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Lower Back Pain in Golfers

Lower back pain is by far the most common complaint for golfers of all ages and ability levels. Data collected from the Titleist Performance Institute (TPI) show that 28.1% of all players have lower back pain after every round. The most common trend is for trail-sided back pain, ie. pain on the right side of the lower back for a right-handed golfer or left sided back pain for a left-handed golfer.

In actual fact the lower back is generally not the cause of the injury but is the area of the body that is overloaded the most and eventually suffers from the pain. Most of the time it is the fault of the body segments above or below the lower back that are dysfunctional. If the hips, upper back, shoulders or ankles do not move correctly it puts more pressure through the lower back than it is supposed to cope with and it subsequently breaks down. For example, if you are tight through your upper back or hips, the rotation required to bring you to the correct position at the top of your backswing is unable to occur in the upper back and hips. This forces your lower back to compensate and attempt to rotate further. Your back is then repeatedly loaded with more force than it can take, ultimately resulting in the facet joint injuries we see so commonly in golf. It may be an injury that comes on all of a sudden during a swing, or it can be a gradually stiffening/tightening of the back or soreness that is present after a round.

There are 3 aspects within a golf swing that have a strong relationship with lower back pain. The first is an S-posture at initial setup position. As you can see in the picture below on the left, the S-posture creates increased compression forces through the lower back due to the excessive lumbar lordosis (curve). This compression puts heavier load through our facet joints and with repetition this can result in an acute irritation of the facet joints or gradual degenerative changes through these joints.

Instead of the S-posture set-up, we ideally need a straighter line through the lumbar spine. This requires core stability to draw the spine out of the large curve and maintain a stable lower back position throughout the swing. If you have an S-posture, you can begin to correct this by practising basic motor pattern and core exercises, sometimes beginning in lying or kneeling positions, then progressing into more relevant standing golf positions.

The second major feature of the golf swing that correlates with lower back pain is the “Reverse Spine Angle”. At the top of the backswing the line between our head and centre of the pelvis should point away from the target. A “Reverse Spine Angle” is where this line of the spine is tilted towards the target. In this position the facet joints of our lower back are in an open position so as we move into the downswing and ball contact there is a rapid compression onto the facet joints as we close down onto them. People may develop a “Reverse Spine Angle” because of an inability to separate the movement of the upper body from the movement of the lower body, such as restricted rotation at the upper back or tightness through the latissimus dorsi muscle (the lats). It can also be caused by restriction in trail hip range of motion or weak gluteals and core muscles.

“Early Extension” is the third characteristic of the golf swing which can result in lower back pain. This is the movement of the hips and/or spine straightening up too early in the downswing. It can be seen on the second image below where the buttocks moves forwards away from the back line, when it should actually remain in contact as the hips rotate rather than straighten. “Early extension” again jams down and compresses onto the facet joints of the lower back. The physical causes for this can be reduced hip rotation of the lead hip, poor rotational mobility in the upper back, tightness/shortness in the lats, poor gluteal or core strength and overall a poor overhead deep squat movement.

As well as assessing the golf swing to determine if these swing characteristics are present, a golf assessment must also include a physical screen. TPI teach a Physical Screen consisting of 16 tests, ranging from hip range of motion, upper back rotational range, overhead squat patterns and even to wrist range of motion. All of these body segments need to be working together as a unit to achieve a successful, safe and reproducible golf swing.

TPI’s philosophy of the golf swing is this:
“We do not believe in one way to swing a club, rather in an infinite number of swing styles. But, we do believe there is one EFFICIENT way for every player to swing and it is based on what the player can physically do.”

At Central Performance we have two practitioners who are TPI Certified to assess the golf swing and perform your golfing physical screen.
Helen Hathaway – Physiotherapist
Danny James – Strength and Conditioning Coach
We are by no means golf coaches who are the experts at swing analysis, but would love to work with you and your golf coach (if you have one) to ensure that the mechanics of your body allow for the most efficient and safe swing for you.

Our physiotherapist, Helen, and strength and conditioning coach, Danny, run Golf Biomechanical Assessments consisting of a Physical Screen and a Golf Swing Analysis. They piece together the information gathered from these tests and establish a plan to help you get the most out of your body to improve your golf game. For some, the goal may be to get through a round of golf without feeling stiff in the back for two days following. This may mean manual treatment with Helen to improve joint range of motion and muscle length, as well as a program of corrective exercises to restore normal function. For others, it may be that they want to improve the power in their swing and could benefit from strength and power development with Danny. If you are having pain or discomfort with your golf, or feel that your game could be improved by improving your body’s mechanics, feel free to call and chat, or email helen@centralperformance.com.au


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