Low back pain is a serious issue for professional and amateur golfers alike. Research studies have shown that low back pain accounts for 18-54% of all golf injuries, depending on which study you read. The golf swing places a tremendous amount of stress on the low back (lumbar spine) combining end-range rotational range of motion at high velocity repeated over and over again over a long period of time. This is a recipe for back pain.
Research studies have shown that the golf swing produces compressive forces equivalent of up to 8x your body weight through the lumbar spine. To put this in context, running generates forces equivalent of 3x body weight. These forces approach, and sometimes surprass, the physiological limit of a tissues failure point, thus leading to pain and injury. Some common injuries can include:
- Disc Herniation
- Nerve Root Irritation
- Facet Joint Dysfunction
- Ligament Sprain
- Muscular Strain
Although low back pain is a serious and potentially debilitating condition, it is by no means a “death sentence” to your golf game.
Since golf is a repetitive assymmetrical rotational sport, the forces on the spine and surrounding tissue are not evenly distributed between the right and left side. According to a study by Sugaya et al, low back pain and injury typically occurred on the trail side of the lumbar spine. These injuries are usually due to compression of tissues on the trail side of the body and impact when you and in right sidebending and moving into left rotation.
This means that for a right handed golfer, low back pain symptoms are typically felt on the right side of the low back.
Given that swinging a golf club places tremendous amounts of stress on the lumbar spine, I want to address the eight major factors for low back pain in golfers and what common swing faults we see in golfers with these sub-optimal qualities and how this can perpetuate low back pain in golfers.
1. Previous History of Low Back Pain
This one is logical: previously having acute or chronic low back pain is the number one risk factor for developing low back pain while golfing. In a study of almost 200 novice golfers, aorund 25% of them experienced low back pain during their first season playing. However, the majority of these players did not feel like golf was the cause of their low back pain. Rather, the study explains the players felt that golf had exaccerbated their symptoms of low back pain which they had previously experienced. Interesting.
It seems logical that the 8x body weight compression force on the lumbar spine during each full effort swing could cause a recurrence of previous low back pain.
In a 2010 study by Tsai et al, the authors examined the differences in biomechanics of the golf swing between golfers with low back pain and golfers without low back pain. The study concluded that golfers WITH low back pain demonstrated significantly less hip extensor strength, decreased lead side (left) hip abductor muscle strength, and limited trunk rotation to the trail side (right). These are all characteristics in the golf swing that can increase stress on the low back, potentially perpetuating their low back pain and impairing performance.
2. Too Much Golf!
This seems to be a common theme among athletes that I work with who play many different sports: too much of a good thing is bad. This is true whether it’s baseball players who pitch over 150 innings a year, gymnasts who practice and compete all year round, or powerlifters who never take a deload week. The body needs time to rest, recover, and get stronger in order to avoid injury. Research shows that golfers who practice more often and for a longer duration are more likely to sustain an overuse injury.
I like the use two concepts of quantifying and measuring overuse in sport when I am educating a golfer on why too much golf can be harmful: The Cumulative Load Theory and The Acute-Chronic Workload Ratio.
Cumulative Load Theory
The cumulative load theory is based on the principle that there is a “threshold range of load and repetition product beyond which injury precipitates.” Basically, there are only so many repetitions of a certain movement that our body can sustain without injury over a period of time (all other variables remaining equal). McCarrol et al described the cumulative load and its effect on golfers in 1982:
“In golf, the combination of large magnitude spinal forces combined with a high frequency of swing repetitions, likely results in lower back injury over time through the cumulative load process. The influence of cumulative load on golf-related LBP is likely why elite players identify overuse rather than a traumatic event as the cause of their LBP.”
Acute-Chronic Workload Ratio
Tim Gabbet is credited with developing this theory to explain why overuse injuries happen. Essentially, this theory defines chronic workload as “what your body is used to doing” and acute workload as “what your body is doing today.” If what you are doing today is a dramatic increase in activity compared to what your body is used to doing, the risk of injury increases.
My recommendation is to begin each golf season by easing into practice sessions, gradually increasing your swinging volume over a period of time to build up a solid foundation. Limiting the amount of abrupt spikes in golf swing volume will help to lessen the risk of injury throughout a season. Also, maintaining an appropriate strength and conditioning program while playing golf can help to build resiliency and decrease the risk of injury.
3. Poor Lumbopelvic Control
We’ve all heard the saying, “It’s all in the hips,” and it’s certainly true in golf. The lower half serves to generate power through the kinematic sequence of the golf swing through channeling and using the ground reaction forces to transmit power from your feet to the club. The legs generate power, the trunk and arms transmits the power, and the club exerts the power on the golf ball.
Poor lumbopelvic control can manifest itself in numerous phases of the golf swing. Golfers who have difficulty controlling pelvic positioning will often have a sub-optimal address position, inefficient kinematic sequence, and potentially a number of different major swing faults. Each of these issues has the potential to place a greater stress on the lower back during each swing.
When I work with a golfer who struggles with poor lumbopelvic control in their golf posture, I often find that other culprits of low back pain on this list are present as well. These can typically include general weakness of the core, glutes, and leg muscles, limited hip mobility, and limited trunk rotational mobility. It is important to recognize that although these are distinct characteristics on this list, some or all of them may be present in golfers who have ever experienced low back pain.
4. General Weakness and Decreased Muscular Endurance
Weakness of the abdominal muscles, hip extensor muscles, and hip abductor muscles have long been correlated with low back pain. The abdominal muscles should be contracting during the downswing and through impact to create a stable foundation for rotation of the upper body. If a golfer has weakness or poor endurance of the abdominal muscles, over the course of a round a golfer may begin to lose some stiffness through the core. Once this happens, the golfer is losing a lot of stability in their swing which can predispose them to placing more stress on the lumbar spine. The same thing occurs with the poweful muscles of the hips and lower body. If these muscles aren’t generating the power in the swing, golfers will attempt to generate this power elsewhere.
It is well documented in the research that prolonged periods of sitting and relative inactivity can have an impact on posture and muscle strength. Im going to stereotype the typical golfer that I work with: 30-55 years old, works a desk job 40-80 hours each week, doesn’t go to the gym as much as he or she wants, and has nagging aches and pains in various areas. Their physical screen reveals weakness and decreased endurance of the core and lower body muscles, and poor motor patterning in movements related to their golf swing. This same person then picks up a golf club Saturday and Sunday morning and plays 18 holes of golf. On Monday, they have significant soreness and discomfort in their low back.
Now, this is definitely not the only scenario of people that I treat for golf-related low back pain. I would say, however, that it is unfortunately the majority of golfers that I see.
The notion that golfers are weak and out of shape has been completely thrown out the window in professional golf. Golfers need to be strong enough to handle the extreme forces the golf swing places on the body. They also need to have the endurance to use that strength over 4+ hours of repeated swinging. I strongly advocate that golfers get into a solid strength and conditioning routine that focusing on general strength, rotational power development, and overall fitness.
Stay tuned for the second part of my post on 8 Reasons Why Golfers Have Low Back Pain: Part 2. In the second part, I will talk more specifically about certain characteristics of a golfer’s physical limitations and how they correlate with major swing faults.