Low back pain is the most common musculoskeletal reason that golfers stop playing. It has been estimated that up to one third of golfers have limited play due to low back pain. In the amateur golfer, the most common causes are poor conditioning and poor swing mechanics, while in the elite golfer it usually relates more to overuse. The golf swing creates significant loads on the spine. It has been estimated that the forces seen on the spine during the golf swing reach the same level as a football lineman hitting a practice sled at full force. With that being said, even a normal spine under these types of loads can breakdown. In addition, unlike other sports, this is one sport that you tend to play more as you age. The following are some tips to minimize the chance of you injuring your lower back during golf:
- Get some proper instruction in the classic type of swing. In general, the biomechanics of the classic swing are better for your back than the modern swing. In the classic swing the hips and shoulders rotate together and there is less lateral bending at impact. In contrast, the modern swing stresses limited hip and pelvis rotation on the back swing, and the initiation of the downswing is with the hips while the shoulders and torso are still in a loaded position. The increased adoption of the modern swing may be one of the main reasons we are seeing an increase in the number of golfers with low back pain.
- Don’t wait to golf season to try to get in shape. There are plenty of things you can do to get in shape for golf season. In general, there are 3 types of exercises players can do on a regular basis to help achieve pain-free golf. The first is aerobic exercise. The goal should be 30 minutes at least three days per week of walking at a vigorous pace, biking, or swimming. This should be coupled with the second and third category of exercise, stretching and strengthening. Studies have shown that golfers who loose hip rotation stress their spines more, so concentrating on stretches for your hip rotators should be a priority. In addition, strengthening of your leg and core muscles will give you a stable foundation from which to make a strong swing while protecting your spine. Often, a visit with a physical therapist or an athletic trainer with expertise in golf-specific exercises is a worthwhile investment of your time.
- Don’t over-practice your long clubs. When you get to the range, don’t start your practice activities with your driver. Start slowly with some chips and pitches, and then work your way up the bag to finish with a few drives. If you over-practice your short game and under-practice your long game, you lower your risk of injuring your back and will most likely decrease your handicap at the same time.
- Don’t over-swing. While we are all tempted to swing for the fences and try to hit a 300-yard drive, most of us are unable to despite our best efforts. Come to grips with that fact and play within your physical capabilities. You will lower your risk of injury, extend your playing life, and most likely hit a better shot.
- Moderate your play to your level of fitness and skill level. Don’t start your season playing 36 holes two days in a row. As you fatigue, your chances of injury increase. If you haven’t played all winter, start your spring golf season with a few holes and work your playing time up gradually. Before you know it, you will have developed enough stamina both physically and more important mentally to play a nice 18 hole round. Plus your spouse won’t know you are missing as much.
- If you have pain stop playing and get it evaluated. If you experience a new pain of moderate to severe intensity, recognize that something is wrong. No pain, no gain is not the correct attitude here. See a sports physiatrist (rehabilitation physician) and let them evaluate you to see what the problem is and how best to not only treat, but also to prevent recurrent episodes. In general, early intervention is a lot easier than trying to treat a condition that is a result of repetitive injury. Many times a personalized rehabilitation program of specific exercises to address some of your deficiencies is all that is needed to return to sports and enjoy this wonderful game.
Dr. Gregory E. Lutz is currently the Physiatrist-in-Chief Emeritus for Hospital for Special Surgery and is a member of the board of trustees. He is also the consulting physician to the National Hockey League Players Association. Dr. Lutz established the Physiatry Department at HSS in 1997 and also established the Physiatry Spine & Sports Medicine Fellowship and has mentored over 50 fellows in practice throughout the USA.
