“Ouch! Every time I swing I get this pain in my lower back . My back is messed up. I am a walking Motrin commercial. I must need an MRI, a low back massage, and strengthening of my lower back. Right?”
Sound familiar? I hope not. But if it does, please read on!
Low back pain is one of the most common golf-related injuries with up to 80% of golfers experiencing back pain at some point. The vast majority of the time, the lower back gets injured as an innocent bystander, caught in the crossfire between poor hip mobility, reduced thoracic spine mobility, and an underactive core. This is a dangerous combination that dramatically increases the strain and load on the lower back, and almost guarantees an eventual injury.
The problem is that working on the lower back won’t solve any of these issues! Without a thorough physical evaluation, it is highly unlikely that you will find the culprit. The key is to NOT focus all the attention on your back. Instead, you need a complete, thorough evaluation from a qualified professional to get to the root of the problem. Only then can you develop a program to safely address it.
It turns out, back pain can come from physical limitations as well as swing related causes. The swing causes are often a result of the physical causes, and thus it is vitally important to have your swing evaluated by a professional trained in the swing-body connection. The Titleist Performance Institute (TPI) has revolutionized the training of practitioners versed in both the golf swing and body mechanics. By finding someone who is TPI certified, you know you are staring in a good place.
At Boundless Health, we boast 3 highly trained, TPI certified practitioners to help identify the main issues and develop an individualized program to address them.
While an exhaustive discussion of back pain is beyond the scope of this blog post, lets look at some of the most common swing characteristics and related body factors that can lead to low back pain:
- Set Up Posture
An “S posture” is a very common cause for low back pain. This is where you have excessive curve in your lower back and your butt sticks out behind you. This automatically puts you in a position where you rotate more through your lower back and less through your thoracic spine and hips. You aren’t even giving your hips and upper back a chance to do their job! Correcting your set up posture to a neutral posture will quickly alleviate this issue. But can you reliably maintain a neutral posture? That is when we have to look at how your body works.
Can you do a slight pelvic tilt and glute contraction while keeping your shoulder blades pulled back, all without thinking about it or forcing yourself into the position? If you sit at a desk or work on a computer all day, the answer is likely NO! With the proper training, however, I guarantee you that you will be able to. And that will go a long way to protecting your back.
Remember, it all starts with proper set up posture. Once you have achieved that, then you are ready for your backswing. But what if your backswing causes you to have a “reverse spine angle?” This is where your weight doesn’t properly transfer to your trail leg, you don’t rotate much over your trail hip, and thus end up leaning towards the target with an arch in your lower back. OUCH! You will feel this one in your back swing and then it will get you again in the compensation needed in your downswing. Twice the risk for injury!
This swing characteristic is commonly caused from limited hip mobility in your trail leg, a weak gluteus muscle, or reduced thoracic spine rotation. With a more thorough screen, we can tell the difference, attack your weakness, and get you moving much better to shift the weight off your lead leg, allow your trail hip to rotate in, thus keeping your spine neutral, and feeling that stored power in your coil. All without asking your lower back to do any of the work. Notice that none of this has to do with weakness in your lower back! Your lower back was an innocent bystander asked to compensate for improper movements.
On the downswing, we need to transfer our weight back to our lead leg so we can rotate around the lead hip. But what if we “hang back” and don’t efficiently get our weight to our lead leg? You still need to deliver the club to the ball, so our lower back will quickly try to take over and shoot your hips forward (toward the ball, not the target), thus causing you to bend through your back again and dramatically increase the pressure and load on your lower back.
To tackle this issue, we need to see if your lead hip can rotate efficiently, and if your core can act as a rotary motor rather than forcing you to move laterally or forward. Since we do not tend to do these motions in our daily life, the necessary muscles are frequently underdeveloped. With directed training, we can help you strengthen properly, and more importantly, develop the needed neuromuscular connections to easily and reliably fire those muscles in the time of need.
This is a brief introduction to the complex topic of golf and low back pain. Remember, the lower back is rarely the cause of the problem, but it is frequently the path of least resistance in the chain that ends up getting injured. With a thorough screen of both your swing and your body’s movement patterns, we can help identify the cause of the increased strain on your back, and help formulate a plan to fix it. Contact us today to learn more how we can help you play better, and help you play pain free!
Bret Scher, MD, FACC
Lead Physician, Boundless Health