles as well as a multitude of other muscles, ligaments, tendons, and nerves comprise the entire shoulder girdle complex.

To look at the boney structures of the shoulder complex we will begin with the shoulder girdle. This is the foundation of the shoulder. It includes the collar bone or clavicle, which extends from the breast bone or sternum to the shoulder, the shoulder blade or scapula, which is a large, flat, triangular bone that forms the back part of the shoulder and sits on the back of the ribcage, and the humerus or the upper arm bone.




The shoulder bones are linked by a series of joints that help create stability or allow movement. The joint between the shoulder blade and ribs is the scapulo-thoracic joint. This joint is not a joint in a classical sense, like the knee or elbow, but it is nevertheless an articulation between bones. The collar bone attaches to the upper portion of the breast bone at one end and the flange on the scapula, which you can feel at the point of the shoulder called the acromion. If you have heard of someone who has a separated shoulder, they have injured the acromioclavicular joint. The shoulder blade is also the home for the shoulder socket. It has a shallow socket that is perpendicular to the body of the scapular. This is called the gleniod fossa. It is more like a saucer or plate than a cup. It has a cartilage called the glenoid labrum that runs around the circumference of the glenoid fossa. Its job is to deepen the socket. Finally we have the humerus. At the upper end of the humerus, in the shoulder region, is the humeral head, or the ball. This sits in the glenoid fossa, and it is this joint that is the true shoulder. Seem complicated? It is! But its design is ingenious, as it provides a stable base that allows the arm to work efficiently.


There are a few other structures that we need to look at. There are bursae (fluid filled sacs that cushion the movement of muscles and tendons over one another. There are also nerves and arteries that run between the acromion and the head of the humerus. When these get pinched we experience pain.

One of the most unique structures in the shoulder is the joint capsule. Not that it is unique at a basic structural level, but its anatomical design is unique. A joint capsule’s job is to hold the joint together and allow motion. In this case, because of the magnitude of motion in the shoulder, the capsule has a large redundant fold in it at the bottom of the shoulder joint. It is this fold that also creates problems like “frozen shoulder” when injured. We will study that more in a later installment in this series.


There are a variety of muscles in the shoulder region. There are the rotator cuff muscles which course from the body of the scapula to the humerus. The rotator cuff is a group of four muscles that are designed to stabilize the head of the humerus against the glenoid fossa and control rotation and stability of the glenohumeral joint. There are several muscles that attach the shoulder blade to the torso. On the back there are the trapezius, rhomboid, latissimus dorsi, and serratus anterior. On the front there are the pectoralis major and minor. There are also muscles that run from the scapula to the humerus. These include the biceps, triceps, deltoid, and the coracobrachialis.

Like the other areas we have studied thus far, this all sounds very complicated, but it is actually quite simple. There are pairs of muscles on opposite sides of a joint or bone. These muscles act in opposition to one another to create mobility and or stability of the area where the muscle resides. The stabilizers generally attach the shoulder blade and collar bone to the torso, and the movers generally run across the shoulder. The key to a good golf swing and a pain-free shoulder is to make sure the pairs of muscles are working in sync with one another, in the correct sequence, and balanced in their tension and strength. This is the realm of golf fitness and preventing golfing injuries.

If you have any questions please email them to me at [email protected].

Here’s to your healthy shoulders and good golf.




Injury Inducing Swing Faults

This entry is part 4 of 7 in the series Shoulder Injuries

Golfers’ Shoulder Pain – Role Reversal

Swing Faults and Injuries-there is a relationship between swing faults and injuries, and poor biomechanics and swing faults. In this lesson we are going to look at how several common swing faults are related to injuries. We will also look at how abnormal biomechanics can create swing faults that create pain.

“Flying elbow” is both a swing fault that results from a shoulder disorder and a swing fault that can cause a shoulder or low back disorder. Here is how it works. Let’s say, for the sake of arguments, that you are a 50-year-old man with poor thoracic mobility. Your thoracic spine is excessively flexed and somewhat rigid because you sit at a desk all day long. As a result, there is tightness in the chest muscles. Because of a lack of mobility in the spine, spine rotation is also limited. Once these problems exist, the scapular mobility increases, “trying” to make up for the lack of motion in the chest and spine. This causes the muscles of the shoulder to act as stabilizers. This role reversal leads to limited shoulder joint motion. Of particular interest to golfers is the rotational component. When shoulder joint rotation is limited, it shows up as “flying elbows” or reverse spine angles. This could be a problem. There may or may not be pain at this point, but the bottom line is that you have a shoulder dysfunction that will affect your swing and lead to pain.

[insert flying elbow.mpg here]

Now golfer, you go out a few days a week for practice and you play a few days a week. When you do this you have a “flying elbow” because of the shoulder dysfunction. At the top of your swing you impinge the humerus against the acromion with each swing…that is what the “flying elbow” does mechanically…and you end up with an inflamed shoulder. Initially some ice and ibuprofen seem to make it feel better after you play or practice. Eventually though, that does not work. You have created micro-trauma to the rotator cuff with each swing. This is all because you have a rigid spine and role reversal in the shoulder complex. But wait, it gets worse. Now because of the discomfort in your shoulder your swing gets shorter, and in response to that you begin to tilt your torso to the left at the top. When that happens it lessens the shoulder impingement. Over time the reverse spine angle leads to more swing and ball flight issues, and your lower back begins to hurt. This is a real problem. Golfers experience it all the time…they do not know that the cause is the “flying elbow,” which is caused by poor thoracic and shoulder girdle mechanics…ROLE REVERSAL.

[insert abduction & adduction of the s.mpg here]

Are you beginning to see a trend? All of these swing problems are related to one another, and all of these swing problems are related to poor biomechanics of the shoulder complex. Do you want to fix the hook or the slice? Do you want to hit the ball long and straight, consistently? Do you want to play golf without injuries to the lower back? The key to accomplishing this is to get rid of the swing faults. The way to get rid of swing faults is to correct the biomechanics of the thoracic spine and shoulder complex. Weightlifting, machines, and the like will only worsen the problem until you fix the mechanical issues. Proper training by a qualified professional fixes these problems.

If you have any questions, please email them to me at [email protected].

Here’s to your healthy back and good golf.


Shoulder Biomechanics

This entry is part 5 of 7 in the series Shoulder Injuries

Golfer Can You Shoulder the Pain?

Biomechanics-the study of motion in living organisms-is the topic of this lesson. Biomechanics is a broad field. Thousands of people are performing research on how the human body moves and why it moves the way it does. At Body Balance for Performance we have taken on this study as it relates to motions of the golf swing. Let’s take a look at the biomechanics of the shoulder and shoulder girdle. To do this we need to apply here what we learned earlier about shoulder anatomy.

Every shoulder is has four joints, the sternoclavicular joint, (SCJ), the Scapulothoracic joint (STJ),  the acromioclavicular joint(ACJ), and the glenohumeral joint(GHJ).

The SCJ is the joint between the collar bone and the breast bone. There is a small cartilage disc in this joint. It acts as a cushion. There are ligaments around the joint and muscles that cross it and control motion of the collar bone. Basically the collar bone rotates. If you unhooked a metal clothes hanger and then unbent it, you would have the approximate shape of the collar bone. Now, hold either end of the hanger and rotate one end…the other end rotates in a larger motion. This is how the collar bone works. It functions as a fulcrum for the movements of the shoulder blade. It also keeps the shoulder on the side of the body. if we did not have a collar bone, our shoulders would point forward like the shoulder of a cat or a dog.


At the other end of the collar bone is the ACJ. This joint is the one injured when someone “separates” their shoulder. This is a common football injury. There is a small cartilage in this joint, too. This is a fairly rigid joint. Its main purpose is to meld the collar bone and the scapular together into one semi-rigid structure. As with the sutures in the skull, there is not much movement in this joint. This, together with the rib cage, and upper spine, is called the shoulder girdle.

The next joint to look at is the STJ. This is the articulation of the shoulder blade on the ribs. This is a joint that allows sliding motion. The shoulder blade slides and rotates along the ribs to allow upward rotation of the glenoid fossa. This moves the acromion to out of the way to allow a great deal of arm motion without impinging the humerus on the acromion.

Finally we have the GHJ. This is the shoulder joint. It is a ball and socket joint. It is the most mobile joint in the human body. Ranges of motion of the shoulder are 180 degrees for forward flexion and sideways abduction, 90 degrees of inward and outward rotation, and 45 to 80 degrees of across the body during adduction and backward extension. There are three degrees of freedom in the GHJ. That means that the joint moves in all planes of motion. The knee has two degrees of freedom. The hip has three degrees of freedom. It also has a much deeper socket and a rigid pelvis that it attaches to so it is only about 50 percent as mobile as the shoulder joint.

Let’s look at the motion of the shoulder complex in the golf swing. On the backswing, the trailside shoulder moves through GHJ abduction and external rotation, the scapula must move down and across the back and rotate slightly upwards, and the collar bone must undergo posterior rotation. The lead-side shoulder adducts, and internally rotates. The lead side scapula moves up and forward. To do this, there needs to be coordinated motion between the shoulder blade muscles, chest muscles, rotator cuff, and the upper arm muscles. That’s it. Simple right? It is if the shoulder girdle and GHJ are stable with balanced muscle function and normal mobility.

[insert shoulder abduction adduction.mpg here]

Here is how the shoulder can break down. If the muscles that support the shoulder blade or collar bone are not balanced correctly we end up with poor scapular motion and limited arm motion in the backswing. For example, if the chest muscles are tight and the upper back muscles are weak, the shoulder blade will migrate laterally and up, with a forward tipping. You will know this is a problem because the lower corner of the shoulder blade will stick out a bit and the shoulders will look rounded. The problem with this imbalance (named lower cross syndrome) is that it limits shoulder motion in the golf swing and makes the shoulder more susceptible to injury. It can also lead to many golf maladies, such as “over the top” and “flying elbow” to name a few.

If the ligaments and capsule of the shoulder are tight, as in a “frozen shoulder,” the humeral head will drive up into the acromion process and you will experience rotator cuff irritation at the top of the swing. On the back swing this can cause shoulder pain. It can also lead to “flying elbows,” “over the top,” limited back swing rotation,” “reverse spine angle,” and many other issues.

[insert shoulder internal external rotation.mpg here]

If there is limited motion in the shoulder complex on the downswing side, you might need ice, not hot sauce, for your “chicken wing.” You will probably decelerate early as there is not enough room to accelerate fully, and this could lead to a shoulder injury.

Short swing on the back swing or downswing sides are signs of shoulder dysfunction. Limited width of the swing is also a sign of a shoulder dysfunction.

Golfer, this is important to you. If you have an imbalance in the shoulder complex, you will develop degenerative conditions and injuries in your shoulder. You will see compensatory motions, and you will struggle to make meaningful change to your swing motion, even if you practice for hours and really understand what you are trying to accomplish. Our experience has told us that if we resolve these imbalances, most shoulder pain can be prevented or at least resolved. Finally, improving shoulder girdle muscle balance will improve the efficiency of your golf motion.

The anatomy of the shoulder complex helps us understand how the region should move and gives us a road map to restore normal motion; that is, normal biomechanics of the area. Once we have an assessment of the biomechanical situation in the region, we can design and implement an exercise or training program to restore normal biomechanics and therefore normal motion. This is how we eliminate shoulder pain and improve the results of the golf swing. Biomechanics are a key, maybe the key, to understanding and fixing the shoulder complex.

Please email me at [email protected] if you have any questions.

Here’s to your healthy shoulder and good golf.



Shoulder Fixes

This entry is part 5 of 7 in the series Shoulder Injuries


Golfers’ Shoulder Pain – Role Reversal

Fixes and Prevention

By now I hope you are seeing a trend…that there are only a few problems responsible for most of the shoulder injuries and swing faults golfers experience. It is very simple: Improve thoracic mobility, scapular stability, shoulder joint strength and mobility, and fix the alignment. Simple, right? Here is the process.

Improve Thoracic Mobility – This process can be easy. You will need to improve forward and backward bending, and rotation to improve flexion and extension, lengthen the muscles and tissues on the chest, and strengthen the spinal muscles in the upper back. The stretching is easy. There are a variety of chest stretches from over the ball, to over a foam roller, to just a static back position…see the pictures below. When doing these stretches you must be careful to not cause pain in the shoulder joint. The spinal muscles in the upper back are easy to get to. You can do rolling activities, or prone extension. Again see the pictures below.


When your flexion and extension improve, it is safe to begin working on rotation. If we work on rotation before we improve flexion and extension, there is a good possibility that the rotational movements will cause lower back pain. This is because a thoracic spine stuck in flexion cannot rotate efficiently or effectively and, as a result, will put pressure on the lower back. To improve rotation in the thoracic spine try the side lying trunk rotation. Once again you must be careful to not irritate the shoulder joint. Once you have stretched, try seated rotation without resistance.


Now strengthen the shoulder and shoulder blade muscles. To do this try the reach roll and lift as in the picture below. You can also try the shoulder rotation exercises called external rotation, first sitting then standing. After mastering these move onto more advanced shoulder exercises like I’s, Y’s and T’s.  Do all of these exercises in sets of 8 to10 repetitions.


Try the exercises noted above to see what happens. The bottom line is that if you do not improve within a week to ten days doing these on your own, you probably will need help from a golf fitness professional who has the knowledge of the areas noted in the previous paragraph. If you want to have us look at this, email us pictures of you: standing with your back against the wall and arms overhead and straight, touching the wall, and with arms in a 90/90 position as shown in the picture below. Once we see these we might be able to guide you to a solution.


if you have any questions, please feel free to email them to me at [email protected].

Here’s to your healthy shoulders and good golf.



Shoulders in Action

This entry is part 6 of 7 in the series Shoulder Injuries


Golfers’ Shoulder Pain

Put it all into action.

Ok, you have the basics of anatomy, biomechanics, swing faults that cause injuries, and fixes. Now what? How do you take what you have learned and turn it into a result that will actually achieve the outcomes you want: no back pain and better golf. There are several approaches. I compare this to home projects. There are do it yourselfers, those who fix the problem themselves, and then there are those who hire a professional and ask them to fix the problem. The same is true in golf fitness.

Many try with varying degrees of success (or failure) to resolve their problems by reading books, listening to friends, or researching on the internet. Then they implement a smattering of fixes that may or may not help them. This works sometimes. Maybe it’s luck, maybe it’s skill, but it can work. The key to the fix is knowing the issue and then applying the correct fix for the problem. If you have bursitis and lift weights, you will hurt more. If you have shoulder impingement and apply the lat fix you will hurt more. The only way to really fix the problem is to fully understand it.

There are some golf fitness providers who are not trained in neurology, anatomy, biomechanics, or the golf swing. They know how to whip you into shape, and they are good at that. However, they do not know how to fix upper cross, or deal with thoracic mobility issues. If you don’t have these issues, this type of professional might be able to help you get into great cardio shape and build fantastic strength. Will it be functional strength that you can use in the golf swing and to prevent shoulder injuries?

In many cases assessing and fixing these problems does not take fancy tests (MRI’s, x-rays, CAT scans, myleograms, etc). It takes a simple biomechanical and functional assessment. The behavior of your body in this type of exam will generally tell you what the issue really is. There is a time and a place to see your healthcare provider. If you have pain at night or during sleep, tingling or numbness in the upper extremities, experiencing focal weakness in the upper extremity, you should seek medical attention immediately. If your pain is in your shoulder, neck, upper back, it does not radiate into the forearm or hand, and golf seems to aggravate the problem, a well trained golf fitness professional can help you.

The bottom line, however, is that any activity is better than no activity, and the right activity is better than any activity where shoulder pain and the golf swing are concerned. We have included several links to exercises that you might want to look at if you have back pain. Try these. If your symptoms increase, STOP and immediately and seek help from a golf fitness professional. If they get better, you are moving in the right direction. You might still want a golf fitness assessment to help you with the host of issues in your body.

Exercise regiment

I believe that there is great controversy about stretching and strengthening. There are many theories on both. Stretching theories include brief intense, long gentle, and somewhere in between. On strengthening there is large volume of light weight, low volume of heavy weight or somewhere in between. The facts are they are all right. Now what? Well the issue is to decide on the goal. Are you stretching to increase range of motion, or to warm up? Are your trying to build large strong muscles or strong long muscles? It is up to you. If you want more motion, then do long duration low load stretch. By the way, long duration means up to five minutes or more, and low load means a barely perceptible stretch. If you want long and strong, more reps with less weight is the generally accepted standard. If you want explosive strength, then six to eight fast repetitions with more weight will do that. You see, it completely depends on the goal at hand. Before you begin, you need to know your goal. The goal to which I refer is long and strong vs. short and strong, warm up vs. increased motion, etc. Once you know this, you know how to exercise. These goals do not dictate what to exercise, just how to exercise. The “what” is answered by understanding the physical issues.

When do I do this? There is no good answer. Some people prefer 4:00 in the morning, some prefer dinner time, and some prefer mid-day. The best time to do this is the time of day that you will actually do it, when ever that is. You do not need to spend hours a day on this project. Usually 20 to 30 minutes a day is more than enough. In some cases that is too much time. The amount of time completely depends on the issues and the goals.

How do I know if I need help from the Golf Fitness ExpertsTM at Body Balance for Performance or some other well qualified golf fitness professional? Do you know what needs to be done? Do you know the goals? Do you understand how to apply the fixes for the faults? If so, then you probably do not need anyone for this project. If you are uncertain about any of this, you should consult with you local golf fitness professional or your local golf instructor. The golf instructor may know who in your community is an expert on this. If not, let me know and I will try to direct you to someone.

If you have any questions, please email them to me at [email protected].

Here’s to your healthy shoulders and good golf.




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