Rehabilitation of lower back pain for golfers

August 29, 2024

Rehabilitation of lower back pain for golfers

If you’re experiencing lower back pain while playing golf, participating in other sports, or doing household chores, this blog is for you. We will cover common golf-related injuries, early rehabilitation, mid-stage rehab, late-stage rehab, and provide some key take-home messages for golfers suffering with lower back pain.

Background

Golf is a popular sport worldwide, with an estimated 66.6 million people playing on nearly 32,000 golf courses (The R&A, 2023). Lower back pain is the most common injury among golfers, accounting for up to 34.5% of all golf injuries in amateurs and up to 55% in professionals (Cabri et al., 2009).

Golfers, regardless of skill level, tend to experience overuse injuries more often than acute injuries. The causes of injury differ between professional and amateur golfers due to variations in swing intensity and training frequency.

Common Lower Back Injuries Amoung Golfers

The golf swing places significant strain on the spine, especially from the downswing to the follow-through phase which may result in lower back pain. Typically, in right-handed golfers, the structures on the right-side lower back bear the highest load of the swing and remain dominant through impact. Consequently, injuries in right-handed golfers are most frequently observed in the right lumbar region (Sutcliffe et al., 2008). Some common lower back injuries in golfers include:

Disc herniation – This injury can be caused by a single major trauma or multiple minor ones. The primary reasons for disc herniation in a healthy spine include lateral bending, compression, and torsion, which are significant elements of the golf swing, particularly for amateur players. Symptoms may include moderate to severe pain, numbness, and weakness that can spread down either leg.

Facet joint syndrome – This injury is caused by repetitive movement in the swing. Symptoms include restricted range of motion, muscle pain, numbness, and weakness. The reverse C swing position which involves extension and side flexion at the lower back also has the potential to cause facet joint irritation (McHardy et al., 2006).

Sacroiliac joint dysfunction – This injury is also caused by repetitive motion. Symptoms include pain in the lower back, buttocks, hips, groin, and pelvis.

Spondylolysis (stress fracture) – This injury is a common cause of lower back pain among young golfers due to overuse. Furthermore, Poor swing mechanics, poor endurance, and muscular imbalances can increase susceptibility to this type of injury (Brandon & Pearce, 2009).

Paraspinal muscle strains – also known as a “pulled muscle”. The paraspinal muscles help to stabilise the spine during the golf swing. Due to the lateral bending, compression and torsional forces on these muscles, these intense pressures can lead to muscle strains (McHardy et al., 2006). These injuries usually resolve themselves in 2-4 weeks with rest and rehabilitation. Paraspinal muscle strains pose a natural risk due to fatigue and stress imbalances that compromise these muscles, particularly in amateur golfers.

Early Rehabilitation

Rehabilitation for golfers with lower back pain involves a multidisciplinary team for a safe return to golf. Early phase physiotherapy rehabilitation should focus on controlling pain. Diagnostics like MRI and ultrasound scans can be useful in diagnosis but are not always essential, followed by treatments like medication, protection, optimal loading, ice, compression, and elevation to help reduce early acute pain.

Once we have controlled the pain levels, it is important to restore full range of motion of a joint or flexibility of a muscle. The movements at the lumbar spine include flexion, extension, side flexion and an element of rotation. It is important to work on exercises that target all these movements.

The next phase of rehabilitation is to increase strength. Core strength and stability is crucial for rehabilitation, involving exercises for diaphragmatic breathing, pelvic tilting, and core activation. Training of various muscles like transversus abdominis and the hip abductors is essential for core stability. Advanced core exercises include plank variations, bridges, curl-ups, side planks, and bird dog exercises.

Golf Screening Assessment

Throughout the rehabilitation of a golfer with lower back pain, it is essential to conduct movement pattern and golf-specific screenings. Here at Physiotherapy Matters, we take golfers through our golf screening assessment. This assessment helps pinpoint dysfunctional movements and whether they stem from stability, mobility, or strength issues. Identifying and addressing imbalances and swing faults early on can help prevent injuries and improve golf performance.

Late Rehabilitation

Phase 4 of the rehabilitation process focuses on proprioception, balance, and sport-specific training. Proprioception refers to the body’s ability to know its position in space without looking, essentially involving balance. When an athlete experiences a sport injury, their ability to balance is often weakened. Improving proprioception can help prevent the recurrence of an injury.

Phase 5 gradually reintroduces the golfer to full activity through sport-specific exercises performed in various directions (low-to-high, high-to-low, and straight across the midline), engaging all three movement planes as golf is a multi-directional sport. It’s crucial to vary the intensity, loads, and volumes of these exercises to optimize training benefits based on the phase of a periodized program. The exercises start at basic levels and progress to higher skill levels to avoid the risk of further injury as muscle control develops. Even after returning to golf, it’s important to continue rehabilitation to prevent further injuries.

Take Home Messages

• Regular reviews with the MDT: golf coaches, physio’s, strength, and conditioning coaches in golf to help correct swing and body mechanics.
• Screening players helps to identify areas of poor conditioning and mobility restrictions.
• Lift heavy weights in a controlled manner on a regular basis will help develop strength and power.
• Avoid excessive overload – structured practice and playing levels.
• Avoid excessive hard ground/ mats practice.
• Ensure effective and appropriate warm up preparation is completed before all practice and play.

If you suffer from back pain and are struggling to keep active, both our Pilates class and our Strength and Conditioning Circuit Class are great ways to maintain and improve strength and stability which can be great for helping to manage your symptoms. In the video below, our MSK expert Robert explains how Physiotherapy can help to alleviate lower back pain and prevent future flare ups.

References

• Brandon, B., & Pearce, P. Z. (2009). Training to prevent golf injury. Current sports medicine reports, 8(3), 142–146. https://doi.org/10.1249/JSR.0b013e3181a61c88.
• Cole, M. H., & Grimshaw, P. N. (2016). The biomechanics of the modern golf swing: implications for lower back injuries. Sports Medicine, 46, 339-351.
• Finn C. (2013). Rehabilitation of low back pain in golfers: from diagnosis to return to sport. Sports health, 5(4), 313–319. https://doi.org/10.1177/1941738113479893.
• McHardy, A., Pollard, H., & Luo, K. (2006). Golf injuries: a review of the literature. Sports medicine (Auckland, N.Z.), 36(2), 171–187. https://doi.org/10.2165/00007256-200636020-00006.
• Sutcliffe, J., Ly, J. Q., Kirby, A., & Beall, D. P. (2008). Magnetic resonance imaging findings of golf-related injuries. Current problems in diagnostic radiology, 37(5), 231–241. https://doi.org/10.1067/j.cpradiol.2007.08.005.
• The Royal and Ancient Golf Club of St Andrews. (2023). Play Golf. https://www.randa.org/play-golf.