Golf and Low Back Pain: How Physical Therapy Can Help
Updated: May 24
Golf is an immensely complex sport that requires a copious amount of skill, technique, and precision. Like many other sports, strength, and power is also a requisite for success if you are hoping to play at any moderate to high level. With that being said, training for golf can be extremely demanding on the body due to the high volume of golf balls hit per week in a repetitive movement, and at high intensity. These repetitive high-intensity movements can lead to stress overuse injuries if you do not train and rehab properly.1,4 With that in mind, let’s first take a look at the golf swing and the demands it requires of the body.
The golf swing can be broken down into many different parts, but for this instance, I want to focus on the swing's main sequencing, including the backswing, forward swing, acceleration, and follow-through. During the backswing, the pelvis, thoracic spine, and shoulder primarily rotate to bring the club to about parallel with the ground above the shoulders. The backswing creates a large amount of torque on the body in preparation for the forward swing. The forward swing is initiated at the hips and is then followed up with thoracic and shoulder turn in a proximal to distal movement creating large amounts of stretch on the torso and in turn more power.2 As the swing progresses towards the impact of the golf ball, there is more activation throughout the wrist and forearm musculature throughout the acceleration phase.2 After impact the club finally surpasses the body's rotational speed and the body continues to turn on the front side leg until eventually facing the target. Now this post is not to break down the swing in extreme detail, but at least to give more novice golfers an idea of the complex nature of the swing and the high demands it can place on the body.
Let's now discuss common injuries seen in golfers of all levels. As previously mentioned, the repetitive high-intensity demand of the golf swing often leads to chronic overuse injuries.1 Acute injuries are also seen in golfers but at a lower incidence rate. Due to the large amounts of asymmetric torque placed on the spine during the golf swing, the low back is the most common site of injury seen in golfers with a prevalence as high as 55% in professional-level players.1,3,4 Other common injury sites include the shoulder, elbow, and wrist of the upper body, and the knee and ankle of the lower body.1 As physical therapists, this is where we step in to identify and discern different impairments and limitations to either prevent injury or manage an injury after it has occurred.
Being the low back is the most common injury site in golfers, let's discuss the primary methods we address at AFI to reduce the incidence of low back pain in our patients. The spine needs an adequate amount of both mobility and stability to complete a full swing. With that in mind, addressing core strength and stability is often the first aspect we address with our golfers. The core is not just the rectus abdominis (the 6 pack muscles) either, it includes the lumbar multifidus and the erector spinae muscles on the back and the internal oblique, external oblique, and the transversus abdominus on the front. All of these core stabilizing muscles need to be working synergistically to stabilize the spine throughout the golf swing. Three entry-level exercises we use to activate and strengthen the core: Prone Plank, Bird Dog, and Pallof Press.
Now there are many ways to progress these exercises but understanding these foundational exercises, and being able to master them with correct form, sets up our golfing athletes for success with higher-level interventions. On the other side of the spectrum is spinal mobility. In order to generate a large shoulder turn during the backswing the lumbar and thoracic spine need to be able to rotate above the pelvis and hips. Two exercises we often use to improve this mobility are the thread the needle exercise and open book. They incorporate not only thoracic and lumbar mobility but also shoulder mobility, which is also required during the golf swing. Below are videos of the above-mentioned exercises previously discussed. Give these a try and see if they help decrease any low back symptoms you may be experiencing.
1. 1.Zouzias IC, Hendra J, Stodelle J, Limpisvasti O. Golf Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2018;26(4):116-123. doi:https://doi.org/10.5435/jaaos-d-15-00433
2. 1.Cole MH, Grimshaw PN. The Biomechanics of the Modern Golf Swing: Implications for Lower Back Injuries. Sports Medicine. 2015;46(3):339-351. doi:https://doi.org/10.1007/s40279-015-0429-1
3. 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
4. 1.Edwards N, Dickin C, Wang H. Low back pain and golf: A review of biomechanical risk factors. Sports Medicine and Health Science. 2020;2(1):10-18. doi:https://doi.org/10.1016/j.smhs.2020.03.002