The most common site of injury and complaint in recreational, amateur and professional golfers is the low back, representing 23 to 35 percent of all injuries. During the golf swing, the back undergoes significant movement in a very short period of time, generating forces similar to that of a football lineman hitting a sled. This force, compounded by repetitive golf swings, contributes to the high rate of back injury. Less experienced golfers compensate for poor mechanics by swinging harder, further increasing forces on the low back.
Swing faults contributing to a low back injury include S-posture, reverse spine angle, early extension, restricted right leg follow-through, and reverse C finish. The “modern swing” with more hip-shoulder separation (X-Factor) creates more stress on the spine. Golfers with limited mobility of their lead hip (the left hip in a right-handed golfer) may have an increased incidence of low back pain. Golfers who carry their own bags also experience more low back injuries.
Common back injuries in golfers include sprains and strains, irritation of the small joints of the spine, lumbar disc injury, and aggravation of underlying arthritis. Treatment of these injuries includes rest or activity modification, anti-inflammatory agents, physical therapy with a focus on flexibility and core strength, and correction of swing faults and practice routine. A treatment plan can include care from a physician, a physical therapist as well as a professional golf instructor.
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Adjustments to the swing can help reduce stress on the lumbar spine; these include minimizing the difference between hip and shoulder rotation, follow-through with the spine perpendicular to the ground (less reverse “C”), and maintaining the appropriate spine angle.
Power is governed by soft tissue tension. The more flexible you are, the more “tension” you can transmit into energy. Increased flexibility allows you to get the club into proper position at impact. The result can be greater distance and accuracy. Core strength contributes to better posture, even spinal pressure, and a more efficient swing with less pressure on the low back.
Aerobic conditioning is important for endurance to help with better shots late in the round as well as reduced risk of injury from fatigue. In general, individuals who participate in a regular aerobic exercise program have fewer low back problems. Like jogging, cycling and swimming, golf is an aerobic exercise when you walk four to five miles on the golf course to play 18 holes.
The key to prevention of low back problems is to stay active year round with an appropriate stretching, strengthening and aerobic conditioning program. Consult a teaching professional for help with your swing and practice routine. And prep like a pro – arrive early and do not rush; stretch before swinging; progress from stretching to slow swings; and minimize fatigue with proper nutrition and hydration. Following these tips will help minimize the risk of injury, increase your playing time and improve your performance.
AJ Cianflocco, MD, is a primary care sports medicine physician specializing in neck and back problems in the athlete. To make an appointment with Dr. Cianflocco or any of our primary care sports medicine physicians, please call 877.440.TEAM.