Of the estimated 25 million golfers in America, up to 62% may suffer an injury while participating in golf. Back injuries are the most common injury in professional and amateur golfers, second to the bending and twisting of the golf swing creating considerable stress to the lumbar spine.
The mechanism of injury is related to the golf swing, with the associated large shear, lateral bending, torsional and compression loads affecting the lumbar spine. During the golf swing, the lumbar spine is subjected to forces of lateral bending, anteroposterior shearing, caudocranial compression, and rotation.
Some of the forces produced on the low back during the golf swing motion are double the safety standards set by occupational health experts for industrial workers. While the forces or loading of the spine occur in both amateur and professional golfers, amateurs generate 80% greater lateral bending and peak shear loads and 50% more torque than professionals due to poor swing mechanics.
The resulting increased loads may predispose amateur golfers to muscle strains, herniated intravertibral discs, and facet arthropathy of the spine. Studies have shown that the loads required to cause disk disruption are similar to those present to a golf swing. Research has also shown that the trail side (right side of a right handed player) of the lower back is more likely to be injured.
Golf associated spinal injuries can be described as mechanical, discogenic, spondylogenic, or related to facet arthritis. Mechanical Injuries Mechanical injuries, which include muscle strains or muscle spasms, typically occur with rough or forceful swings or reverse weight transfer during the downswing. Discogenic Back Pain Discogenic back pain generally refers to disorders of the intervertebral disk, which results in nerve root irritation and may also include a disk herniation or ruptured disk. This injury is exacerbated by sitting, coughing and sneezing and may be accompained with the sciatic leg pain associated with a herniated disk when sitting. Discogenic injury is usually a result of poor swing mechanics. Spondylolytic Back Pain Spondylolytic back pain is a stress related injury to the pars interarticularis in which the pain is localized lateral to the midline and may be exacerbated with hyperextension or bending backwards. It is caused by repetitive loading of the lumbar spine during the golf swing. Facet Arthritis Facet joint arthritis may be the result of aging and minor trauma. The forces primarily responsible for these degenerative changes include rotation and compression. Physical examination will reveal a loss of the normal lumbar lordosis or curvature with a loss of motion. In advanced cases the corresponding nerve root may be impinged resulting in sciatica or leg pain. The pain is relieved by sitting, which opens up the space surrounding the nerve as opposed to the pain of the herniated disk, which is worsened by sitting.
Less Common Injuries: Vertebral Compression Fractures and Rib Stress Fractures In addition to the common injuries of strains, sprains and disc injuries, golfers may also be susceptible to less common injuries such as vertebral compression fractures and rib stress fractures. Vertebral compression fracture, are more common in elderly golfers with osteoporosis. During the golf swing, the lumbar spine undergoes a compression load about eight times a person’s body weight. Such a compressive load is enough to cause vertebral compression fractures in osteoporotic spines. Golfers can also suffer thoracic back pain from stress fractures of the ribs. Weakness in the serratus anterior muscle on the leading side is believed to cause muscle fatigue that eventually leads to stress fracture occuring most commonly on the posterolateral aspect of the fourth to sixth ribs.
Treatment of acute back injury may involve the use of anti-inflammatories and/or muscle relaxants. Additionally treatment with palative measures may be helpful for a low back strain or sprain caused in the course of golfing. Golfers with chronic back pain, require specific therapeutic exercise program, with the goal of developing increased muscle strength and flexibility. SportExcel Health and Human Performance through its Golf Program features computerized MedX protocols, body stabilization, and back and hip flexibility exercises.
Prevention of further spinal injury can be accomplished by improvement of swing mechanics and by increasing the fitness level of the individual. Studies have indicated that the fitness levels of the individual will dictate the risk of back injury. Individuals with a lower activity level tend to have reduced strength of the trunk muscles resulting in higher incidence of back injury. The most accepted preventative course of action is strengthening the paraspinal and abdominal muscles including the external obliques. Increased flexibility and a thorough warm-up prior to hitting balls is critical.
The strain on the lumbar spine due to loading may be reduced by adjusting the golf swing in either of the following ways:
1) reduce the amount of rotation by shortening the backswing or increasing the hip rotation, thereby reducing the amount of difference between the shoulders and hips.
2) improve flexibility of the hips and chest decreases the stress to the lumbar spine.
3) avoid the reversed ‘C’ at completion of the follow through.
When excessive flexion of the back as well as lateral bending with rotation through the back swing is avoided when addressing the ball, a reduction of lower back injuries may result. Reduced flexion can be accomplished by shortening the backswing, increasing hip rotation and avoiding lateral bending. SportExcel Golf Professionals have also identified several equipment related causes due to mal-fitted golf clubs.
In conclusion, like any other sport, golf can produce injuries. If the pain continues for more than two to six weeks, a specific and definable problem may be the cause of pain and a medical professional should be consulted. As with so many health conditions, a little effort to prevent back injury goes a long way.
Four key areas of prevention are:
1. Warm-up
2. Swing mechanics
3. Proper physical conditioning
4. Proper equipment
A Sports Medicine Physician, Sports Physical Therapist, PGA/LPGA Instructor, and Certified Golf Equipment Specialist should evaluate each area to help create a back safe swing, and in turn improve your game.
Provided by
