Going through with a functional diagnosis, rather than simply a pathological diagnosis, I opted to tape the patient’s wrist in a specific, driven direction mainly because she had no pain at rest and only way I could assess my hypothesis was to tape, then get her to swing the club.
I could not find a great picture to show arthrokinematics of the radiocarpal joint with the wrist going into extension, radial deviation and pronation; but I hope you get the point with the picture below showing the need of the scaphoid volarly gliding on the radius (or the radius dorsally gliding on the scaphoid).
Knowing this, I opted to tape the radius from an anterior to posterior direction (or dorsally). The patient went out back and an immediate change, no pain with the same swing.
Treatment from here consisted of seeing her 4 visits over 4 weeks:
1st week. I educated the patient to hold off on playing for an entire week (which worked well since she was going on vacation).
2nd week. The next visit (over a week later), she returned and said she had an x-ray to be sure and it was negative for any findings (just inflammation via MD). This aided in our functional diagnosis and made the patient (and parents) less concerned overall. I performed mobilization with movement applying anterior to posterior glide on the radius with active pronation and extension. Otherwise, HEP consisted of wrist flexion/extension, circles and MCP flexion/extension AROM. I educated her on an interval program to return to golf (basically try all wedges at 50% intensity and work her way up letting pain be the guide).
3rd week: Same manual program and incorporated FlexBar exercises for wrist strengthening. She was returning to her swing coach so I encouraged her to ask him of anything specific that she is doing wrong with her swing (the swing coach has a high speed camera and honestly, I am not a good golfer so wanted to ask a professional!). Interval program continued letting pain be the guide.
4th week: Patient participated in the interval program and has worked her way up to drivers without pain. She was feeling good and just wanted exercises to help strengthen her wrist (long story short, she opted to by a red and green FlexBar by TheraBand). The swing coach taught her to follow through higher up over her head, rather than across the chest. May be tough to see, but this does make sense as it decreases the amount of pronation her wrist has to have at the end of the swing. Fore!
I shared this case based on a physical therapist’s ability to incorporate a functional diagnosis into practice and use of a mechanical treatment approach to help in ruling-out a more pathological reason for pain. It did help that she eventually had an x-ray but the positive change that occurred after a plausible approach simmered down probability of something more serious.
I hope you enjoyed. Thanks to my wife for letting me tape her and for the pictures of me in very hot heat here in North Carolina. Let me know what you think and if you would have done something different.