I think this should be a big topic for everyone. Recently it has been for me. Statistics out there show that up to 50% of golfers have some degree of low back pain at some point in their playing careers. This is actually no surprise to me. Just take a second to look at the swing of a player who hits an average drive of say 250 yards and you can imagine the amount of force put on the spine. Now this force isn’t simply in one plane of movement either, multiple movements, around the lumbar spine particularly, occur all at once, and this can put anyone at risk for low back injury and pain (1, 2). For instance, lateral bending, combined with compression and torsion, are a significant cause of disk herniation, and guess what movement all of these spinal motions occur in… 🙂 Not to mention professional golfers who have faster swing speeds and swing an obsessive amount of times (think practice session after practice session). So ya, no surprise about the back issues right? Some studies suggest that the force put on the spine during the swing can be up to 8 times your body weight (1). Ultimately, I think that the golf swing may not be a fully natural movement for the human body, at least at the frequency required for fairly avid golfers. However, there is no way that I am going to stop playing golf…period! Especially since I just shot the best round of my life (76), and I felt that there was plenty of room to make up strokes on some poor shots. So, the question then becomes, where are most low back injuries seen, and what musculature is most active during the swing. With a strong knowledge in these area, we can likely limit or eliminate the damage that can be caused by a lifetime of powerful golf swings.
Common Low back Injuries In Golf
Here is a quote from a study describing the cause of low back pain from the golf swing (1):
“Given the limited range of axial rotation in the lumbar spine and the emphasis on torsional loading during the swing, it’s not surprising that the most frequent cause of acute LBP is thought to be local soft-tissue damage; this includes muscle strain, internal disc disruption, and facet joint capsule trauma . Based on analysis of the forces generated by the golf swing, it is clear how repetitive lumbar spine loads may potentially predispose a golfer to muscle strains, herniated nucleus pulposus, stress fractures of the vertebral body and pars interarticularis, spondylolisthesis, and facet arthropathy .”
Yikes, right? So basically what we are doing here is trying to force our lumbar spine into a rotational range of motion past what it is built for, and then on top of that we are twisting our torsos as fast as we can. This by itself is a great mechanisms for injury. However, you may ask why don’t all golfers experience back pain, and the answer likely falls on the fact that everyone is different with different ranges of motion and strengths. Now, that being said, here are some of the suggested reasons why some people experience injuries because of these rotational forces:
Muscular imbalances lead to improper stability of the spine during the swing (1).
Improper muscle recruitment and coordination during the swing leading to decreased spinal stability (1)
Increased flexibility without increased muscle coordination/activation leading to improper stabilization through an increased range of motion (1)
Decreased spinal stability due to fatigued muscles (1) – think about how tired your muscles can be after hitting 150 balls on the range, they are clearly weaker at that point, and less able to protect your spine from the forces produced
Limited trunk muscular endurance (3)
Limited trunk muscular strength (3)
So, at the end of the day, there is a good deal of low back injury risk in golf. The question is, how can we prevent or at least reduce, our risk of injury and pain? Before we get there, there is one more thing we need to look at, and that is what musculature is activated most during the golf swing?
Most Active Muscles During the Swing
The most active muscles during trunk rotation and the golf swing are the erector spinae, internal/external obliques, quadratus lumborum, latissimus dorsi, psoas major, rectus abdominus, and gluteus maximus (1). The largest activation, during rotation, seems to be in the obliques and the latissimus dorsi muscles, while the quadratus lumborum, erector spinae, and rectus abdominus provide the major stabilizing factor (1). Regarding the golf swing specifically, the down/forward part of the swing shows the most muscle activation compared to the other parts of the swing, and the gluteus maximus is shown to play a large role in pelvic stabilization and swing power production (1)
OK, so since we now know the likely mechanisms of injury and the muscles involved in our swing, we should have sufficient information to develop a plan to ensure we are reducing our risk of injury when playing golf.
So to start with, and I truly hope this is obvious for everyone out there, studies have shown that 2 common sense steps can be taken to reduce golf related injuries and these are: use a push/pull bag cart, and warm up (1, 3). Yes, that’s right, I said warm up! Get to the course early and perform a proper 15-30 minute warm up that is dynamic. You can reference my upcoming post to be titled “My Ultimate Guide to Golf Fitness Part 3. This post will provide you with a suggested pregame or practice session warm up. Also, if you include hitting some shots at the range as part of your pregame warm up, you will be pleasantly surprised since it will likely improve your score.
This part may not be obvious to everyone, but since such great forces are produced around your spine during the swing, it is very important to train your core musculature (1, 3). This training should include both static (think planks), and dynamic (think med ball throw) exercises. It is also very important to ensure that full body strength is sufficient to be able to produce and endure the forces placed on your body during the swing. It’s also important to note that these forces are very powerful in nature, meaning that a high level of force is produced at a very fast speed of movement. Therefore, exercises such as squats, deadlifts, Olympic lifting, and jumping should be included in your training routine to increase your bodies ability to safely sustain these type of forces during your swing (1, 3).
We also need to be able to move our bodies through a full, unrestricted range of motion, and this can be achieved through dynamic range of motion (mobility) and stretching exercises. In the end, for a healthy body and swing, we should have regular full range of motion in all of our joints. However, some of the specific areas related low back pain and the golf swing are reduced range of motion in internal rotation of the hip, the hip flexors (1, 3), and the hamstrings. So when should you stretch? Everyday, and always following a round of golf or practice session.
Also, to ensure that we are able to maintain proper muscle activation through a full range of motion (reference reasons why injury occurs above), the exercises we perform should be done through a full range of motion, if the weight doesn’t allow you to do so, decrease the weight until you can move through a full range of motion with proper form.
Golf is a power sport and can certainly lead to injury, particularly low back injuries. It should be treated like any other sport in the sense that we need to be preparing our bodies appropriately to reduce the risk of injury. I hope the above has provided you with some things to think about for now. Please refer to my post series titled My Ultimate Guide to Golf Fitness (here and here) for further specifics.
Part 2 of this post will focus on the differences between the modern and classic golf swing and what that might mean for low back pain.
The Barefoot Golfer