Golf is a highly skillful and patient sport, yet requires a high demand on the athlete’s body. A majority of golfers, from weekend warriors to professional, have experienced some form of back pain. Due to the explosive rotational movement of the golf swing, there is a significant amount of stress placed on the body, particularly the spine. Golfers also spend a considerable amount of time in a forward bent position while putting, adding stress to the back. Combine all of the stress along with hundreds of repetitive motions, and it is not a surprise that back pain is the number one injury sustained by golfers. Injuries to the back can range from acute muscular strains to chronic low back pain caused by a disc bulge. In order to prevent back injuries from golfing, it is important to have a strong and stable core to protect the spine, adequate strength and endurance of the back muscles, optimal movement patterns during the golf swing, and good mobility in the thoracic spine, lumbar spine, and hips.
COMMON GOLF-RELATED LOW BACK INJURIES
Muscle strains are the most common types of back injuries in golf. Muscle strains occur when the muscle tissue is overstretched during a movement and causes micro-tears in the muscle fibers. This could be caused by inadequate warm-ups, stiffness, over-exertion, or fatigue of the muscle. Depending on the severity of the strain, healing times range from a couple days of rest to inactivity for weeks. In the event of an acute muscle strain of the back, the best treatment is to allow the muscle to rest and use cold packs to reduce inflammation. The best ways to prevent muscle strains are to stretch and warm up before playing golf, rest when your muscles feel tired, and exercise regularly to maintain a strong and healthy back.
Disc injuries are fairly common in golf and usually caused during the golf swing. There is a great deal of rotational stress from the golf swing at the L5/S1 junction. When the deep core muscles (Transverse Abdominus and Multifidus) are not properly activated during dynamic movements, there is a greater incidence of a disc injury. Also, when there is poor mobility in the thoracic spine and the hips, compensation of the low back occurs and can lead to an injury such as a herniated disc. These types of injuries are more severe than a muscle strain and may take weeks to months to resolve. The best ways to prevent disc injuries are to maintain a strong core, proper swing mechanics, and adequate mobility of the thoracic spine and hips.
PREVENTION of BACK PAIN for GOLFERS
Hip flexor stretch – When the hip flexor is tight, it pulls the pelvis forward into an anterior tilt and places additional stress on the lower back. Perform the hip flexor stretch for better alignment of your back by going into a 1/2 kneeling position, then tuck your pelvis downward into a posterior tilt and lean forward. The stretch should be felt on the along the front of the hip and thigh of the knee that is touching the floor. Hold for 30 seconds ad perform 2-3x each side.
Thoracic spine (T/S) rotation is an absolute must during the golf swing. The inadequate mobility of the T/S will result in compensations in the lower back and may lead to injury. To improve T/S rotation, start off in the quadruped position on your hands and knees. Place one hand behind your head, and then rotate to one side, starting with your neck followed by your T/S. Inhale and Exhale at the end range for additional rotation. Hold at the end range for 5 seconds and perform on each side 3-5 times.
Perform the 3-way prayer stretch to loosen up your low back muscles. Starting in a quadruped position, kneel your butt down onto your heels while reaching forward with your hands. The stretch will be felt in your lower back or your lats if they are tight as well. Place both hands on your right side and kneel back to focus the stretch on your left side and vice versa. Hold each position for 15-30 seconds and perform each one 3 times.
World’s greatest stretch is a great one to work on T/S mobility and hip mobility at the same time. To perform this stretch, first go into a long lunge position, then place the opposite hand on the ground next to the front leg, then rotate your back and hip toward the front leg until the rotational arm is facing straight towards the sky. Hold this position for 5 seconds, perform on both sides 5-10 times.
The piriformis muscle is a rotator of the hip, which often becomes tight during golfing. There are many ways to stretch this muscle out, one is to place your leg on a surface that is lower than waist height. The leg should be externally rotated with your shin bone completely horizontal on the surface. Then hinge from the hip forward and you will feel a stretch deep inside your buttock. Hold a comfortable stretch for 30 seconds and perform 3x on each leg.
The lunge and twist with a resistance band is a great warm up exercise to start off with and activate the rotator muscles in your back. First while holding a resistance band with both hands, perform a lunge. Then with the same arm with the leg in front, open up and rotate your torso until the arm is completely behind you. The opposite arm should be holding the band and not be moving. Perform 10-15 repetitions on both sides.
Bridges are a great way to warm up and fire your gluteal muscles. To perform this exercise, lay on your back on the floor in a hook-lying position (knees bent, feet on floor). Then activate your deep core and lower abdominal muscles, squeeze your buttocks together and drive your hip up towards the sky. Perform 3 sets of 12 repetitions. If this exercise is too easy, challenge yourself with single legged bridges by holding one leg up towards the sky while the other leg drives your hips up. The single leg glute bridge is a good exercise for hip stability and gluteal strength.
Core exercises are vital to strengthening your core and protecting your back during dynamic activities such as golf. A good exercise to engage your core muscles is called the dead bug. Start off on your back with your low back flat against the ground and your deep lower abdominals engaged. The starting position is with both knees at a 90/90 degree position and arms straight up towards the sky. While maintaining your core activation, slowly straighten out one leg and lower it to the ground along with the opposite arm. If you feel your back losing the pressure on the floor and starting to round up, then you are lowering your leg/arm too far. Perform 3 sets of 10-12 repetitions.
Medicine ball rotational throws is a very effective exercise to build rotational explosive power to improve your golf swing. This is a high-intensity exercise requiring a good amount of power from your back and hips, as well as core stability. Start off in a 1/2 kneeling position with a light medicine ball. The leg in the front should be closest to the wall. With both hands holding onto the medicine ball, start rotating away from the wall to wind up your throw. Then rotate your upper back and hips simultaneously and releasing the ball after it crosses over your front leg to perform the throw. Perform 3 sets of 6-8 repetitions on each side to maximize your rotational power.
Another simple yet effective exercise for improving rotational power is the cable twist exercise. Place the cable height at the lowest setting near the ground and set the weight that is fairly light, to begin with. In a split high lunge stance, hold onto the handle with the same arm as the front leg. Then in a fast and controlled motion, pull the cable back while rotating towards the front leg. There should not be a lot of rotational movement in this exercise. Perform 3 sets of 8-10 repetitions.
If you have sustained an injury playing golf, participation should be stopped until you have been assessed by a qualified health professional. Minor injuries such as a pulled back may only require rest, ice, and time to heal up. More serious injuries may require an extended period of rest and rehabilitation. Physical therapists are highly trained to assess and treat all ranges sports injuries, improve overall function, and help the athlete return to their sport(s) without limitation. Contact NAKOA to speak to a physical therapist or schedule and evaluation.
Another newbie gem to the NAKOA Physical Therapy Team is Jon Luu. Born and raised in San Jose, CA, Jon has been an active kid since day one playing all sorts of sports from organized team sports like basketball and volleyball to individual hobbies like skateboarding and snowboarding. Like many athletes, Jon’s time playing sports throughout high school and college led him to sustain injuries of his own which is what sparked his initial passion for physical therapy. His own positive experience with dedicated physical therapists that helped him rehab, recover, and return to the game motivated him to pursue a career in physical therapy, to help other people overcome their injuries and return to doing what they love most.
Jon earned his Bachelor of Science in Kinesiology from San Jose State University and his Doctorate of Physical Therapy from The University of St. Augustine. Jon utilizes a comprehensive and individualized approach for patient care; combining the use of:
His goal is not just to treat patients, but to educate and help people understand the cause of their injuries so that they can better overcome their obstacles, improve overall wellness, and prevent future injury. Outside of the clinic, Jon can be found playing beach volleyball, watching sports, going camping and off-roading, and spending time with family and friends.