Reducing Low Back Injuries in Golfers
By: Sandra Gomes, PT, DPT
As we kiss winter goodbye and store away our shovels and snow boots, we welcome in the spring. Many will be pleased with the disappearance of snow, others the welcoming of flowers, but one thing that many people have been looking forward to the most, is dusting off their clubs and playing some golf. Golf is a phenomenal sport packed with strength conditioning, coordination, cardiovascular benefits, and much more. However, despite its boost to our morale and health, golfing may also come with its fair share of athletic injuries.
As seen within most avid golfers, the greatest swings require skill and precision with rotation of the spine, upper and lower extremities, proper weight shifting and follow through. Many professional and skilled golfers are able to achieve all of these components in one fell swoop and make it look smooth and easy. However, even the most skilled of golfers are at risk for injury if all of these components are poorly executed or overused.
Golf injuries are typically associated with: overuse, poor swing mechanics, improper gripping mechanics, lack of proper warm up or cool down, excessive rotational stress placed on the extremities and spine, and overall strain placed on the musculoskeletal system with powerful swings and poor postural deviations or stability. Most golf injuries include but are not limited to: rotator cuff injuries of the shoulder, medial or lateral epicondylitis or golfer’s and tennis elbow, wrist and hand arthritis, hip strains, knee arthritis, and ankle sprains. However, the most commonly reported source of pain amongst golfers is typically attributed to low back pain.
Lumbar spine pain associated with golf play can result from a number of different reasons including poor postural patterns and compensations, stress from repetitive motion and overuse, and weakness in key stabilizing muscles. During play, golfers can be found in a flexed or bent position for several hours. Prolonged thoracic and lumbar flexion, hip flexion and knee flexion; coupled with spinal rotation and side bending during hundreds of repetitive swings, can disrupt the arthrokinematics of the vertebrae, disrupt vertebral discs, and cause surrounding muscle imbalances. Constant lumbar and thoracic flexion can cause increased opening along the vertebrae and increased pressure along the disc spaces, resulting in bulging or herniation of the annulus fibrosus or nucleus pulposus, the outer and inner portions of the disc. As a result, golfers will commonly find that they have sharp pain along the low back with extended positions and some will suffer with associated nerve pain that may radiate from the low back into the leg. Not only can you increase your risk of developing degenerative disc or herniated disc conditions along the lower spine, you can also cause muscle imbalances among the lower chain of the body.
Our key core stabilizing muscles are our abdominal muscles, pelvic floor muscles, the diaphragm and the multifidi of the spinal segments. Poor strength and activation of these key muscles will result in previously mentioned low back injuries due to lack of stability. Additionally, increased flexion patterns along the hip and knee will lead to tightness and overactivation of the iliopsoas, quadriceps and hamstring muscles. Myofascial restrictions along these large lower extremity muscle groups can lead to weakness along the gluteus maximus, medius and minimus muscles as well as weakness along the abdominal muscles. Most of these muscle imbalances can be associated with lower crossed syndrome which typically leads to tightness along the erector spinae muscle group and hip flexors with notable weakness along the gluteus and abdominal muscles.
Strength and proper activation of the abdominal and gluteal muscles can help to reduce the risk of low back injury. Additionally, proper stretching of the iliopsoas, quadriceps, hamstrings, calf and erector spinae muscles can help to increase activation of the key stabilizers by reducing the state of the muscles in a lengthened position and increasing muscle shortening for improved activation. Though activation of the abdominal and gluteal muscles leads us to a position of increased lumbar flexion, via inducing a posterior pelvic tilt, they help to provide stability of the vertebral discs and spinal segments while the spine is flexed, reducing the overall risk of low back injuries.
Therefore, the aforementioned information requires that as golfers, we work on strengthening key stabilizing muscles, reducing prolonged time spent in a bent and rotated posture, and improve overall flexibility in the back and lower extremity muscles. How do we achieve this? We can begin with proper stretching warm ups and cool downs, as well as establishing frequent breaks in between swings. Strengthening of key abdominal muscles, namely the transversus abdominis, and the gluteal muscles can be achieved via carefully designed exercise programs. Some such exercises may include bridges, clamshells, abdominal crunches, planks, etc. Typically, golfers can seek guided exercise assistance via physical therapy, by which movement specialists can assist with proper strengthening for lumbar spine stability and can train individuals on how to achieve optimal golf swing mechanics. With proper posture, strength, stability and flexibility in place, physical therapists can help to break down swing components and train golfers to execute powerful but safe swings with reduced chances of low back injuries.