GOLF AND LOW BACK PAIN
Introduction: Golf, one of America’s all-time favorite sports, is becoming more popular than ever. For the millions of people who have chronic, long-standing low back pain, golf can still be an enjoyable sport. However, like any other sport, golf can produce injuries. One very common golf injury is low back pain (usually due to muscle strains & sprains). Additionally, people who suffer from chronic or recurrent episodes of low back pain can be frustrated because the pain hinders their ability to play golf.
To help golfers avoid injury and help people with low back pain enjoy golf, this article provides a few suggestions for:
- Respect your pain. “No pain no gain” doesn’t apply.
- Prepare and train to play golf.
- Seek professional guidance to improve golf swing biomechanics.
- Pace your playing.
- Warm-up with flexibility and stretching exercises.
I hurt my back while golfing today. What do I do?
Most acute low back injuries that occur during a game of golf will get better over a couple of days to weeks. The most common injuries include:
- Muscle strains: typically occurs with rough or forceful swings or a sudden shift during the downswing.
- Muscle and tendon attachment: generally occurs due to excessive use, accidents or swing abnormalities
- Disc injuries: can occur from swinging abnormalities (note that this is usually due to a pre-existing disc lesion that is aggravated by golf).
For relief of the pain and to promote healing, it is generally advisable to rest for a day or two, apply heat and/or ice, and take pain medication. Medications like ibuprofen or naproxen can help decrease inflammation, and acetaminophen may be taken in conjunction with these medications to further help reduce pain.
It is generally recommended to rest and not play through a low backache to avoid irritating inflamed muscles. Taking time off from golf will allow the muscles to heal more quickly. Continuing to stretch is advisable, as is continuing a low-impact aerobic exercise program, such as walking for 30 to 40 minutes every other day. After the back pain has stopped, slowly return to the sport and apply the prevention tips (described above) to help avoid future occurrences. If the pain continues for more than two to six weeks, a specific and definable problem may be the cause of pain and a medical professional should be consulted.
Playing with low back pain:
Stretching and maintaining flexibility will be even more important to individuals with low back pain in order to prevent further injury or muscle strain. Individuals with chronic low back pain tend to lose flexibility, and if a stretching program is not maintained on a daily basis, the resulting loss in flexibility will lead to further low back pain.
Staying aerobically conditioned will also help lessen discomfort and keep the individual more functional and allow them to enjoy golf. Low-impact aerobic conditioning, such as walking or stationary biking, are both gentle on the back and are usually well tolerated. This type of exercise should be done for 30 to 40 minutes at least three times weekly.
For those individuals who have difficulty walking the course because of pain, using a golf cart is a perfectly reasonable option. Although they will lose the advantage of the exercise they would get walking the course, riding will allow them to continue to enjoy golfing. People with spinal stenosis or degenerative spondylolisthesis can maintain their aerobic conditioning with stationary biking, which is usually a better tolerated form of exercise than walking.
Additionally, modification of the swing may be necessary in the injured or elderly athlete. Modifications typically comprise a relaxed posture, shorter back swings, increased hand action and a shorter finish.
AN OUNCE OF PREVENTION
As with so many health conditions, a little effort to prevent back injury goes a long way. Four key areas of prevention include: warm-up, swing, bio-mechanics, and carrying the golf bag.
Going directly to the tee at 7:00 a.m. , pulling out the driver, and then proceeding to try to hit the cover off the ball is probably the surest way to sprain one’s back muscles and ruin the rest of the day. Instead, a thorough warm-up-including stretching and easy swingsâ€”is critical for the muscles to get ready for the game. First, start with stretching. Stretching should emphasize the shoulder, torso, and hip regions as well as the hamstring muscles. The shoulder and torso may be stretched by holding a golf club behind the neck and shoulders and then rotating the torso. The hips maybe stretched by pulling the knee to the chest. The hamstrings maybe stretched by bending over and trying to touch the toes. Next, gently swinging a golf club helps warm up the necessary muscle groups and prepares them for the torque (force) and torsion (twisting) that a golf swing produces. Time permitting, going to the driving range before a golf game is very helpful. Practice should begin with the smaller irons and progress up to the larger woods. This process allows the muscles to incrementally warm up. Overall, muscles that have been stretched and gradually loaded are much less prone to being injured and can take more stress before either being strained or sprained.
The objective of a golf swing is to develop significant clubhead speed, and to do this a lot of torque (force) and torsion (twisting) is applied to the back. Golfers should emphasize a smooth, rhythmic swing, as this produces less stress to the low back (such as minimizing muscular effort and disc and facet joint loading). With a proper swing, the shoulder, pelvis (hip), and thoraco-lumbar segments (chest and lower spine) rotate to share the load of the swing. The shoulder and hip turn, along with the wrist snap, will produce more clubhead velocity than a stiff arm swing. Good balance is achieved by slightly bending the knees and keeping the feet approximately shoulder-width apart. The spine should be straight, and the golfer should bend forward from the hips. Weight should be distributed evenly on the balls of the feet. As most golfers will agree, while developing an easy, fluid swing may be desirable in terms of reducing stress to the low back, this is often easier said than done. Beginners would be well advised to work with a golf pro when starting out, since most aspects of a golf swing are not natural or intuitive. Additionally, golf lessons may be useful for senior golfers who have decreased flexibility and strength.
The force generated by a golf swing largely stresses the L5-S1 disc space because the joints at this segment allow considerable rotation. The other joints in the low back allow more flexion/extension and not as much rotation and are relatively protected. Most conditions that affect the L5-S1 level are more common in the younger population (30-40 year olds), such as degenerative disc disease or isthmic spondylolisthesis, and this younger age group also tends to swing the hardest. For these individuals, an easy and fluid swing is a must if they are to avoid low back pain and enjoy the game. They also need to really concentrate on flexibility in the hamstrings, since this will allow more motion in the pelvis and help reduce stress to the L5-S1 disc space.
Carrying the golf bag
Repeated bending over to pick up a golf bag can stress the low back and lead to a muscle strain. An integrated bag stand that opens when the bag is set on the ground can eliminate the need to bend over. Some individual’s like to carry their bag to get more exercise, and while this maybe a good idea, bag straps that place all the pressure on one shoulder can be hard on the back. It is advisable to use dual straps to evenly divide the weight.
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