Added on April 12, 2017
This post is inspired by an unfortunate event that occurred the night before the 81st playing of The Masters when a certain #1 player in the world slipped and fell injuring his back. While low back pain is very common among golfers, the mechanism of injury was not. So, falling down the stairs aside, what do we know about low back pain and golf? Continue reading to find out!
Low back pain (LBP) is consistently cited as the most common injury among golfers. This statistic has led many researchers to conduct studies and formulate correlations between LBP and physical characteristics of the golfer that may result in swing faults. However, it should be noted that many authors admit LBP is a multifaceted condition that is difficult to control in scientific research. Furthermore, it is not within the scope of this post to review the anatomy and pathophysiology behind different medical diagnoses (ex. disc herniation, stenosis, muscle strain, etc.) in regard to low back pain. However, it has been well documented that treatment should not be performed with only the medical diagnosis in mind and that each individual should be evaluated thoroughly. With that said, the following is a summary of different mechanisms that have been found to contribute to low back pain in golfers.
Hip Internal Rotation: It has been concluded that decreased lead hip (left hip for right handed golfer) internal rotation (IR) may contribute to LBP in golfers.
Hip External Rotation: There is an established correlation between decreased lead hip FABER range of motion and LBP.
Non-Lead Hip Range of Motion: No correlation in amateurs or professional golfers.
Lumbar Extension: Decreased lumbar extension has been shown to correlate to a history of LBP.
Lumbar Flexion: There was no correlation between decreased lumbar flexion ROM and a history of LBP.
Trunk (Thoracic) Rotation: Golfers with LBP have less rotational flexibility in the trunk (Lindsay and Horton, 2002).
Toe Touch: An inability to perform a toe touch was also related to LBP in one article. To see how to perform this test click here.
Reverse Spine Angle: The #1 related swing fault to trail sided LBP in golfers. Usually a compensatory pattern that results from decreased hip or trunk rotation (see above).
S - Posture: In the world of orthopedics, this is also called lumbar lordosis. It has also been coined "lower-crossed syndrome." This posture places the lumbar spine in hyper-extension.
C - Posture: This is a posture that places the lumbar spine in flexion.
Hanging Back: Considered to be a potential swing fault for various reasons, I find it is due to lack of lead hip internal rotation or lack of stability/ balance on the left leg. This lack of hip internal rotation or stability decreases the player's ability to transition to the lead side and complete the follow-through.
Early Extension: Another swing fault due to reduced lead hip internal rotation. There are physical parameters and screens that correlate to this swing fault.
Even though range of motion and technique is very important in the golf swing to protect the spine, we cannot forget about strength and stability in the lower extremity and core. It is well documented that strength and power can improve performance, but we need to remember that it can also reduce the risk of injury. Without going into excessive detail, the lower body and core should have adequate stability in order to attenuate considerable amounts of load on the spine during the back-swing, impact, and follow through. Several tests can be helpful to detect core and lower extremity stability deficits.
Single Leg Stance: a test for overall balance that can highlight any side to side asymmetries can be found here.
Bridge with Leg Extension Test: a great test for lumbo-pelvic-core stability especially gluteal function is shown here.
Trunk Stability Push-Up: tests the ability to stabilize the spine in an anterior and posterior plane during a closed-chain upper body movement. An overview of this test is here and reasons why it's important are here.
In conclusion, certain physical characteristics have been found to cause low back pain in amateur and professional golfers alike. To see if you are at risk or to see if a physical characteristic is causing a swing fault that may cause LBP, book an appointment at Ivy Rehab today.
Luke DeLorenzo, DPT
Ivy Rehab, Toms River, NJ
1. Grimshaw, P., Burden, A. M. (2000). Case Report: reduction of low back pain in a professional golfer. Medicine & Science in Sports & Exercise, 32, 1667-1673.
2. Lindsey, D., Horton, J. (2002). Comparison of spine motion in elite golfers with and without low back pain. Journal of Sports Science, 20, 599-605.
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. Phys Ther Sport. 2009;10(4):131-135.
4. Vad, V. B. (2004). Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. American Journal of Sports Medicine, 32, 494-497.