Adolescent Growth Spurt and Asymmetrical Rotation
Ava is 14, 5 ft 9 in, and grew about 8 cm in seven months. She plays five rounds weekly plus range sessions and reports low-back ache after practice; she has no night pain, numbness, or radiating symptoms. Her parents want her to "get stronger for golf." Assessment shows thoracic rotation 28° right and 42° left, hip internal rotation 25° right and 40° left, and knee valgus during the single-leg squat. She is otherwise healthy and plays on a school team. She asks whether she should start a heavy lifting program and practice more to keep up with older players.
1. Explain the growth-related and movement factors that make this scenario worth managing carefully.
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During an adolescent growth spurt, bones can grow faster than muscles and tendons, creating relative tightness and altered coordination. Ava's asymmetrical thoracic rotation (28°/42°) and hip internal rotation (25°/40°), plus knee valgus in the single-leg squat, suggest she is loading one side more and may lack hip control. Five rounds plus range sessions is high volume for a growing athlete. Low-back ache after practice without night pain or neurological symptoms is common but should not be ignored. The risk is that repeated extension and rotation under fatigue loads the lumbar spine. The plan should reduce volume and address mobility and control, not simply stretch her back.
2. What changes would you make to her training and practice for the next two to three weeks?
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Cut practice volume by roughly 30–40% for two weeks, with at least one full rest day and no back-to-back high-volume days. Add thoracic rotation and hip internal rotation mobility, glute and hip control (single-leg squat to a bench, side plank), and anti-rotation core work. Avoid heavy axial loading and maximal medicine-ball throws during the growth spurt; use bodyweight and light resistance. Keep golf fun and monitor fatigue. Re-test rotation and the single-leg squat in two to three weeks.
3. How would you communicate the plan to Ava and her parents, and when would you refer?
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Talk with Ava and her parents together: "This is a load and movement issue to manage, not a diagnosis. If pain wakes her or radiates, she needs medical review." Document the findings and the plan. Do not promise performance gains; prioritize staying healthy. If pain persists beyond two to three weeks of modified load, or if new symptoms appear, refer.