Failed Seated Trunk Rotation Test? Now What?

Before we get started, let’s review the Seated Trunk Rotation Test (STRT).  To view the test on TPI’s website click —> HERE.

1) Assume a seated position with knees and feet together 2) Place golf club on chest 3) While keeping the club parallel to the ground, rotate as far as possible 4) Repeated with club on back
1) Assume a seated position with knees and feet together 2) Place golf club on chest 3) While keeping the club parallel to the ground, rotate (both directions) as far as possible 4) Repeat all with club on back

As per TPI, the test is designed to “identify how much rotational mobility is present in the thoraco-lumbar spine.” This is very important to understand because most would assume a failed test is caused by the thoracic spine alone.  Though this is most often the case, it is incorrect to assume because the lumbar spine does contribute to approximately 10-15 degrees of axial rotation which is most limited by the sagittal orientation of the facet joints. Each joint/segment only allow 2-3 degrees of rotation [1].  Contributing the most to rotation of the trunk is the t-spine which should rotate 45-50 degrees [1].  Therefore, we need to have the ability to dissociate thoracic mobility deficits from lumbar mobility deficits to identify the specific area that is limiting motion.  More on this later.

Architecturally incompetent for rotation compared to the T-spine and Hips!
Architecturally incompetent for rotation compared to the T-spine and Hips!

It is also important to understand how a failed Seated Trunk Rotation Test is interpreted. The STRT is part of the TPI Screen which is used to screen golfers.  This screen is a series of tests that can be used by any member of The Team, and as we know from the Functional Movement Systems principles, only evaluates risk.  It is not a medical evaluation or performance test.  In other words, do not get caught up on trying to diagnose the cause of the dysfunction from this quick screen, or to determine the skill of the athlete.  Just understand the findings, and put that athlete in the hands of someone who can further assess the impairment.

This leads us to the first member of The Team – the golf instructor.  For more information on the team approach click —> HERE.  Just as it is not appropriate for a medical or fitness professional to give swing advice, it is not appropriate for the golf professional to give medical or fitness advice (unless they are licensed or certified).  With that said, if the golf instructor determines that the athlete has failed this test they should consult the medical professional.  It is my opinion that the medical professional should be consulted before the fitness professional because Low Back Pain is the #1 injury in golf and thoracic spine pain is the top injury related to lost practice time [2].  So, we want to make sure that a mobility deficit is all that needs to be addressed.  Together, the medical and golf pro can determine whether this deficit is causing a swing fault, and if movement optimization would improve their swing.

Further Evaluation of the STRT (a.k.a. The Breakout)

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…”a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation.” In other words, use it to find the cause of the problem.

Once the golfer is referred to a medical professional, he or she will systematically evaluate (breakout) the movement pattern by using a standardized evaluation process.  In my opinion, the most sophisticated is the Selective Functional Movement Assessment. However, other tests should be used especially if there is pain associated with this movement.  It should be understood that the STRT is part of the breakout of one of the top-tier tests in the SFMA.  However, it is not the purpose of this post to elaborate on this, but only to educate the reader on how to determine if the mobility deficit is thoracic or lumbar (or both) in nature from a failed STRT.  The medical professional will evaluate all movement patters of the athlete, but in terms of spinal rotation they will use an algorithm that uses to primary tests: 1) Lumbar Locked T-Spine Rotation Extension and 2) Prone on Elbow Unilateral Rotation/Extension.

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1A) Lumbar Locked T-Spine Ext/Rot ER….Functional = 50 degrees.

 

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1B) Lumbar Locked T-Spine Ext/Rot IR…..Functional = 50 degrees.

 

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2) Prone on Elbows Ext/Rot…..Functional = 30 degrees.

Starting with the Lumbar Locked position which isolates the thoracic spine, the athlete will assume a hands on head (ER) position shown in the picture 1A above.  A video demonstration can be seen by clicking —> HERE.  If this is found to be functional the t-spine is clear and the prone on elbows test will be conducted to assess the lumbar spine.  However, if the lumbar locked ER test is dysfunctional (<50 degrees) the lumbar locked IR position will be performed as shown in 1B.  This helps to isolate the t-spine and rule out the shoulder girdle’s relationship a rotation limitation.  If both are found to be dysfunctional, then the t-spine is in fact the culprit.  If 1A (ER) is dysfunctional but 1B (IR) is functional the shoulder girdle should be evaluated further (broken out), as well as the lumbar spine.

To further evaluate the thoracic spine, all planes of motion should be performed and overpressure can be used to increase the sensitivity of the test.  In other words, have the patient flex, extend, and rotate in isolated planes and add overpressure to understand full active and passive motion in addition to the above tests.  If the clinician determines that further isolation is necessary, local joint play testing can be used to determine segmental mobility.

Once a conclusion is drawn to the area of the spine that is limiting spinal rotation, the golf pro and medical professional should consult and devise a plan that is individualized.  Once this plan is created, the golfer should be educated on the findings of the test and evaluation, its implications to the golf swing, and how interventions relating to improving spinal mobility will improve their swing/ durability/ performance/ etc.

 

References

1. Pearcy MJ, Tibrewal SB. Axial rotation and lateral bending in the normal lumbar spine measured by three-dimensional radiography. Spine. 1984;9(6):582–587.

2. Cabri J, Sousa JP, Kots M, Barreiros J.  Golf-related injuries: A systematic review.  European Journal of Sport Science. 2009; 9(6):353-366.

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