Lumbar Instability, Elite Golfer Management & McKenzoid Lumbar Case: WIR 17
Week in Review: Lumbar Instability, Elite Golfer Management, and a McKenzoid Lumbar Case
In this week’s episode of the Week in Review, the FARM team dives into three fascinating and highly instructive cases that showcase the wide spectrum of challenges clinicians face on a daily basis. From the complexities of lumbar instability, to the precision required when caring for an elite golfer, and finally to the nuanced evaluation of a McKenzoid lumbar case, this conversation highlights both the art and science of clinical decision-making.
Lumbar Instability: Navigating the Gray Areas
The first case centers on lumbar instability, a condition that continues to challenge clinicians because of its variable presentation and overlapping symptoms with other low back disorders. Instability often manifests in patients who have recurrent episodes of back pain, difficulty with sustained postures, or a sense that their spine “gives out” during movement.
The FARM team emphasizes that instability is not always visible on imaging. While flexion-extension X-rays or advanced imaging can sometimes reveal excessive motion, many cases are identified through careful history-taking and movement assessment. Patients may describe unpredictable episodes of pain, “catching” sensations, or difficulty transitioning from sitting to standing.
Management requires a blend of stability training, motor control restoration, and functional movement progression. The team highlights the role of dynamic neuromuscular stabilization, core endurance work, and carefully graded loading strategies. Importantly, they stress that progress is rarely linear—setbacks are common, but with consistency, patients can regain confidence and resiliency.
This case underscores a theme that runs through much of modern musculoskeletal care: clinicians must be detectives, piecing together subtle clues rather than relying on a single test or image.
Caring for the Elite Golfer: Precision and Performance
The second case shifts to a very different patient population: an elite golfer. Golf places unique demands on the spine, hips, and shoulders. The FARM staff note that elite players often exist in a paradox: their bodies have adapted to perform at the highest level, but those very adaptations can predispose them to overuse injuries.
Golf requires repetitive high-velocity rotation, often asymmetrically biased to one side. Over time, this can create imbalances in mobility, stability, and strength. The FARM team discusses the need to respect the athlete’s movement signature while identifying underlying dysfunctions that could limit performance or increase injury risk.
Management in this case was not just about treating pain—it was about optimizing performance. That meant integrating mobility drills, rotational strength training, and swing-specific stability work. The team also considered broader elements such as recovery strategies, workload management, and even the mental aspects of injury.
A recurring point is the collaboration between the clinician, the coach, and the athlete. In high-level sport, outcomes improve when healthcare providers, strength coaches, and skill coaches share a unified vision. By aligning treatment with the golfer’s performance goals, the FARM staff were able to provide care that went beyond rehab and into the realm of performance enhancement.
The McKenzoid Lumbar Case: A Lesson in Mechanical Diagnosis
The final case brings us back to the lumbar spine, but this time through the lens of a McKenzoid presentation. The term refers to a mechanical diagnosis and therapy (MDT) classification, popularized by Robin McKenzie, where repeated movements or sustained postures can centralize or abolish pain.
This case illustrates the power of patient-driven assessment. Rather than relying solely on passive treatments, the FARM team walked the patient through repeated end-range movements to identify patterns of pain centralization. The McKenzoid framework empowers patients, helping them recognize which movements alleviate symptoms and which exacerbate them.
The discussion highlights a critical clinical insight: the same diagnosis can present very differently in different patients. Some may respond quickly to extension-based movements, while others require more nuanced progression. The clinician’s role is to guide, observe, and adapt, not to rigidly apply a single protocol.
Equally important, the FARM team emphasizes communication. Patients who understand why a certain movement strategy works are more likely to engage consistently and regain independence in managing their symptoms.
Themes Across the Three Cases
While each case is unique, several unifying themes emerge:
Clinical Curiosity – The staff demonstrate the importance of questioning assumptions, testing hypotheses, and following the evidence presented by the patient’s response to care.
Individualization – Whether treating a weekend warrior with instability or an elite golfer, one size never fits all. Care must be tailored to the patient’s goals, history, and functional demands.
Integration of Systems – The FARM approach is holistic, blending manual therapy, exercise science, movement education, and collaboration with other professionals.
Empowerment – Especially in the McKenzoid case, but evident across all three, patients were given tools to take ownership of their progress rather than relying passively on treatment.
Why These Conversations Matter
Episodes like this remind us that musculoskeletal healthcare is both challenging and deeply rewarding. Every patient arrives with a story, a unique set of experiences, and a specific set of goals. The clinician’s role is to meet them where they are, provide clarity amidst complexity, and chart a path forward that balances science with empathy.
For the broader audience—athletes, patients, and healthcare professionals alike—this podcast episode offers a window into the real-world application of clinical reasoning. It reveals how theory meets practice, and how subtle clinical choices can make profound differences in outcomes.
Final Thoughts
The Week in Review continues to deliver thought-provoking, case-based discussions that highlight the evolving landscape of movement-based healthcare. This episode in particular illustrates the diversity of challenges clinicians face: from stabilizing an unpredictable spine, to fine-tuning an elite golfer’s performance, to decoding the mechanics of a McKenzoid lumbar case.
Each story is a reminder of why curiosity, adaptability, and patient-centered care remain the cornerstones of effective practice. And for listeners—whether clinicians seeking new insights or patients looking to understand their own journey—the takeaways are clear: the human body is complex, but with the right approach, progress is always possible.
