It was during a physical therapy session at Bryn Mawr Rehab Hospital in Malvern that Barbara Graham first heard about a unique new program being offered at another Bryn Mawr Rehab outpatient location―Main Line Health Newtown Square―designed specifically for golfers.
Graham had been diagnosed earlier that year with a ruptured disk in her spine, and combined with arthritis caused by normal wear and tear, she was experiencing significant back pain. After four weeks of therapy at the Malvern facility, including hands-on intervention, stretching and resistance band work, she was feeling great again.
While fully committed to the post-rehab daily home exercise program prescribed by her physical therapist, Graham was aware that alone might not be enough to protect her from further injury once she returned to the golf course.
"Golf, in general, is pretty hard on your back," says Graham, a retired certified public accountant who lives with her husband John in West Chester. "I knew the more I understood about my physical limitations, the better I could adapt my golf swing to prevent future injury. I wanted to continue feeling good and be able to enjoy a hobby I love."
During her course of therapy at Bryn Mawr Rehab in Malvern, Graham contacted Main Line Health Newtown Square to speak with Nicholas Leister, PT, DBT. She was eager to learn more about the new program for golfers. Leister advised Graham to complete her physical therapy sessions for pain, then schedule an evaluation with him. Her first appointment would be in November 2021.
Leister is the lead therapist for the Golf Rehab Program at Bryn Mawr Rehab in Newtown Square. With a Level 2 Medical Professional Certification from the Titleist Performance Institute (TPI)―the world's leading educational organization dedicated to the study of how the human body functions in relation to the golf swing―Leister understands how physical limitations can translate to faulty swing mechanics that lead to injury.
"For each patient, I conduct a formal TPI evaluation to assess that individual's functional ability, and identify negative swing patterns that might result in pain and reinjury," explains Leister. "Unlike taking a lesson with a golf pro, who is solely focused on improving your swing, I'm focused on correcting movement patterns that create injury. I look at such things as, how did you get into that position? Is your shoulder tight? Is your hip tight? Is there too much mobility? My goal is to help people hit the ball better with more consistency and less risk for injury."
Par for the course
The TPI evaluation utilizes digital video motion to analyze every joint and plane during a golf swing, combined with a comprehensive physical exam of the spine, pelvis, shoulders, wrists, hips and ankles. This provides data assessing both mobility and stability, as well as faulty swing mechanics, that can be used to educate each patient as to how imbalances or deficits can translate to injuries on the golf course.
Patients are asked to hit foam golf balls into a net inside the clinic and can then view their results on a large-screen television. Each patient receives a numeric score based on their complete TPI evaluation. In turn, Leister develops a personalized plan consisting of stretching and strengthening exercises geared towards improving that patient's golf swing to prevent future injury.
Additional TPI evaluations are conducted over the course of therapy to measure progress. Most patients require approximately six sessions to achieve optimal results.
Developing proper mechanics
"My goal is not to fix your slice," says Leister. "My concern is the limitation on your functional mobility. So, when you slice the ball, you're using a proper movement pattern. This ensures when you're playing golf, you're doing so without pain today, tomorrow, next week and next year."
Leister uses all the equipment in the gym to improve a patient's strength, range of motion and mobility, balance, and dynamic stability―strength in motion. He applies strengthening techniques, education about proper warmups, instrument-assisted soft tissue mobilization and joint mobilization, and every other traditional physical therapy treatment available. Each program is customized.
"When Barbara first came in, her body was not allowing enough movement for a proper golf swing, and she was at risk for continued back pain if she kept swinging in that manner," Leister recalls. "We discovered the reason for her struggles was not the back injury per say, but that her hips were really tight. She couldn't rotate her hips properly, so her lumbar spine, which is designed to be a point to pivot from―not to pivot itself―was sustaining motion where it shouldn't be. Barbara had a reverse spinal angle and an early extension―two negative swing characteristics. We needed to fix the issues with her hips and her pelvis."
Graham saw Leister twice a week for six weeks. Early on, her program was based on rotational and global hip stretching. Once she was able to gain that range comfortably, Leister helped her develop neuromuscular movement patterns to use her available rotation. He introduced mat work, parallel bars, resistance bands and free weights.
Says Leister, "Our goal was to create a greater range of motion in Barbara's hips, to train her brain to use the proper muscles and not use the ones she shouldn't, then strengthen those muscles so she could use them without pain. When she was discharged, she reported no pain sleeping, no pain walking, no pain grocery shopping and, most significantly, no pain swinging the golf club. Barbara is a testament to how well the Golf Rehab Program can work."
Hitting the links
"Nick really understands the golf swing and what the body needs to swing correctly," says Barbara. "That's why I found this program so beneficial for me and so interesting, to have someone as knowledgeable as Nick break it down in terms of exercises that help in each of the areas I needed to improve.
"I'm not a 25-year-old flexible woman," adds the 73-year-old grandmother of seven. "Now, when I touch my toes, I go down further. I can turn further. I continue to work on my muscles and flexibility in my at-home program. And all of this translates into swinging the club properly. I don't need to be a great golfer. I just want to be able enjoy some fresh air and sunshine with my friends and feel good."
For Leister, an avid golfer who played on the Radnor High School team and worked at several golf courses and driving ranges before becoming a physical therapist, bridging his two greatest passions is a dream come true. It was Leister himself who discovered the TPI Golf Rehab Program and introduced the concept to Main Line Health. He is immensely proud of what it has become.
"I believe our program is the most comprehensive and the most inclusive in the region," says Leister. "Often, golf rehab targets elite golfers. Here, we welcome the weekend warriors. I get to work with people recovering from injury, surgery and stroke, and those diagnosed with Parkinson's disease. I've worked with an amputee, and with a visually impaired golfer who competes across Pennsylvania. All of this is why I became a physical therapist―to help people get back to doing what they love."