Did you know that low back pain is THE most common ailment suffered by golfers of all ages in both amateurs and professionals?
However, the lower back is rarely the original cause of the pain, more often than not, it is a symptom of a muscular imbalance. The lumbar spine is usually the area that is being overworked to the point of injury.
In many cases, the lack of mobility seen in the ankles, hips, thoracic spine and shoulders of many golfers forces the lower back to carry excessive load and is the primary cause for most back injuries.
Typically we see one of the following injuries occur:
- Muscle Strain or Ligamentous Sprain – A muscle strain or “pulled muscle” as well as an injured ligament will usually resolve itself in 2-4 weeks with old rest and recovery. However, there can be some residual muscle stiffness, fascial restrictions, joint fixations or movement alterations that may need to be addressed afterwards. Sprains or strains are the most common form of lower back injury. Symptoms may range from a minor ache to a sharp debilitating pain. Most sprains and strains are localized in the lower back region, meaning pain does not radiate into the glute or leg. The chemical inflammation around the injury is usually sore to the touch and the pain usually subsides with rest.
- Disc Injury – The lumbar intervertebral disc acts as a spacer between adjacent vertebrae to help absorb compressive forces and create space for the spinal nerves to exit the spinal column. Imagine the disc as a jelly filled donut. If excessive or abnormal stressors are placed on the disc, tears can occur. When this happens, the force of the jelly against that tear can cause a bulge in a portion of the donut leading to a “bulged disc.” In more severe cases, the jelly can actually exit through the donut wall leading to a “ruptured disc.” The discs are also susceptible to degenerative changes over time. To continue the analogy, imagine the jelly inside of the donut drying up. Any of these disc problems can leave the spinal nerves vulnerable to irritation or compression resulting in dysfunction and pain. Most disc pathologies create radiating pain into the glutes or the leg (think sciatica) due to the irritation of spinal nerves. Sitting for prolonged periods of time, bending forward into a slouched position, or lifting heavy objects can all exacerbate disc symptoms.
- Altered Joint Mechanics or Motor Control – Interestingly, the brain can completely change the lumbar spine’s ability to move just by changing which muscles are firing or by altering the sequence of when muscles fire. This can occur in the absence of any visible injury. These altered motor control or joint mechanics can begin as a protective mechanism, but can lead to chronic problems over time. Most experts believe over 80% of all chronic lower back problems begin this way.
- Degenerative Arthritis – Just like all joints, with over-use, abuse, or even lack of use, spinal joints can become arthritic. Bone spurs and osteophytes act like stalactites and stalagmites inside a cave closing in on the opening for the spinal nerves. With time, these bony outgrowths can fuse joints, irritate nerves and create general inflammation in the area. Stenosis, the narrowing of the canal or cave that houses the spinal nerves is a very common problem with arthritic changes. Most arthritic problems in the spine create sharp pain with certain movements. The resulting inflammation can then cause chronic dull pain over time.
- Bone Fracture – Stress fractures and pedicle fractures (spondylolysis) are common problems seen in the lumbar spines of rotational athletes. This occurs due to the rapid extension and rotation of the spine, causing adjacent vertebrae to collide into each other at their end range of motion. This action places high forces on the posterior portions of the vertebrae and can lead to these types of fractures. Injuries of this sort can lead to deep dull pain and instability in the spine.
Creating optimal movement patterns to avoid low back pain
To avoid low back pain we need to create optimal movement patterns in the areas directly above and below the lumbar spine – the hips and thoracic spine. The golf swing requires great rotational mobility to develop and transfer energy to the club. That mobility should come from the joints in the body that are designed to rotate, the hips and the thoracic spine. If the lower back is forced to be a primary rotator due to a lack of hip and thoracic mobility, it’s only a matter of time before an injury will occur.
Remember! The hips and thoracic spine do not operate in isolation : Abnormal motion in the ankle can cause poor hip motor control. And poor motion in the shoulder can cause poor thoracic spine motor control. Therefore, we can’t neglect the ankle or shoulder joints in our assessments.
To understand why a player has lower back pain, we first evaluate the movement patterns of all the surrounding areas. At Elite Performance Therapy, we use a combination of a TPI assessment screen and Functional Movement Assessment to identify any of these altered movement patterns and make a true starting diagnosis. Once the dysfunction has been identified, we can address each mobility restriction and then create the stability required to normalize motor control. When the areas above and below the lumbar spine are functioning properly, the lumbar spine can gain some much-needed rest. Once normal movement patterns are optimized, a solid conditioning program is the best form of prevention.
The 3 most common swing mechanics that can cause low back pain
When it comes to optimizing swing mechanics, it is easy to see how some common swing characteristics can induce abnormal stressors into the lower back.
Reverse Spine Angle
The most common characteristic is Reverse Spine Angle (RSA). This is usually caused by a lack of mobility in the hips and thoracic spine causing the lumbar spine to extend excessively in order to pick up some much needed range of motion. Because RSA puts excessive extension in the spine at the top of the backswing, the player must excessively flex and right side bend to get back to impact. This movement has been proven to add significant stress to the lumbar spine.
The second most common swing characteristics that can lead to low back pain is called S-Posture. This is typically a set-up problem and begins before the players even takes the club back. S-Posture places the lumbar spine into Lower Crossed Syndrome Pattern (LCSP). This is an extremely common postural adaptation to muscle imbalances created by prolonged static positions, like sitting at a desk for hours. With LCSP the abdominal and gluteal muscles become weak due to tightness in the hip flexors and lower back. Due to this imbalance in the muscles surrounding the lumbar spine, excessive stress is placed on the structures of the lower back.
The third most common swing characteristic that can lead to low back pain is called Hanging Back. Hanging Back can force a player to excessively right side bend through impact. This can put added stress onto the right side of the lumbar spine and lead to low back injuries. Some players hang back or right side bend in an attempt to open the clubface through impact. The is a very common compensation for a closed clubface in the golf swing. Additionally, many players with low back pain can become tentative in their swing and may exacerbate the problem by npt properly shifting their weight forward in the downswing, hanging back instead.
How Elite Performance Therapy can help your low back pain!
Here at Elite Performance Therapy, we work with both amateurs and professionals. Whether it is to win your next bounce game, lower your handicap, secure the club championship, progress through the various professional tours or simply to enjoy golf without pain, we can help.
At Elite Performance Therapy we understand you would like that extra 15 yards on your irons and want to be comfortable taking repetitive swings without body aches and pains during or after a day of golf.
You’ve worked hard on the mechanics of your game, your swing, and your approach. But have you worked hard on the motor behind it all?!