Golf and Low Back Pain

Spring is here!

As the spring weather rolls in, excitement is in the air as we prepare for the 2023 golf season. It is very common for us to see golfers early on in the season with injuries, especially after such a long winter layoff. Those of us lucky enough to have gone down south during the cold months or had access to simulators have kept swinging and in turn will likely fare better physically as we get into the swing of things.

Don’t Dive In

For those of us not so fortunate, we should ensure that the new season brings with it a minimal risk of injury. Aside from those chronic, nagging conditions that often need to be accommodated for, other more acute soft tissue injuries very often become problems early on. Tendonitis and muscle strains are the most common. Jumping head on into a full-effort 18 holes after 4-6 months of little golf-specific activity can result in tendon and muscle overload, especially considering that the golf swing is a very specific type of movement not usually done during everyday life.

Low Back Injuries are Common in Golf, especially Lower Handicap Players

The low back tends to be the most common area of injury. It is a region where a large amount of rotational and side-bending force is produced during the golf swing. Lower handicap players tend to sustain more low back injuries, owing to the fact that they more often generate tremendous torque in this region and in turn are usually longer hitters than those with higher handicaps.

The X-Factor Factor

These high swing speed players tend to have a large X factor, that is the difference in rotation between the hips and the shoulders. A flexible player can often have their shoulders rotating at 90 degrees or more from the start position, with their hips rotating approximately 45 degrees. This creates a significant amount of kinetic energy, and when the player unwinds this force is delivered to the clubhead and ball like a cracking whip. Stiffer individuals will have a smaller X factor, thus resulting in less swing speed and distance, but in turn less torque on the back and less injury in that region (assuming all other variables are equal).

Classic Golf Swing

A textbook golf swing often emphasizes finishing with your chest to the target, and this results in a hyper-extension force being placed on the spine as well. This “arched” position is a compressive one for the facet joints of the low back, and attempting to exaggerate this position can be met with low back pain over time. In the ‘classic’ golf swing, this X factor was nearly non-existent, as the hips and shoulders rotated in a near 1 to 1 ratio.

Modern Golf Swing

As the modern swing evolved and more distance was needed/desired, more of a lumbo-pelvic dissocation was needed to create more clubhead speed. This can be seen in the PGA Tour frequently needing to modify and adapt course to help challenge today’s long hitters. It is a common mistake for individuals to try to produce a textbook modern golf swing, seeing as how that’s what the best players do.

Work with Your Body

Aside from the injury risk involved, this approach does not take into account the person’s individual physical characteristics that may prevent them from attaining this goal. For instance, flexibility exists on a spectrum, from very stiff to hypermobile or even unstable. Someone with inherently stiff tissue may be able to improve this somewhat through a stretching and exercise program, but pushing repetitively into ranges that your body is not physically capable of often will result in injury. A workaround to this is adapting your swing to help account of chronic injury/physical limitation, thus maximizing your ability to play well by playing within yourself. It is very common, for instance, for individuals to have limited thoracic (mid-back) rotation. Our mid-back is where most of our spinal rotation occurs, as it is an area designed for mobility. When this is limited, compensatory movement is then taken up in the low back as we try to increase our shoulder turn.

Amateur Swings and Back Pain

It has also been found that amateurs have much more muscle activity in the low back during the swing, resulting in 80% more torque and shear in this region. This is explained via the inefficiencies seen in amateur swings. A pro swing is much more efficient, using much less muscle effort to get the job done.

Hip Stiffness can Drive Low Back Pain

Hip stiffness is another common theme in players with low back pain. With a stiff hip(or hips), the low back often becomes the ‘path of least resistance’ as compensatory rotation is taken up in this area. Hip strength and mobility are crucial for a good golf swing. Weakness, arthritic change, and other intrinsic issues in the hip joint and its associated musculature can play a very important role in causing and perpetuating low back pain.

A Physiotherapy Solution

As physiotherapists, we can play an important role in helping to prevent these low back issues from occurring. A thorough assessment involving a detailed history and objective examination allows us to document any movement or strength deficits that may be playing a role in your back pain. From there, an individualized plan tailored to your specific needs and goals can be created, maximizing your recovery and helping to get you playing pain-free as soon as possible.

Authored by: Steven Georges, BHK(Hons), MPT, CIDN, MCPA

Registered Physiotherapist and avid golfer