Research suggests that lower back pain is the most common ailment suffered by golfers of all ages and abilities, with one in four experiencing lumbar discomfort after their round. The professionals appear equally susceptible as over 23% play with the condition. The repetitive action of the golf swing is the number one cause of lower back pain in golfers and ‘wear and tear’ injuries increase as we get older, because the joint and tendon tissues become less able to withstand stress. Often, an injury sustained earlier in life, while engaged in another sport or activity, is aggravated while playing golf.
The various parts of the lower back can all be affected, but in golfers, particularly senior ones, the more typical injuries include muscle or ligament sprains, a herniated, or ‘slipped’, disc and degenerative arthritic changes over time both as a result of overuse and misuse.
The lower back is frequently the source of pain, but its cause lies elsewhere. It is movements occurring in adjacent or more distant areas of the body that are forcing the lower back into excessive workload and, over time, causing it to break down. A lack of mobility in the ankles, hips, thoracic spine, or shoulders can all force the lower back into compensatory movements that it is ill-designed to perform, thereby overloading it and causing injury. Any such physical restrictions therefore need to be addressed as a matter of priority. All golfers should undertake a screening programme to ascertain their level of golf specific fitness and then condition their bodies as appropriate, if they are to optimise performance and reduce their risk of injury. See: http://fittergolfers.com/free-videos/self-assesment/
Your brain determines the way your lumbar spine moves by the sequence in which it fires the active muscles. Often changes in the neural motor control of joint mechanics begin as a protective mechanism, but themselves then lead to chronic problems over time.
Trunk strength and stability exercises, can be highly effective in the prevention of lower back pain. For example, good endurance strength in the transverse abdominis, erector spinae and both the external and internal oblique muscles is very important for protecting the lumbar spine by tensioning the thoracolumbar fascia in a process known as abdominal bracing. Golfers with lower back pain tend to have a significantly reduced ability to maintain contraction of these muscles compared to healthy golfers and consequently lack the requisite degree of spinal stability when swinging the club. They would be well-advised to strengthen all their trunk muscles, before degenerative arthritic changes occur in that area. Also, golfers with a trail side holding deficit of 12 seconds or more in the static side-bridge endurance test suffered more frequent episodes of moderate-to-severe lower back pain, which serves to highlight the need for achieving a balanced musculature.
Given the importance of trunk rotation in the golf swing, in truth it would benefit golfers, irrespective of whether or not they suffer from lower back pain, to undertake a conditioning programme to strengthen the muscles responsible for stabilising the spine. Furthermore, rotational mobility should come from the joints in the body that are designed to rotate. The joints (facets) of the lumbar spine are designed to allow flexion and extension, but only minimal rotation, so it is important also to create optimal movement patterns in the hips and thoracic spine. If the lower back is forced to be a primary rotator due to a lack of hip and thoracic mobility, it’s only a matter of time before an injury will occur in the lumbar spine. Therefore every golfer should perform exercises to increase rotational range of motion in their hips and thoracic spine.
However, it shouldn’t end there. The body’s structural interconnectivity means that neither the hips nor the thoracic spine operate in isolation. Inhibited motor control of the hip can be a consequence of inflexibility in the ankle and restricted thoracic ROM linked to impingements in the shoulder. Therefore, a comprehensive screening is always advisable. [See: http://fittergolfers.com/free-videos/self-assesment/] If dysfunction is identified, an appropriate conditioning programme should be undertaken – mobility restrictions should be targeted first and then the stability required to normalize motor control should be built.
When the hips and thoracic spine are functioning correctly, the lumbar spine will get some much-needed relief. However even that should not be the end of it. Once normal movement patterns are optimized, conditioning work should continue, because the asymmetrical nature of the golf swing means that problems will re-occur over time unless continued conditioning maintains a balanced musculature. All golfers should build the requisite levels of stability, strength and mobility in order to keep their lower back healthy.
To understand the causes of lower back pain it is first necessary to understand the potential impact of faulty swing technique on the human body. There are a number of swing faults that can cause the onset of lower back pain, because they introduce abnormal stresses into the lower back.
One such cause of lower back pain is a postural problem known as the ‘S-Posture’, which is essentially a pelvic adaptation to muscular imbalances created by prolonged periods of sitting. The abdominal and gluteal muscles become weak as a consequence of tightness in the hip flexors and lower back. This imbalance causes the pelvis to tilt down at the front and places excessive stress on the lumbar spine. Golfers with ‘S-posture’ problems must restore muscular balance with appropriate conditioning exercises if they are to avoid lower back pain. An ability to assume the correct neutral-spine posture at address is vital, because it enables golfers to brace properly and to stabilize their spinal mechanics so that they can maintain a neutral spine throughout their backswing. Also, because the lumbar spine is already extended at the start of the swing, an ‘S-Posture’ also increases the likelihood of a subsequent ‘reverse spine angle’. [See: http://fittergolfers.com/your-swing-fault-physical-or-technical/reverse-tilt-aka-reverse-spine-angle-reverse-pivot/] A reverse spine angle is one of the more common swing flaws and is often the result of a lack of rotary mobility in the hips and thoracic spine (thus easily fixed by appropriate conditioning exercises – see Part 1). In an effort to recover some of the lost range of rotational motion, many golfers hyper-extend and try to rotate the lumbar spine in the backswing. Not only does a reverse spine angle exert excessive tension on the lower back owing to the inhibition of the abdominal musculature during the backswing, but, as we know, the lumbar spine is designed to allow only for minimal rotary movement and over time this swing flaw will undoubtedly lead to degenerative spinal symptoms.
Over-extension of the spine ‘at the top’ means the upper body tends to tilt toward the target, which then encourages a ‘reverse weight shift’ in the downswing, which is a double whammy, because hanging back encourages further excessive trail side lateral bend through impact that introduces both compressive and shear stresses to the trail side of the lumbar spine and thus exacerbates any lower back injury. [See: http://fittergolfers.com/your-swing-fault-physical-or-technical/hanging-back-reverse-weight-shift/] Furthermore, if hanging back can cause lower back pain, the reverse is also true. Golfers who already have lower back pain tend to swing more tentatively and do not properly shift their weight into their lead leg in the downswing, hanging back instead. A vicious and destructive circle! A proper weight shift is key to reducing excessive trail side lateral bend through impact.
Finally, let’s take a brief look at a few other simple measures that you can take to reduce your susceptibility to injury still further.
Always get to the course in good time to allow yourself a leisurely and proper preparation for your round. Going directly to the first tee, pulling out the driver, and trying to hit the cover off the ball is a form of golfing suicide! Not only is a wildly inaccurate tee shot likely to follow, but also a strain in the lumbar spine muscles, resulting in nagging low back pain. As a minimum, every golfer should perform a thorough warm-up before teeing off. It is vital to prepare the muscles first. [See the Fitter Golfers pre-round warm up.]
Ideally, this should be followed by a trip to the practice range. Golfers should begin with the PW or 9-iron and progress through the clubs hitting a few shots with either the odd or even numbers finishing with 5-wood, 3-wood and driver. Muscles that have been stretched and gradually loaded are much less prone to being injured.
During your round, repeatedly bending over to pick up a golf bag can stress the low back and lead to a muscle strain. An integrated golf bag stand that opens when the bag is set on the ground can help, but the act of carrying a standard golf bag places weight asymmetrically onto one shoulder which can be hard on the back stabilisers. I would strongly recommend a battery-powered trolley, but at the very least have twin straps on your golf bag to divide weight evenly across your back and reduce the risk of developing low back pain. [NB: Sitting in a golf cart, while driving over rough terrain increases spinal compression forces within the low back.] Equally, in order to preserve optimal spinal health, it is important to ensure that you employ good technique whenever bending to place or pick up a tee or a ball, or to pick up a bunker rake and, of course, especially when actually raking the bunker.
After your round, further preventative action to be encouraged is the inclusion of proper recovery procedures into your post-round routine, which will help to reduce inflammation, repair muscle and joint ‘wear and tear’ sustained during the round. Such procedures can include a proper warm down, the use of ice packs, heating pads, cold/hot baths, etc. Nowadays many golfers play at courses that are part of a complex which offers all kinds of helpful facilities. Massage is another great way to reduce muscle soreness and rejuvenate the soft tissue, but if that is a step too far for some, simply replenishing carbohydrate, protein and hydration levels can go a long way towards minimising soreness and muscle fatigue.
Once away from the course, it should be remembered that playing golf for around four hours takes its toll on the body and it is important that night to get a minimum of eight hours of sleep to give the body time to repair itself. Without it, most golfers will feel a bit sore the next day. Hopefully, you can incorporate at least some these recovery procedures into your post round routine.