Milwaukee's Certified Crossbow Evaluation Physical Therapists

Don't Let Back Pain Handicap Your Golf Game

Every golfer at some point in his or her life experiences some type of back pain. Lower Back Pain (LBP) can come on suddenly from quick, unnatural movements (yard work, lifting, sports) or become chronic from the onset of degenerative disk disease (DDD), herniated nucleus pulposus (HNP or disc herniation) or spinal stenosis (narrowing). These problems can present with or without sciatica (leg symptoms). Golf injuries to the lower back are the most common injuries in both professional and amateur player's world wide. 80% of amateur golfers suffer from chronic or recurrent episodes of low back pain and are frustrated because the pain hinders or prevents their ability to play golf and do the things they enjoy in life.

Causes of LBP are poor technique, poor strength and conditioning of core muscles (abdominals, gluteals, hip rotators and back muscles), and/or the repetition of hitting balls that usually leads to injury. The repetitive nature of the golf swing predisposes the back to stress, strain, pain and injury. The golf swing requires both strength and flexibility, specifically of your core area to withstand the high levels of stress (swinging a 3 foot club at over 100 mph) from your swing. If your core  is weak and/or you have areas of inflexibility, not all the mechanical forces from your swing will get distributed equally throughout the body and can go right into your lower back, irritating fatigued muscles, ligaments and the disks.  

The repetitive motion of the golf swing and bending occurs more than one-hundred times per round when you combine practice before play, pre-shot swings, actual contact swings, and bending over to put the ball on the tee and to get it out of the hole after you've made your putt. This rotating of your upper body over a stable lower body and the flexed postures with bending are the physical demand we are talking about that can wreak havoc on golfers' low back and cause a high level of pain and dysfunction.

Prevention of Lower Back Pain to Keep Swinging Strong

To help prevent low back pain, we recommend golfers start by visiting a health professional who offers a golf-specific training program (i.e. physical therapists or personal trainer). A well-trained health professional can identify musculoskeletal imbalances and provide personalized golf-specific exercises to improve your posture and overall conditioning specific for golf. Correct posture and muscle balance will enable you to get into the proper positions required to effectively swing the golf club.

The golf swing is considered an unnatural movement for most people, especially sedentary people who sit or drive a lot for work. As with most sports, golf requires many rotary movements. When we sit most of the day, certain muscles get accustomed to that position and become tight while other muscles become stretched out and weak. These positions can cause significant muscle imbalances resulting in unnecessary back stress.

In all likelihood, the sedentary person's golf muscles have gone dormant and don't know what to do. The muscles that absorb force and reduce load during a golf swing (the lower and deep abdominals and back) are relatively weak and cannot work together. And, if your hips and shoulders are tight, the chance of incorrect mechanics and movements are greater.

Exercises for a Healthy Back

Traditional exercises have been shown to be an effective treatment for patients with low back injuries. Multiple studies have examined the benefits of exercise in treating patients with low back pain; however, there have been very few published reports describing specific program designs as it relates to golfers.

Golf exercises are one of the quickest ways to eliminate and prevent back pain from occurring. Exercises specific to the core from a rotational standpoint will be the most effective. The golf swing is a pure rotational movement, so training your body with exercises involving core rotation will give you the best return from your efforts. These exercises do not have to be performed in a gym, nor with fancy equipment. You can incorporate simple and effective exercises with light dumbbells, exercise tubing and weighted medicine balls. All very inexpensive and available at most local fitness equipment stores in your locale. If you utilize a personal training, they can design a golf-specific routine.

Since the golf swing also requires a higher level of flexibility, it is wise to implement golf stretching exercises that isolate the core, lower back, hips and even the gluteals. These stretches can be both dynamic (stretching during movement) and/or static (holding without movement), depending on the time they are done. For example, before playing golf you should do more dynamic stretches to prepare the body to perform, and after golf, exercise or even a warm shower, static stretches should be performed isolating the above mentioned areas. Golf stretching is only effective if done consistently, preferably on a daily, if not every other day basis. Muscles are elastic and can easily be improved, as well as quickly tightened if not stretched regularly.

A few of the most important areas to address that impact the low back are lower abdominals gluteals, hip rotators and lower back muscles (multifidi and rotators). Balance and coordination also plays a role and should not be discarded.  Here are four exercises to try.

• Hip and Buttock Strength: Lie on your back with knees bent and feet flat, raise your bottom off of the ground (bridge), slowly straighten one knee so it is parallel with the opposite thigh and avoid hip teetering.. Hold for 10 seconds, if your pelvis drops or your hamstrings begin to cramp, then you have weak or inhibited gluteals.
• Lower Abdominal Strength: Lie on your back with knees bent and feet flat. Keep your back flat on the floor and attempt to lift one knee at a time to waist line without rocking pelvis. Repeat alternating leg motions as if riding a bicycle. work up to 60 seconds.
• Hip Stretching:  Lie on your back and cross one leg over the other. Reach and grab knee with both hand and pull toward your opposite shoulder until a stretch is felt in hip or buttock area. Hold this stretch for 30-40 seconds and repeat on opposite side. This may be performed on the golf course by standing along side the golf cart, holding onto the side bars and crossing on leg over the other and sitting down and back for the stretch.
• Single Leg Balance: Try to stand on one leg with your eyes closed. The average balance time on one leg in the PGA tour is 28 seconds.
• Pelvic Mobility: Stand upright, place your hands on your hips, and try to rotate your pelvis forward and backward (pelvic tilts). You should be able to do this without bending your knees or moving your spine.

Golfer's Preseason Checklist to Ensure a Healthy Back

1. Visit a physical therapist who is experienced working with golfers. Ask for a golf-specific physical assessment and conditioning program that includes strengthening and stretching.

2. Take a lesson from a PGA professional about fundamentals and how the body should move during the golf swing. Preferably, choose a PGA instructor who uses video to analyze your swing.

3. Practice golf-specific drills to learn correct movements during your swing. This will help to decrease the chances for back injury.

4. Ensure your clubs fit you properly. For example, are your clubs too short or long? Are the shafts too flexible or stiff?

5. Get to the course early to make sure you do a golf-specific warm-up routine before hitting balls or playing golf. A thorough warm-up includes easy swings, stretching and mentally thinking about your swing mechanic to prevent a strain of one's back muscles. Work on each component of the swing and especially tempo, so you don't over swing. This may include using the driving range and putting green.

6) Consider some type of anti-inflammatory before, during and/or after playing 18 or more holes of golf. Ice is a natural anti-inflammatory and should be used to relieve lower back pain after repetitive activities like golf (15 min). Heat is indicated if more stiff waking up in the morning.