Golf often has the reputation of being a low intensity sport which places little stress upon the body. Those who play golf will tell you that is far from the case. As an avid golfer myself and Physical Therapist, I can testify that golf is a demanding sport on the body and golf health is something that is important to address for anyone who plans to pursue the lifelong game. The most common golf-related injury is low back pain (LBP) with 15-35% of amateurs and 55% of professionals experiencing LBP at some point in their lifetime [1] . With such an overwhelming number of golfers experiencing LBP, it is important to distinguish the facts vs the fiction of golf related LBP.
Golf related low back pain can be seen across multiple demographics making it difficult to reduce the causes of LBP to one or two factors. With such a large and diversified population in the golf community, there are dozens of theories regarding the causes of golf-related LBP. First, we will address these theories and use research to see what we actually know regarding golf-related low back pain.
- Golf injuries are a result of one bad golf swing.
False, the majority of golf injuries are actually overuse injuries [1]. This is amplified as a result of the golf swing being an asymmetrical, repetitive activity. Even for low handicap golfers, we are still looking at close to 34 full swings per round and that does not include swings on the range beforehand.
- Low back pain is more prevalent in those who carry their bags.
True, research does show a higher prevalence in low back pain for those who carry vs those who do not [1]. This does not mean I am advocating everyone should ride in a cart; a push-cart is a great alternative to get the benefit of walking and to reduce the load on the spine that a golf bag adds.
- BMI (Body Mass Index) plays no factor in the occurrence of low back pain while golfing.
False, research shows that in amateur golfers, there is a correlation between high BMI and LBP in golfers [1]. Hypotheses for this include that at higher BMIs there is increased spinal loading during the golf swing, highlighting the importance of staying in shape leading up to and throughout the golf season.
- A weak core is responsible for low back pain with golfing.
Mixed. Research has shown that muscle weaknesses are correlated with golfer’s with low back pain but the areas to address may surprise you. When we usually think of our “core” we think of our abdominals, studies found no significant difference in trunk rotation strength (oblique strength) between golfer’s with and without LBP[3]. Another muscle group largely responsible for the core is our glutes, studies found that there was also no significant difference in hip extension strength (glute strength) between golfers with and without LBP [3]. Instead, the research did support that weakness in the trunk extensors (lumbar erector muscles) in the address position and weakness in lead hip adduction (groin muscle; responsible for squeezing our legs together) were associated in golfers with LBP compared to golfer’s without [3].
- Low back pain is a result of practice/playing frequency.
Mixed. From our most up to date systematic review, the research found two studies to support a decreased rate in low back in golfer’s who practiced less than an hour of full swing practice per week, as well as an increase in spinal pain with increases in rounds played and practice hours per week. On the contrary, multiple other studies in this review found no correlation in practice frequency (full shot and chipping) and those with and without low back pain[1]. The one thing to consider with these findings is the golfer’s level of conditioning compared to the frequency of practice/play. Let’s use the analogy of running, if you went on a run for the first time in a few months, it is highly discouraged to run a 10k for your first run. This approach should also be taken with golf, at the start of the season, start with shorter practices and less swings and progress practice time and number of swings per week as your body gets more conditioned over the course of the season.
I hope after reading this blog, readers will have a better understanding about what we know, as well as what we are still trying to understand in regards to golfing and low back pain. The next step from here is to understand how we can apply this information. While golf is considered a low intensity sport, we are performing a high velocity activity for multiple repetitions over a round of golf. In order to prepare our body for the golf season, we should spend time in the offseason training with a research backed program in order to reduce the occurrence of low back pain and to prevent having to take time off during the season. At FX Physical Therapy we aim to keep golfer’s going all season with our preseason and in-season golf therapy. Our program consists of progressive mobility and strength exercises, as well as swing analysis and interpretation using our K-vest and in-house golf simulator. Let FX Physical Therapy help you play your best season of golf this year by setting up an appointment!
References:
1. Smith JA, Hawkins A, Grant-Beuttler M, Beuttler R, Lee SP. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Sports Health: A Multidisciplinary Approach. 2018;10(6):538-546. doi:https://doi.org/10.1177/1941738118795425
2. Tsai YS, Sell TC, Smoliga JM, Myers JB, Learman KE, Lephart SM. A Comparison of Physical Characteristics and Swing Mechanics Between Golfers With and Without a History of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy. 2010;40(7):430-438. doi: https://doi.org/10.2519/jospt.2010.3152
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