It’s that time of year again when many golfers dig out the golf bag and shine up the clubs. Most of us are planning how many games we can fit in during the first month, Mother Nature permitting of course. Canadian golfers, in particular, have been eagerly awaiting the appearance of green grass all winter. Some golfers, however, will have the misfortune of going overboard. In fact, many golfers experience an injury due to golf at some point that will limit the amount of time played. The most common injury reported by golfers, by both new and seasoned vet’s, is low back pain. Up to 36% of all reported injuries in golf relate to back pain (1). One thing is for sure, golfers love to golf, and most will compensate for an injury such as back pain, by changing the mechanics of the swing.

Improper Golf Mechanics Cause Back Pain

The mechanics of the golf swing that relate to back pain include the back swing, down swing, point of impact and the follow through. In other words, you can’t swing a golf club properly without some movement in your back occurring. The twisting of the torso that occurs during the golf swing, especially at the top of the back swing and again at the very end of the follow through, are the most likely culprits when it comes to back pain. In addition, biomechanical studies have shown compressive loads on the spine can be up to 8 times the normal body weight (similar to loads experienced by NCAA football lineman during tackling drills!) during a typical tee shot (2).If I think about swing mechanics in professional golfers, I can see a large amount of twisting during the swing and unfortunately most weekend warriors will then think large rotational swings are more beneficial. Not true. In fact, professional golfers also report a high level of back pain injuries (1).Perhaps over-rotation of the low back region is the main cause of golfer’s back pain?

Low Back Rotation in Golfers Causes Back Pain

For golfers, amateurs and pro’s alike, gaining an appreciation of just how much rotation may be occurring in the low back during the swing may be useful in preventing back pain before it starts. I recommend trying the following test: Place one thumb on the lowest rib you can feel before the soft tissue of your abdomen, then place the index finger on the bony protrusion just below (Called the anterior superior iliac spine). Next do the same procedure with the other hand. Once in place, take up your typical golf stance and mimic a swing. Note how your thumb and index finger spreads apart the further you rotate (see Figure 1a and 1b).

Golfing Back Rotation - Optimum Integrative

This will show you how much rotation is going through your low back. For example, if you’re a right-handed golfer, you may feel the left thumb and index finger spread apart while the right moves closer together. That would suggest you have a significant amount of rotation in your upper and mid back compared to your lower back. Now add a large amount of compressive force to the lumbar spine either at the start of your downswing or that twisted pretzel-looking follow through we see all the pro’s doing and you have a recipe for back pain.

Proper Golf Mechanics Utilize the Hips

To limit your upper and mid back rotation, resulting in less twisting and compression of your low back, you may want to try using your hips. There are a handful of clinical case studies that suggest your hips are inherently linked to your back pain (3)(4). Let’s revisit the rotation test to see how much low back rotation can be removed by simply using the hips. Instead of twisting through the mid back, try first to tip your pelvis forward and rotate your buttocks around (see Figure 2a and 2b).

Golfing Hip Rotation - Optimum Integrative

The hips will only allow for so much rotation, but in most cases this should be enough to reduce the twisting and subsequent compression in your low back. You may also have tight hips. Not uncommon in golfers either. If this is the case, then hip stretching/warm-up activity may help prior to the first tee.

In conclusion, low back pain in golfers is not uncommon. The link between back pain and the rotational and compressive loads placed on the back during a golf swing are not difficult to comprehend. It is also clear that the hips have a role to play in minimizing the loads through the low back, ensuring proper golf mechanics. So before you steady yourself and take a deep breath for hit that first glorious tee shot, be kind to your spine and learn how to effectively use your hips! Enjoy swinging into spring!

 

References

1. Cabri J, Sousa JP, Kots M, Barreiros J. Golf-related injuries: A systematic review. European Journal of Sport Science. 2009 Nov;9(6):353–66.

2. Hosea TM, Gatt CJ. Back pain in golf. Clin Sports Med. 1996 Jan 1;15(1):37–53.

3. Murray E, Birley E, Twycross-Lewis R, Morrissey D. The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Physical Therapy in Sport. Elsevier Ltd; 2009 Nov 1;10(4):131–5.

4. Lejkowski P, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Journal of Bodywork and Movement Therapies. Elsevier Ltd; 2013 Feb 6;1–5.