Lumbar Pain in Golfers

Many well-known professional golfers, such as Jack Nicklaus and Fred Couples, are plagued by back pain. If the professional golfer, who has excellent swing mechanics and is physically fit, can have low back problems, the recreational golfer is certainly not immune to these problems. The professional golfer tends to develop low back pain from overuse, while the recreational golfer develops low back pain from sporadic play, poor swing mechanics, or a poor physical fitness level.

During one's daily activities, the spine is able to withstand a certain amount of stress. Each individual has a different spine tolerance level, depending on age, body type, and fitness level. As one goes beyond his or her tolerance level and overloads the spine, stiffness in the facet joints occurs. The facet joints are flat, platelike surfaces connected to the vertebrae (Fig.). The muscles that stabilize, protect, and guard the irritated joint can, over time, become irritated, causing pain.

After a physician's diagnosis of lumbar pain, the patient is often referred to a physical therapist, who completes a thorough evaluation to check flexibility and strength and specifically assess the movement of the facet joints. If a dysfunction or lack of movement of the facet joint is found during the evaluation, manual therapy is performed to restore normal movement of the joint. A home exercise program for lumbar flexibility and strengthening is usually prescribed. Once the facet joint dysfunction is resolved, the patient's pain and mobility improve. Additionally, many golfers find that their swing improves after their dysfunction is resolved.

Weekend golfers who have poor swing mechanics, lack fitness, or do not warm-up properly are more likely to injure themselves. Poor swing technique causes strain on the low back. Taking golf lessons to learn the proper mechanics can prevent low back pain. Golfers with poor swing mechanics tend to swing harder, causing larger spinal loads and increased muscle activity, resulting in more stress to the lumbar spine.

Golfers with degenerative disc disease or arthritis in the lumbar spine are more susceptible to overloading their spines. The discs lose their shock-absorbing capabilities, and the loads are transferred to other structures within the spine that are unable to withstand these forces. A poor golf swing causes large shearing, compression, and torsional forces on the low back.

An exercise program for the full body will strengthen and increase trunk, buttock, and lower extremity flexibility. Aerobic conditioning is also extremely important. Walking is a great exercise for increasing muscle endurance and delaying the onset of muscle fatigue - one of the primary causes of injury. It is also important to know one's physical capabilities. A weekend golfer with poor physical fitness should not try to play longer or harder than his or her body can handle. As fatigue sets in, so do poor mechanics, leading to stiffness in the spine and resulting in low back pain.

Before playing golf, warm-up exercises should be performed to increase flexibility and blood flow. Exercises should include neck range of motion, shoulder stretches, trunk side-bends and rotations, and hamstring stretches. A golfer should also spend a few minutes at the driving range, putting and driving before the game begins.

Golf can be enjoyed with less chance of low back pain through a good fitness program during the week, use of proper swing mechanics, and warm-up exercises before tee off. If you are having back pain, see your physician and physical therapist to obtain a diagnosis and to be properly treated. Then you can play a pain-free game.

Babette Smith, P.T.
Columbus, Georgia

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