Lower back pain

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Why do I have low back pain with golf? (And what can I do about it?)



Golf is a simple game, right? You have this stationary ball on a tee that you hit with a club that’s two to three times its size. What can go wrong?

Unfortunately…a lot. Especially if you bring in swing biomechanics, shoulder and hip turn ratios, ball speed, clubhead speed, angle of launch, etc, etc. Even Roy “Tin Cup” McAvoy succumbed to paralysis by analysis.

And when we see the pros swing so hard they literally jump off the ground, we want to do the same. There’s a reason John Daly and Tiger Woods are still two of the most popular golfers in the world despite neither having contended in years; they hit the ball hard, and they hit it far.

But when your average 18-handicapper tries to mimic Long John Daly’s swing, he ends up doubled over in pain. Why is this? No offense, but you’re not strong enough.

Low back injuries account for the highest percentage of golf injuries in both professional and amateur golfers. Over 50% of golf injuries are to the low back.

For pros and amateurs alike, the most likely cause is core weakness and instability of the lumbar spine. I’m sure everyone reading this has heard some variation of “you’ve got to work on your core,” but what does the “core” really mean? Abdominal muscles are included, sure. But the core also includes muscles of the hips and muscles that run up the back. For golfers, the two muscles we should be most concerned about are the multifidus and the transverse abdominis. Before you become Doctor Google, let a Doctor of Physical Therapy explain why. It is my job, after all.

The culprit in low back pain in golfers (and, frankly, everyone) is fatigue of these muscles. Once you approach hitting your 70th (…or 100th) shot of the day, the timing of activating these muscles is delayed. Their main purpose is to keep the vertebrae and other connective (or “passive”) structures in the lumbar spine stable as you rotate through your golf swing. Once this timing becomes delayed, you then rely on those passive structures to keep your spine stable. Unfortunately, they’re not designed to do this, and your golf swing becomes painful.

So what do you do about this? Stabilize that spine!

Here is a quick progression of exercises to activate your “core” muscles and improve your endurance so you can finish your round of golf pain-free.

  • The good, old-fashioned “pelvic tilt.” This exercise gets a lot of flak because anyone who’s ever gone to physical therapy for low back pain has been prescribed the pelvic tilt as an exercise. Maybe it’s simplistic and not very functional, but at the very least, it teaches that muscle memory our body needs to automatically stabilize the spine without thinking about it. That’s why I’m including it here.

Instructions:  lie on your back and “roll” your pelvis down toward the floor to engage your abdominals; think about “bringing your belly button toward your spine.” Hold for up to 20 seconds while breathing. Repeat up to 10 times.

  • The Sahrmann Core Progression. Once you’ve learned how to engage your abdominals, you need to learn to stabilize the spine against movement of your extremities. Here is a great link to the progression: https://www.livestrong.com/article/145718-sahrmann-abdominal-exercises/
  • Quadruped Multifidus “Unloading” Progression. Now we move to hands and knees position to work further against gravity. Core muscles are not just muscles of the abdominals; they include the hips and small muscles that run up and down the back. The multifidus is a key part of this equation, as it helps to keep your spine in a neutral position with movement.

Instructions:  get on your hands and knees with a pillow/seat cushion under one knee. Brace your abdominals and just barely lift the other knee (that’s not on the pillow) off the ground. Make sure you keep your back straight during this exercise (don’t twist or roll to one side). Perform 20-30 repetitions. Repeat on the other side. Once you’ve mastered this, then add in extending the knee of the leg you lift up to “reach” your toes to the wall behind you. This will help recruit your glutes.

  • Palloff Press. Ok, now we can get on our feet. The Palloff Press is a great way to activate your obliques and hip rotators in the standing position, which (guess what?) targets the prime movers of the golf swing.

Instructions:  using an elastic band anchored on a wall/doorknob/bannister, keep the band close to your stomach with both hands as you walk sideways away from the band. Use your abdominals to keep your trunk from rotating and your hands/the band close to your stomach. After you take a few steps to increase tension in the band, then “punch” forward to extend your arms. Again, use your abdominals to keep your trunk from twisting and to keep your hands directly in front of you. Punch 2-3 times. Walk back to your starting position. Repeat 8-10 times on one side. Repeat on the other side.

Use these exercises 4-5 days a week to improve your core endurance to get a full 9 or 18 holes in without pain. And, per usual, contact your physical therapist or primary care physician if your pain persists. Hit it hard, man!








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