In the third of a series of articles on injuries common in golfers of all abilities, ETPI.com’s Nigel Tilley – a Consultant Physiotherapist on The European Tour – examines lower back injuries in golf and how physiotherapy can help.
Picture this: It’s a cold Saturday morning and you’re on the first tee at your local golf club for the morning medal. You got up late and rushed to the tee with just a few moments to spare after a 30 minute drive to the course. You’ve had no warm up, you haven’t played golf for more than a week and the last time you did any type of exercise was many moons ago. Does this sound like you?
Does this sound like the ideal way to prepare your body for the forces and stresses about to go through it when swinging a club aggressively and hitting a golf ball many times? Do you think this is how professional golfers would prepare for a round? Do you think you will play your best? Do you think you will wake up tomorrow feeling fresh and with no aches and pains? Obviously, the answer to all of those is most likely, no.
We know that lower back injuries are the most common injuries in golfers, accounting for roughly 30 per cent of physical complaints involved with playing the sport. The average golf swing will place high downward compression, side to side bending and back to front shearing forces through the lumbar spine. The spine is poorly adapted to tolerate these types of stresses. Loads of eight times body weight have been shown to go through the lumbar spines structures during the golf swing. Poor technique can increase these stresses further.
However, with regular conditioning, improvement in technique, warm ups and structured practice, the improvements in golfers’ performance and reduction of injuries can be significant. Your physiotherapist can help you with this as well as provide you with effective treatment should you suffer with any injuries.
Lower back injuries
Non-specific low back pain
What is it?
There are a large range of conditions involving many structures that can be injured or develop pathologies in the lower back. These can cause pain among other symptoms and affect range of movement. The small joints (facet joints), connective tissues (ligaments, muscles, tendons), discs, and nervous tissues may be involved. Acute conditions such as sprains and strains and the normal effects of ageing cause these structures to wear and reduce their ability to tolerate the high forces and ranges of movement that are required in the golf swing. However, the soreness and stiffness that people often present with is called ‘non specific’ as it is not usually clear which structure is causing the problem and/or pain.
There is a poor correlation between pathology of musculoskeletal structures as seen on scans such as MRI’s, CT’s and X-rays and the symptoms and pain people report and present with. In fact, as we age it is very normal for the majority of us to start to have changes to many of these structures.
Evidence has shown that the vast majority of people have no pain or symptoms despite having changes to the structures seen with imaging. It is, therefore, critical that we do not rely on scans and investigations to drive the diagnosis and management of low back pain. We aim to use sound clinical assessment and reasoning and a holistic look at the individual as they present to us.
Poor technique and lack of flexibility in the mid spine and hips are all linked with increased incidence of lower back pain. Often it presents as an aching and discomfort on moving into certain positions and doing certain activities, but can come on after a sudden movement and/or activity or for less obvious reasons.
The modern golf swing requires a player to be able to generate, control and slow huge forces during the execution of a golf swing. The problems we often see involve a combination of poor practice routines, poor technique, lack of conditioning, lack of flexibility at the spine and other areas of the body and lack of ability to cope with the huge forces the golf swing puts though the body and the structures.
How does physiotherapy treat this type of condition?
Physiotherapists are highly trained professionals and will be able to assess you fully and identify non-specific lower back pain (NSLBP) from potentially more serious lower back pathologies.
Trying to remain active and avoiding extended periods of rest is important in people with NSLBP. Whilst it may be a good idea in the very initial stages of the problem to reduce or avoid significant movements or activities that aggravate the symptoms, it is a good idea to keep mobile and try to do stretches and exercises that relieve the symptoms and promote normal movement.
These are often specific to each individual and your physiotherapist will discuss the best options for you. Often in the initial phases, the use of heat via hot packs and baths can help as well as manual therapy treatments, soft tissue massage, TENS and advice on the best ways to lift, bend, sit and move in out of the car and bed.
The aim of physiotherapy is to promote self-management, help you understand your pain better and to help develop your physical conditioning. It has been found that physical de-conditioning plays a role in acute NSLBP. This can be general fitness conditioning as well as specific exercise, stretches and programmes that aim to address limitations in certain parts of the body and prepare the body to tolerate the requirements and forces of the golf swing.
We know that in golfers, technique faults and a lack of flexibility and/or movement in the hip and thoracic (mid) spine are linked to lower back pain. Physiotherapy can help with NSLBP by restoring movement to these areas and providing golf specific stretches and exercises that can help to improve technique and promote better conditioning of the body for playing golf.
Well taught and well performed strength and conditioning exercises working on compound movements (multi joint/whole body) and developing strength and control in the lower limbs, trunk and upper body are fundamental components of a professional golfer’s training. These can be extremely effective techniques to help those with NSLBP control and eliminate their symptoms while improving their golf performance.
It is important that you warm up properly each and every time before you play golf to prepare your body for the activity it is about to do. A warm up should last 10-15 minutes and involve increasing heart rate & blood flow, activating the muscles involved in the swing and spinal control, and stimulating the bodies motor control mechanisims. This will help prepare you for playing golf and help reduce your risk of injury.
The ETPI aims to ‘make golfers stronger, more robust and more stable’. This should be the goal of your training and conditioning programme.
Reviewing your practice and play habits can also help identify and direct your golfing activity more appropriately to reduce the effects of overload.
For safety, optimum treatment and to reduce the risk of re-injury, players and patients should visit and complete a full assessment of all injuries and receive treatment and rehabilitation under the guidance of a chartered physiotherapist.
Work on your golf fitness on-line with the European Tour Performance Institute and Road to Health at Tour fit for Golf (TFFG)
The European Tour Performance Institutes in Terre Blanche, France and at the Jumeirah Golf Estates in Dubai have highly qualified and expert physiotherapists, osteopaths, medical staff, biomechanists and support staff that are able to help you with your injury assessment, diagnosis, treatment and improve your golf performance. To arrange a visit or book an appointment with them email: