Stop Back Pain, A Definative Golfers Guide

Back PainI have written articles about low back pain and the golf swing previously (here and here) that are actually quite popular posts on the blog.  Those posts were a bit general in outlining some of the issues specific to back pain and golf, with a large point made about the classic vs modern golf swings.  Because of the popularity of these posts, I decided I would write another post with a bit more detail into how we can relieve back pain related to golf.

Stopping Back Pain – The Obvious

First and foremost, getting back pain from golf can really be no different from getting back pain from your daily life, and unfortunately, daily back pain is common for many people, not just golfers.  So, just like with non-golfers, to prevent or relieve back pain we need to do all the proper things off the course including proper sitting and standing posture, appropriate exercise, and limit extended periods of sitting.  It is also extremely important to learn how to move properly and ensure you have a sufficient amount of mobility through your whole body.  I will talk golf specific mobility shortly but without a doubt, mobility in general is needed for life and golf alike.  So get out there and squat, crawl, lunge, climb, sprint, throw things, lifting things off the ground, etc.  If you don’t know how to do these things effectively find someone to teach you and do it all as often as you can.  I outlined some more golf fitness tips for beginners here.

At the end of the day, our first step to prevent golf related back pain is to do all the things that can cause non-golf related back pain.  Unfortunately, this is not always enough since the golf swing is arguably not a natural movement and it puts a great deal of stress on our spine and hips.  Therefore, the following addresses some things we can do over and above the everyday back pain prevention steps

Back Pain – Addressing Weaknesses

Just a few quick things to think about as you read through the remainder of this post.  I will be going over different areas of the body and providing some considerations and helpful tips for each area.  Not everyone will need to focus on every area to prevent or reduce their back pain.  What you really need to do here is identify your major weaknesses first, then build on the other areas from there.  However, if you do decide that you have the time to focus on all the below at the same time, the more power to ya!

The Warm-Up

I cannot friggin’ stress this point enough…Always perform a proper warm-up before a practice session or round of golf.  You don’t see a baseball player step on the field and immediately try and hit a 90 mile/hr fastball as their first movement, that would be silly, they could injure themselves.  Very true, but why do people think they can step up to the first tee and perform a full speed swing before preparing their body to do so?  Well…you can’t, unless you want to risk injury and back pain.

Here is a sample warm-up you can perform before a practice session or round of golf.  This is only one suggestion as there are a variety of appropriate warm-ups.

  1. Reverse lunge with twisting reach back: 5 -10 each leg
  2. One leg romanian deadlift: 5 -10 each leg (do not use weights like in the video)
  3. Squat stand: 5 – 10
  4. Front leg swings: 5 -10 each leg
  5. Side leg swings: 5 – 10 each leg
  6. Arm Swings: 10 front and 10 back
  7. Hip Circles: 10 each way
  8. Trunk rotation: 10
  9. Gradually increasing full swing speed: These are done with a short club (pitching wedge) and no ball.  Perform a forward and backwards swing, gradually increasing the speed of both the forward and backwards swings until you begin to feel close to your normal swing speed.
  10. Hit a number of 1/4, 1/2, 3/4 shots with a short club (pitching wedge).  Work on solid contact and acceleration through the downswing.
  11. Hit a number of full shots with a short club (pitching wedge).
  12. Now you can move through your regular practice session or preparation for your round (i.e. hitting balls with the rest of your clubs).

Note: During the warm up is the time to make sure you are preparing your “trouble” areas for your round so they do not cause problems for you.  For me, a big focus is on my hips so I will do more hips focus exercises than what is outlined above.

Believe me, running through a proper warm up like what is outlined above will go a long way in preventing or reducing golf related back pain.

Proper Golf Posture

Posture ultimately ties back into doing the daily things we need to do to keep our backs healthy.  We need to have proper posture when we sit, stand, walk, lift weights, bend over, jump, run, etc.  This is no different when we golf.  Proper posture is not only essential for an efficient and powerful swing, but also essential to limit back pain.  Strangely enough, if you are not walking around the golf course with proper posture this, in and of itself, could be causing you some back pain.

Let’s get back to the swing.  You will see many different setups out on the course, some people will be bent over with a very rounded back and some people will be very upright with their chest out and butt in.  The below picture provides examples of 2 poor golf postures: rounded (kyphotic) and over arched (lordotic).  The correct posture is somewhere in the middle and it’s called neutral spine.  Here is a couple resources for finding neutral spine.

1.) Golf specific posture

2.) How to find neutral spine in general

If you can keep a neutral spine while walking around the course and during your swing, you will go a long way in preventing back pain.

Back Pain and The Thoracic (mid) Spine

To start this section, here is a quote from a peer reviewed study (1) on low back pain and the golf swing:

“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 [36]. 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 [13].”

Basically, our lumbar spines have a very limited range of rotational movement and during the golf swing, we are attempting to move them through maximal and supramaximal ranges of motion at the same time as applying high joint forces.  This is the perfect situation for injury to occur.  Keep in mind that the limited range of motion is actually because of the fixed structures of our lower back, not because of lack of muscle and ligament flexibility.

So, because of this limited range of motion in the lumbar spine, the vast majority of the rotation in our swings comes from the thoracic spine and hips (see below).  In light of the above, we should be doing our best to increase the mobility (full active range of motion) in our thoracic (mid) spine.  How do we do that? Increase flexibility and active range of motion.  Here are some videos of exercises you can do.

Flexibility:

1.) Self massage/trigger point

a.) https://www.youtube.com/watch?v=CrKstFEd3oU (don’t use the weight unless you know what you’re doing)

b.) https://www.youtube.com/watch?v=nboERV7j00E

c.) https://www.youtube.com/watch?v=CTtR0TINZPM

2.) Active Movements:

a.) https://www.youtube.com/watch?v=6vvYNqIi9CQ

b.) https://www.youtube.com/watch?v=hAhzbRKQ9hI

Note that when you are performing the active movement exercises, the hips are staying stationary in a mostly neutral position, this way the focus is on movement in the thoracic spine, not the hips.

Golfer Back Pain and Hip Mobility

Referring back to the limitations of the lumbar spine with respect to rotational range of movement, it is also critical that we have sufficient mobility in our hips in order to get sufficient body rotation to produce a swing of proper length and thus power.  To allow our hips to rotate along with our lumbar spine while our feet are in a fixed position (i.e. flat on the ground), we need to have sufficient internal and external hip rotation.  For a right hander, the backswing involves external rotation of the leading hip (target side) and internal rotation of the trailing hip, and the downswing involves a powerful reverse these movements.  Here are some exercises for hip rotation mobility:

Flexibility:

External Rotation

Internal Rotation

Active Movement:

Internal Rotation

Internal Rotation – Don’t let your butt come off the ground like this guy does

External Rotation

Hip mobility is also important for the ability to maintain proper spinal posture, whether during your golf swing, walking, or standing.  For instance, if your hamstrings are too tight, you will have a rounded lower back, if your hamstrings are too loose and your hip flexors are too tight, you will have an over-arched lower back (see above picture of golf posture).  Here are some exercises to help improve hip mobility in general:

General, General, General, General, General

Extension, Extension, Extension

Flexion, Flexion, Flexion

Golfer Back Pain and Shoulder Mobility

Obviously we have some shoulder involvement in the golf swing.  For right handers, the left arm needs to come fully across your chest while maintaining a straight arm (horizontal adduction).  At the same time your right arm needs sufficient horizontal abduction and external rotation (think rotator cuff stuff here).  Also, given the dynamic movement of the golf swing, and the fact that the shoulder is not the most stable joint , it is very important that we have full shoulder mobility in all directions to ensure that we have the optimal shoulder stability to deal with the dynamic nature of the swing.  Therefore, we need to work on the golf specific mobility mentioned above, as well as general shoulder mobility.

Golf Specific:

Adduction: This will probably need the least amount of work for most people.

Focusing on the scapula will possibly be a better option

External Rotation, External Rotation

 

General:

Internal Rotation, Internal Rotation

Extension

General

**If you can only do one shoulder mobility exercise, this is it: Wall Angels

A Quick Note on Static vs Dynamic Stretching

You have probably heard me talk a bit about this previously.  I am a big fan of full active movements for improvements in mobility; however, this is not always enough depending on the person and their mobility limitations.  For someone that is sufficiently mobile, movement through full ranges of active motion is probably sufficient to maintain appropriate mobility (think dynamic warm ups, and even weight training through full range movements).  However, most of us need a little extra to get to where we should be from time to time.  This is where stretching comes in, but I am not talking about static old school stretching, ask many professionals these days and they will tell you that static stretching is dead.  Where the magic happens in the stretching realm is with proprioceptive neuromuscular facilitation (PNF).  This is a method where you put yourself into an end range of motion static stretch position, and then you reverse that movement isometrically against some type of resistance (the joint doesn’t actually move), hold it for 5 seconds, and then move into a deeper stretch position (you will actually be able to do so!).  Without getting too technical this basically allows for a deeper, more controlled stretch.  You will note that most of the stretching videos I linked to above are done with this PNF style.  It’s also important to point out that stretching and a warm up are very different things.  Stretching can actually reduce your joint stability and possibly increase risk of injury if it is done just prior to a training session or round of golf.  So save your stretching for after training and rounds of golf, and/or on your off days.  Dynamic movement is what a proper warm up is made of

Final Thoughts on Stopping Golf Related Back Pain

At the end of the day, I guess I could really call this post the definitive guide to stopping mobility related back pain for golfers, but that just didn’t sound good.  There are other aspects of limiting back pain from golf that I have not spoken about here, namely appropriate strength and power production to maintain joint stability, but this area is covered more in my posts of golf fitness (here, here, and here), as well as in my ongoing training page where you can find workouts listed up to 3x/week.

Ultimately, stopping back pain related to golf involves a combination of a lot of factors; however, with this post and my fitness posts you have hopefully been armed with the tools needed to stop back pain.

Note: You will notice that a number of the stretching/mobility videos I have linked to include strange/advanced level mobility exercises with apparatus such as bands and kettlebells.  Remember to scale these exercises to your comfort level (i.e. do the PNF stretch without the band or extra apparatus until you are comfortable with it)

Sincerely,

The Barefoot Golfer

 

References:

1.) http://www.ncbi.nlm.nih.gov/pubmed/?term=The+lumbar+spine+and+low+back+pain+in+golf%3A+a+literature+review+of+swing+biomechanics+and+injury+prevention

 

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