| Age / Sex | 45-year-old male |
| Occupation | Corporate attorney, weekend golfer (18 handicap) |
| Primary Complaint | Medial elbow pain radiating into forearm, worst during golf swing and gripping |
| Duration of Symptoms | 10 months |
| Previous Treatments | Rest, ice, NSAIDs, cortisone injection (1x), elbow strap, golf lessons to modify swing |
| Diagnosis | Medial epicondylitis (golfer’s elbow) with thoracic hypomobility and hip rotation deficit contributing to compensatory arm loading |
Background
This 45-year-old attorney lived for his weekend golf rounds. It was his primary stress relief and social outlet. When medial elbow pain started creeping in during his backswing, he ignored it. When it progressed to the point where gripping the club made him wince, he finally took time off. Three months of rest did nothing. A cortisone injection helped for six weeks, then the pain returned worse than before. His golf pro suggested swing modifications, but every change he tried either aggravated the elbow or created new problems. He had not played a full round in four months when he came to our clinic.
Assessment Findings
The medial epicondyle was inflamed and the flexor-pronator mass was tender, but the golf swing analysis revealed the real story. His thoracic spine was rigid, with almost no rotation through the mid-back. This meant his golf swing was being powered almost entirely by his arms and shoulders rather than by trunk rotation. Additionally, his left hip had a significant internal rotation deficit, preventing him from clearing properly through the downswing. These two limitations forced his forearm flexors to absorb forces they were never designed to handle.
DNS assessment showed poor diaphragmatic engagement and a compensatory pattern where his superficial muscles were doing the work of his deep stabilizing system. His core could not stabilize his trunk through the rotational demands of a golf swing, so his arms were doing the heavy lifting.
Treatment Protocol
Phase 1 Weeks 1-2 | Chiropractic mobilization of thoracic spine to restore segmental rotation. Hip joint mobilization to improve internal rotation. DNS-based breathing and core activation to establish trunk stability. Soft tissue work to the flexor-pronator mass to reduce acute inflammation. |
Phase 2 Weeks 2-4 | AiM-informed rotational loading sequences to retrain the trunk-hip power transfer pattern. Progressive rotational core training using DNS developmental positions. Gradual reintroduction of grip loading as elbow symptoms reduced. Chipping and putting reintroduced with corrected movement pattern. |
Phase 3 Weeks 4-5 | Full swing reintroduction with emphasis on trunk-driven mechanics. Progressive return to full rounds. Home maintenance program for thoracic mobility and hip rotation. |
Progress Timeline
| Months 1–10 (Pre-Treatment) | Rested from golf for several months. Iced and took NSAIDs regularly. Received one cortisone injection with short-lived relief. Used an elbow strap during activity. Even took golf lessons to modify his swing. Nothing resolved the underlying problem. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | Thoracic mobilization produced immediate improvement in trunk rotation. Breathing retraining initiated. Elbow pain reduced with daily activities. |
| Week 2 | Hip internal rotation improved by 15 degrees. Could grip objects firmly without pain for the first time in months. |
| Week 3 | Began chipping and putting. No elbow pain. AiM rotational sequences showing clear improvement in movement quality. |
| Week 4 | Half-swing and three-quarter swing at the range with no pain. Trunk rotation measurably improved. Swing felt more powerful with less effort. |
| Week 5 | Played a full 18 holes pain-free. Reported his swing felt better than it had in years. Elbow pain completely resolved. |
Outcome
After 10 months of failed treatments and forced time away from the game he loved, this patient was back on the course in five weeks, playing pain-free with a swing that actually felt more powerful and efficient. The key was recognizing that golfer’s elbow in a recreational golfer is almost always a compensation problem. His thoracic spine could not rotate, his hip could not clear, and his core could not stabilize, so his forearm flexors were absorbing the rotational forces of every swing. Chiropractic restoration of spinal and hip mobility, combined with DNS core retraining and AiM movement correction, eliminated the mechanical overload at the source.
This case study represents a real patient treated at City Integrative Rehabilitation. Details have been modified to protect patient privacy. Individual results may vary.