Two Indiana University golfers found a gamechanging fix to back pain. What can others learn?

For as long as Clay Merchent slogged through injury – patching his golf game together with physical therapy and ice baths while searching for a meaningful diagnosis – his painstaking comeback from a left rib surgery reached a landmark point in a most mundane location. The Merchents, from Noblesville, Indiana, were at a family wedding in Colorado earlier this summer when a golf simulator bar caught the eye of Clay and his dad Mike.

Clay’s career, temporarily shelved 21 months earlier, had played out on the biggest stages. He was a Drive, Chip and Putt National Finalist, won AJGA events, contended at the Sage Valley Junior Invitational and Western Junior and arrived at Indiana University in the fall of 2020 as a top in-state recruit.

But Clay, named Big Ten Freshman of the Year in 2021, has not been seen in a college golf event since Sept. 27, 2022. After his breakout freshman season, a nagging injury became debilitating. Months went by before a doctor could not only connect the persistent pain he was feeling in his back and shoulder with a problem in his ribs but also repair it.

That day in the simulator, eight months post-op, Clay, now 22, hit more full golf shots than he had since undergoing the procedure – dozens of them, pain-free, for hours. A once-uncertain comeback materialized before him.

“It was a eureka moment. It was like OK, it’s ready, let’s go do this thing,” Clay said. “I played my first nine holes that very next day when we got back home.”

He finished T-6 at the Golfweek Hoosier Amateur and T-4 at the Indianapolis City Amateur in preparation for the fall college season.

Ethan Chelf, Clay’s teammate at Indiana, knows something of his slog, having gone through it himself. The 21-year-old has also been sidelined from competition for much of the past two years. He can trace his back pain to a single event that began an equally drawn-out road to the right diagnosis.

Ethan suffered many of the same symptoms as Clay but found a solution at the West Virginia University Medicine Heart and Vascular Institute when he met thoracic surgeon Dr. Adam Hansen, a leading expert in Slipping Rib Syndrome. Hansen performed surgery on both men to treat the condition, likening the procedure to Tommy John surgery for baseball players.

Their ribs repaired, Clay and Ethan enter a redshirt junior season at Indiana with a story that might spark a lightbulb moment for anyone experiencing similar pain.

‘Waiting for the guillotine to fall’

When Clay’s pain was at its worst, he felt like he had almost no control over the left side of his body. Forget swinging a golf club.

“It shut down and there really was no muscling through it. I would take the club back and I would just collapse,” said Clay, who plays right-handed. “My left side would not move or respond the way I had intended it to.”

Nagging pain in his lower left lat was a reality of high school and early college golf. It would flare up about once a month, and when it did, he knew he could manage it with an ice bath and a day off. Intermittent pain just became part of the equation and it was manageable until the pace picked up his sophomore season at Indiana.

“It started to bother me earlier in the season, and this time it wasn’t going away,” he said. “My tricks of the trade were not really getting it to settle down.”

At the NCAA Regional in Palm Beach Gardens in mid-May 2022, the pain hit a new level. For the first time, the sensation was like a knife, twisting, in his ribs. The pain started under his left shoulder blade, extended to his ribs and down into his hand, fingers and toes. He withdrew after the first round.

Clay focused on rehab that summer and didn’t play a tournament for two months. In late September 2022, in his second start with the team at the Northwestern-hosted Windon Memorial in Chicago, the intense pain returned. Clay limped in with a final-round 83.

In the team van on the drive back to campus in Bloomington, Indiana, Clay remembers staring out at Lake Michigan, questioning whether he’d just played his last competitive round. He was frustrated that the fix he thought he’d cobbled together through physical therapy – after numerous doctor visits, bone scans, x-rays and MRIs – was no longer working.

“It was hard on him mentally because he wanted to do it,” Mike Merchent said of Clay’s continued efforts to play the game, “but it was like he was waiting for the guillotine to fall. He just knew it was only going to last for so long.”

Down the rib rabbit hole

Ethan, at 6-feet-6-inches tall, had weathered growing pains in high school – particularly after a large growth spurt as an upperclassman. The Maryland native was a top recruit from the Mid-Atlantic area who arrived at Indiana in the fall of 2021. In January 2022, however, he was towel-drying his hair in his dorm room when his back seized up.

When Ethan’s father Brett Chelf was in college, he had suffered spontaneous lung collapses. Knowing there was a hereditary component to this, Ethan immediately called an athletic trainer about his pain.

“Every breath I take is kind of getting shorter, I can barely move, I can barely get my seatbelt on to come see you,” Ethan told the trainer.

X-rays ruled out a lung collapse, but while there, the trainer mentioned that Ethan might have a rib rotation – a foreign concept to Ethan, especially since he felt the pain in his mid-right back. He shared the thought with his dad, and they continued to look for solutions.

Through soft-tissue treatment, Ethan was able to return to competition in the spring of 2022. Still, the pain never fully subsided, even after prolotherapy and a round of PRP.

“It would feel OK a day or two and then it would come back to where it was almost a new norm for me,” he said. “You know golf, if you’re a degree off, that’s a lot of yards. It’s kind of hard to play when you’re hurt.”

Ethan finally hung up his clubs in July of 2022 to focus on addressing his pain, either through rest or more doctor visits. That initial comment from the Indiana trainer, however, had led his dad “pretty deep down the rib rotation wormhole.” A Facebook group for people with similar pain eventually led Brett Chelf to Hansen, and thus to a breakthrough for both families.

“A lot of the symptoms people were talking about and symptoms that I read about matched [Ethan’s], so I started looking into doctors who knew about slipping rib,” Brett said.

Through the process, Brett couldn’t help but think of the likely statistics.

“The fact that you have two guys on the same golf team of 10 guys that both have this and both had it surgically repaired says to us that there are probably tons out there that have it.”

A large number of the Slipping Rib Syndrome patients Hansen sees are athletes whose sports involve an asymmetric move, like swinging a golf club or a baseball bat. Recreational golfers who experience side pain that becomes progressively more severe after picking up the sport – to the point that they quit the game – is what Hansen calls a classic presentation of the condition.

Hansen has pinpointed ribs Nos. 8-10 as the ones susceptible to Slipping Rib Syndrome. Those ribs are attached to one another by ligaments.

“If those ligaments tear, then you get the ability of one or more of those ribs to basically hang freely in the front and become a floating rib when they’re supposed to be attached.

“If they come loose and become floating, they now have the ability to pop in and out, back and forth, slide around – where they once were firmly connected. When they do that, they pinch and compress or impinge upon nerves that lie between each of the ribs.”

Those nerves beneath the ribs, called intercostal nerves, are not only powerful and sensitive, they control everything from the bottom of the neck down to the pelvis. Thus, a slipped rib can create a wide array of symptoms.

Initially, it was tough for Ethan to accept that a rib injury may be causing his back pain. That apprehension faded away as Hansen so accurately and specifically described his pain during a November 2022 consultation.

“I told (Hansen) going in I had back pain but didn’t really specify where. He had traced it back to pretty much pinpointing where my pain was on my back,” Ethan remembers of his first visit with Hansen. “I was like, that’s the wildest thing.”

He underwent surgery on March 8, 2023.

Clay arrived in Hansen’s office in August 2023 and described Hansen’s initial evaluation and the spot-on explanation of his pain in almost exactly the same way. If there was a solution, Clay decided, Hansen had it.

He booked his surgery for Nov. 1, 2023.

‘I didn’t fall in love with golf by hitting 15 balls a day’

Hansen has never found Slipping Rib Syndrome in a textbook. It is difficult to diagnose not only because the condition causes pain in other areas of the body, but because most imaging studies do not show the slipped ribs. Hansen consults only a CT scan before visiting with patients.

The persistent nature of Slipping Rib Syndrome pain, as well as the difficulty in diagnosing it, leads many patients, Hansen has observed, to develop significant anxiety and depression. It’s a reality that has driven Hansen’s efforts to educate the medical community about symptoms and treatment.

Over the course of six years and 700 cases, Hansen has blazed a trail to an effective repair technique.

“Now we have a really nice operation that is not just suturing the ribs up,” Hansen said. “We’ve spaced the ribs out, we do a much better reconstruction. It puts them back to like the normal shape that they should have been.”

For two college golfers itching to get back to the game, however, the recovery from that surgery unfolded slowly.

For the first three months after his surgery, Ethan was not allowed to carry anything over 20 pounds, much less swing a golf club. Still, he found ways to pass the time while watching his teammates play golf. He would often walk with a Perfect Putter, dropping balls on lines to work on AimPoint. He also doubled down on schoolwork, finishing his undergraduate degrees in finance and accounting in three years so he could begin an MBA program.

Three months post-surgery, he had wedges in his hands. But at six months, when the 2023-24 golf season began, Ethan was nowhere near where he imagined he’d be. He had been cleared for bodyweight lifting but simply pressing his weight into his legs one day in the gym made him feel like he’d been hit in the back with a hammer.

Hansen reassured Ethan he was still on track, and Ethan scaled back. He played his first 18-hole rounds on a spring break trip to Florida. The rib injury now an afterthought, Ethan suffered another gutwrenching setback over the summer when he dislocated his left shoulder while swimming. He remains confident he’ll be able to get close enough to 100 percent to compete in the fall.

Clay, learning from Ethan’s experience, reached that day in the simulator a few months faster. But there were still moments in the first six months post-op when reality didn’t match the image Clay had in his head. Everything golf-related felt measured, and his golf swing itself seemed robotic and overthought.

“I didn’t fall in love with golf by hitting 15 balls a day,” he said. “It was the freedom of going out, hitting balls and playing and chipping and putting and thinking your day is over and then going out to play an extra nine. It just wasn’t like that anymore.”

Both men – with two years of remaining college eligibility each – spoke of professional golf careers with cautious optimism. The desire remains if their bodies and games hold up.

There are things about the recovery process that the two men, now roommates, know only the other one will understand, like being outside the game itself for so long. Clay also knows that if Ethan and his dad didn’t solve the riddle first, the comeback he’s riding doesn’t even exist.

“We were talking about it like, the competing is great, but going out there for an evening nine? We were dreaming about it, like how nice would that be?” Ethan said. “. . . When it’s stripped away from you, you definitely long for it a little more.”

In the wake of a grueling comeback lies a positive perspective.