Lower back pain (LBP) is the most common injury for golfers as 34.5 % of all golfing injuries involve the lumbar spine. It is important to understand the golf swing in order to identify the cause of injury and provide optimum treatment. Most injuries occur due to the impact of the golf club and the follow-through phase. Follow-through phase promotes lumber extension and eccentric contraction of abdominals in order to generate force and rotation; this places increased pressure on the spine and intervertebral discs (Finn et. Al 2013). Hosea et. al found that the compressive load during a golf swing was considerably higher in professionals than amateur golfers, with a difference of 7584 N versus 6100 N. The compressive load in a professional golf swing is equivalent to 8 times body weight (Dale and Brumitt, 2015). It is important to compare this to cadaveric studies which have shown disc prolapses to occur at 5,500 N; this highlights that the golf swing (in both amateur and professional golfers) is able to generate enough force to injure the lumbar spine (Lindsay and Vandervoot,2014).
The golf swing is repetitive, asymmetric in nature and dependent on the dominant hand; this can determine the location and severity of LBP. For example, in a right-handed golfer, the right- sided external obliques, paraspinal muscles and abdominals take the most impact and therefore the right lumbar region is most commonly injured. Also, the end position of the golf swing is called reverse C position which promotes lumbar extension and increases the risk of facet irritation. In more severe cases, spondylosis and discogenic back pain can occur from poor technique and severe muscle imbalances. (Finn et. Al 2013)
It is important to focus on muscle imbalances, thoracic and lumbar mobility and technique to prevent and recover from LBP. From analysing the swing mechanics, core stability exercises are essential in LBP rehabilitation (Evans and Oldreive,2013). Horton et al. found a delay in muscle activation in abdominal muscle for golfers with LBP, especially the lead external oblique during back swings; this further highlights the importance of core strength and endurance in protecting lumbar spine. (Horton et. Al 2001). Hip stabilisation and mobility is equally important to aid trunk rotation and lumbar stability. Vad et. al demonstrated that reduced lead hip rotation (internal and external) and lumbar spinae extension were found in golfers with LBP; this may be due to decreased hip rotation in the leading lower limb causing more force to be directed into the spine (Vad et. al 2004). Therefore, ensuring glute strengthening exercises in rehabilitation are key to provide a base of support for trunk rotation. (Finn et. Al 2013)
Reference List
-
Dale, R.B. and Brumitt, J. (2016). Spine biomechanics associated with the shortened, modern one-plane golf swing. Sports Biomechanics, 15(2), pp.198–206. doi:https://doi.org/10.1080/14763141.2016.1159723.
-
Evans, C. and Oldreive, W. (2000). A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance of Transversus Abdominis. Journal of Manual & Manipulative Therapy, 8(4), pp.162–174. doi:https://doi.org/10.1179/jmt.2000.8.4.162.
-
Finn, C. (2013). Rehabilitation of Low Back Pain in Golfers. Sports Health: A Multidisciplinary Approach, 5(4), pp.313–319. doi:https://doi.org/10.1177/1941738113479893.
-
HORTON, J.F., LINDSAY, D.M. and MACINTOSH, B.R. (2001). Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise, 33(10), pp.1647–1654. doi:https://doi.org/10.1097/00005768-200110000-00006.
- Lindsay, D. and A. Vandervoort, A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine, 5(4). doi:https://doi.org/10.5812/asjsm.24289.
-
Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D. and Andrews, J.R. (2004). Low Back Pain in Professional Golfers. The American Journal of Sports Medicine, 32(2), pp.494–497. doi:https://doi.org/10.1177/0363546503261729.
