Top golf opened in January, the weather is fire (literally), and getting a tee time requires a bit more planning than hopping on Golf Now the day of. It’s golf season! Golf is a sport enjoyed by many of our Made 2 Move athletes, but one of the common complaints they come to us with is low back pain.
Last week’s blog delved into the concept of regional interdependence. This concept couldn’t be more relevant to our golfers with low back pain. Why is back pain common in golfers? What can we do to minimize this pain and make 18 holes feel like a breeze? Let’s jump in.
Why low back pain?
A 2023 study aimed to uncover the most common injury and pain reports among 1170 recreational golfers. Researchers found that 37.3% of the golfers experienced low back pain within the past 7 days (Murray et. al 2021). Was every golfer’s back pain caused by the same mechanism? Absolutely not. Like any injury, reasons for experiencing chronic back pain are going to be highly individualized and require a full evaluation to uncover the root cause.
Golf involves the transfer of power through almost every joint in the body. Muscles have to fire correctly and technique has to be on point in order to have a coordinated, fluid, and pain-free golf swing. What happens if one of these joints is lacking mobility, strength, or coordination? Another part of the body tends to compensate.
PT for golfers often looks like strengthening your glutes or gaining more mobility in your shoulders or hips. This seems odd, but the sequencing and timing of firing muscles is critical for golf and a mishap at one link in the chain can have an effect at the other. The low back is responsible for transferring ground reaction forces from the ground through the legs, back, core, shoulders and into the ball. This is a HUGE responsibility we ask of our back! Let’s give our back a helping hand by strengthening the muscles and mobilizing the regions above and below the low back. Then we can work on making this strength functional for your game by practicing power transfer from the ground up.
The million dollar question: So how can we help this LBP?
A 2013 article noted in regards to golf related injuries, “Poor swing mechanics, poor endurance, and muscular imbalance can increase susceptibility to overuse injury” (Finn et al. 2013). We may not know the exact reason you are experiencing low back pain, but the research gives us a solid understanding of a few solutions that can be a part of your rehab.
Hone into swing mechanics:
Mike Scaduto, physical therapist and director of golf performance at Champion PT, talked in a recent podcast about how swing faults like “early extension, sway, and slide” can put unnecessary load on the back and cause back pain. This is where working with a golf coach can have incredible value. While Made 2 Move can help with PT related issues, we will can send you to a golf specific coach who has an eye for swing faults if we suspect that to be a contributing factor in your pain.
Manage the volume: This is the concept of doing too much too soon. It’s exciting when golf season starts, so you may go hit 85 balls at the range and play 36 holes in one day, walking the entire course. It was a blast, but now your back hurts. Within your PT at Made 2 Move, we work on building up the capacity through your back and lower body so that your threshold for play is much higher.
Mobility (hips, shoulders, T-spine)
This is the bread and butter! If we don’t have adequate mobility in the hips, shoulders, or thoracic spine (T-spine) then the low back may compensate. Our bodies are smart! If our body senses that a certain region like the T-spine or hips don’t have the rotation required for your backswing, then the body will find a different way to accomplish the task of hitting the ball, which often looks like over rotating through the low back. Your low back may decide that it is capable of taking over for your less mobile hips and T-spine, and is successful in doing this but is now painful since it is having to do a job it was not prepared or designed for.
The hips: In order to get a full and proper takeaway and backswing, the lead hip has to internally rotate. For a right handed golfer, you can feel this in your lead hip (the left hip) as you take the club behind you. The hip rotates towards the center of your body in the socket. While a causal relationship hasn’t been established, many case studies have found a lack of internal hip rotation to be correlated with lower back pain in golfers. (Murray et. al 2009).
An example of this is a 2013 case study done on a 56 year old non-professional golfer. He complained of low back pain that he’d had for a while that wasn’t resolving with the back targeted exercises and manual therapy he was receiving. Upon further evaluation, hip range of motion limitations were observed. After just TWO treatment sessions targeting the hips, rather than the back, his pain improved and continued to improve upon following up with him 2 months later (Lejkowski et al. 2013).
Can we say with certainty that his hip pain is what caused his back pain? No, of course not. And this was a case study with just 1 golfer. Regardless of these variables, the same principle applies: the back and the hips are intimately related. The hips are inherently designed to be more mobile. Think about the joint: it is a ball in a socket. In contrast, the lower back is inherently designed to be more stable. Thus, if you lack mobility in the hips, the lower back will often compensate by over rotating and this could lead to lower back pain.
The shoulders: Have you ever developed an “over the top” swing pattern (ie. “coming down on the ball” vs “through” the ball)? This could be due to faulty swing mechanics, but Mike Scaduto talked in his podcast, about how he often sees the “over the top” pattern in golfers attempting to compensate for a lack of shoulder mobility.
The T-Spine: Similar to the hips, the thoracic spine or T-spine, is designed to be more mobile than the lumbar spine, but if the T-spine lacks mobility, the lower back may compensate by over rotating. Add in some T-spine rotations to your warmup or fitness routine to work on this often overlooked region of the bodu.
Interestingly, there are some athletes we see at Made 2 Move who are hypermobile, or extra mobile. For these athletes, we work more on motor control, strength, and stability exercises vs. the flexibility and mobility we emphasive for our patients who struggle with stiffness. This goes back to why a thorough examination by your PT is so vital!
Overall strength and power:
Getting stronger can help you drive the ball farther! We also know that muscles like the the glutes, core, and upper back can provide stability through the swing and in doing so, likely lessen your back pain. A 2021 article noted, “In a golf context, there is a common myth that the core muscles are our main source of power in the swing. In reality, the main role of the core is to provide stiffness and stable support for force/power transfer from our legs to our upper body.” (Randall and Marais 2021).
Power= Force x Velocity. Building strength is the first step, but as a golfer, you have to be able to coordinate and control this strength in a rotational manner at high speeds. Transferring this new strength into a functional golf swing would be the next step in your rehab plan. We may even have your bring your clubs to your PT sessions!
When it comes to strengh training at Made 2 Move, we are not just going to have you doing crunches on the floor all day. We will focus on anti-rotation movements and stability work through the core and do strength training exercises that not only pertain to you, but are sustainable and enjoyable for you . As noted in a research article on low back pain in golfers, “Core stability is a fluid continuous motion among many parts. If one part is not functioning properly, the entire motion is compromised biomechanically” (Finn et al. 2013). This “compromised” motion could be contributing to that nagging low back pain.
Dial in your breathing: This helps to stabilize the core, as well as calm down your body so you can swing and putt for birdie!
Weight loss: Higher body weight has also been found to be correlated with greater incidences of low back pain in both golfers and the general population. While walking the golf course may not be as fun or fast as riding in the cart, it is a great way to burn some extra calories.
Come work with Made 2 Move
A 2013 article notes, “Rehabilitation and prevention efforts must focus on movement pattern and muscle imbalance correction as well as technical swing changes” (Finn et al. 2013). While Made 2 Move is not a team of golf pros, we know a few stellar ones that we collaborate with to ensure a well rounded rehab process. At Made 2 Move, our PTs take a multifaceted approach in assessing and treating your low back pain, utilizing the above methods, to get you back to playing 18 (or 36) pain free holes. Reach out to firstname.lastname@example.org today to set up your initial evaluation!