Low Back Pain in Golfers: Evidence-Based Treatment & Prevention Tips from a Fellowship Trained Osteopractic Physical Therapist

Table of Contents:

1. Understanding Back Pain in Golfers

2. Individualized Approaches to Back Pain

3. Common Back Pain Myths

4. Effective Management Strategies

5. When to Seek Professional Help

Understanding Low Back Pain in Golfers

Did you know that low back pain is the leading cause of disability in the US, affecting at least 80% of individuals at some point during their lifetime (AlMazrou et al. 2020, Kaye et al. 2022)? The annual costs associated with low back pain are a staggering $100 million and rising (AlMazrou et al. 2020).

For golfers, the statistics are even more concerning: Low back pain is the number one cause of pain among amateur golfers, with 28% of golfers playing despite experiencing low back pain (McCarrol et al. 1990, TPI web-source). That means nearly one out of every three golfers on the course is dealing with back pain!

By understanding evidence-based approaches to spinal health, you can optimize your golf performance while minimizing pain and injury risk.

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NO TWO BACKS ARE EQUAL

We must recognize that each golfer is unique. Our bodies differ in fundamental ways:

• Physical morphology: Height, weight, torso length, disc shape, nerve variation, and predominance of muscle fiber type

• Movement capabilities: Motor control abilities, tissue flexibility, available joint motion, and muscle strength

• Personal factors: Injury history, age, lifestyle, occupation, dietary habits, hydration status, and sleep quality

This is precisely why generic exercises or quick-fix videos promising to reduce low back pain rarely work for most people. Non-specific low back pain is challenging for researchers because they often try to generalize treatments instead of classifying patients into specific groups.

Without a comprehensive initial assessment and detailed patient information, a shotgun approach will only help a small percentage of individuals. This highlights the importance of consulting with a Physical Therapist who can identify and treat your specific musculoskeletal causes and pain sources.

EXAMPLE: The Importance of Targeted Treatment

If you visited my clinic complaining of low back pain, and my assessment revealed limited thoracic spine mobility as the root cause, treatment would focus primarily on improving thoracic motion.

While I would treat your complaints of pain, simply prescribing core stabilization exercises or dry needling without addressing the underlying thoracic spine limitation would not resolve your back pain in the long-term.

Similarly, without guidance on how to avoid overloading your spine throughout daily activities, complete pain relief may remain elusive. This example illustrates why details matter and generic approaches often fail when treating back pain in golfers.

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LOW BACK MYTHS DEBUNKED

Let's examine common misconceptions about back pain that could be hindering your golf performance and recovery:

Myth #1: Increasing back flexibility is good for performance and injury prevention.

FACT: Flexion and rotational stretches of the low back can overload the annulus fibers of the lumbar disc and cause eventual failure, especially when performed early in the morning (Adams et al. 1980).

FACT: Research shows that individuals with greater spinal mobility and lower extensor muscle endurance had increased occurrence of first-time back troubles (Biering-Sorensen 1984).

Myth #2: Fitter individuals have less back pain.

FACT: Studies indicate that fitter individuals actually report more back pain (McGill et al. 2013).

Myth #3: I need a strong back to minimize injury risk.

FACT: Muscular endurance of back muscles, not just raw strength, is protective against injury (Luoto et al. 1995).

FACT: Proper lifting mechanics and hinging from the hips play a crucial role in minimizing back injury (Potvin et al. 1991).

Myth #4: No pain, no gain when it comes to low back rehabilitation.

FACT: Pain inhibits optimal motor patterns (McGill and Karpowicz 2009).

FACT: Training with pain ensures poor or dysfunctional motor patterns (McGill and Karpowicz 2009).

FACT: Inappropriate motor patterns can cause further injury (McGill and Karpowicz 2009).

Myth #5: Improving Transverse Abdominis strength alone improves back stability.

FACT: Abdominal bracing, which activates all three layers of the abdominal wall (external oblique, internal oblique, and transverse abdominis), is much more effective than isolated abdominal hollowing for enhancing spine stability (Brown and McGill 2008).

Myth #6: A bad back is a life sentence.

FACT: The majority (83%) of massive disc bulges shrink over 2 years with complete and sustained resolution of symptoms (Benson et al. 2010).

Myth #7: Carrying one bag of groceries in one hand is better than carrying two bags in both hands.

FACT: Carrying similar loads in two hands versus one hand reduces compressive loads on the spine by up to 44% (McGill et al. 2013).

Myth #8: Low back injury is more likely to occur in the evening than in the morning.

FACT: Disc bending stresses increase by 300% and ligament stresses by 80% in the morning compared to evening, making injury risk greater with morning forward flexion (Adams et al. 1980).

HOW TO MANAGE BACK PAIN EFFECTIVELY

Having back pain doesn't sentence you to a lifetime of discomfort or limited golf performance. Research suggests that early intervention following a back injury leads to better outcomes (Martin et al. 2020), so contacting a qualified Physical Therapist promptly is crucial.

While Physical Therapists offer specialized treatments like manipulation, electric dry needling, neural mobilization, and targeted strengthening exercises, here are evidence-based strategies you can implement:

1. Maintain a Neutral Spine

Establishing and maintaining a neutral spine position is critical because it reduces stress on passive structures like ligaments, discs, joint capsules, and nerves. Whether sitting, standing, pushing, pulling, or lifting, maintaining neutral spine alignment throughout the day minimizes injury risk.

2. Change Positions Frequently

Sitting in one position for more than 50 minutes can lead to disc delamination (deterioration). By changing positions regularly, you load and unload various tissues, preventing overload on specific areas like intervertebral discs.

3. Avoid High-Risk Activities

Minimize stress on your spine by avoiding:

• Sit-ups

• Back extension machines

• Prolonged forward bending (common in gardening and certain golf stances)

• Excessive spinal rotation

  
  

These activities significantly increase load on passive spinal tissues, heightening injury risk and potentially prolonging recovery.

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WHEN TO SEEK PROFESSIONAL HELP

If you're experiencing persistent or recurrent back pain that affects your golf game or daily activities, professional evaluation is recommended. A golf-specialized physical therapist can:

• Assess your specific movement patterns

• Identify underlying biomechanical issues

• Develop a customized treatment plan

• Provide golf-specific rehabilitation exercises

• Analyze and modify your swing mechanics if necessary

  
  

Remember: Back pain doesn't have to ruin your life or your golf game. By taking control of your activities and movements, you'll be surprised at how much you can reduce daily spinal load and ultimately your pain.

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Patient Success Story:

"I am very grateful for Dr. Didlake. He has helped to recognize my body-swing-connection that will help me to continue to play golf for the rest of my life. Learning new stretches and workouts to incorporate into my daily routine will prevent injuries in the future." - Zane W., Recreational Golfer

Ready to Improve Your Golf Game Without Back Pain?

Schedule your comprehensive golf performance assessment today! Call (636) 777-0973 or book online at www.theintegrativeclinic.com. Special golf performance packages available.

SCHEDULE HERE

REMEMBER: Back pain doesn’t have to ruin your life.

Here’s to your health and your golf game!

Dr. David Didlake, DPT

PT, Cert. SMT/DN, CSCS, Cert. TPI Medical Level 3, Dip. Osteopractic, FAAOMPT

Owner, Integrative Therapeutics "Home of the Saint Louis Golf Doc"

Follow me @theintegrativeclinic @thestlgolfdoc

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Frequently Asked Questions About Golf-Related Back Pain

Q: How quickly can physical therapy help my golf-related back pain? 

A: Many golfers experience significant improvement within 2-3 weeks of starting targeted physical therapy, though individual results vary based on factors like injury severity and adherence to home exercises.

Q: Should I stop playing golf completely if I have back pain? 

A: Not necessarily. A physical therapist can assess your specific condition and may recommend modifications to your technique or temporary activity limitations rather than complete cessation.

Q: How is golf-specific physical therapy different from general treatment? 

A: Golf-specific physical therapy incorporates swing analysis and sport-specific movements to address the unique biomechanical demands of golf, resulting in more targeted and effective treatment.

References

For those interested in the scientific evidence behind back pain, we've included some key research citations:

1. AlMazrou S.H., Elliott R.A., Knaggs R.D., AlAujan S.S. Cost-effectiveness of pain management services for chronic low back pain: A systematic review of published studies. BMC Health Serv. Res. 2020;20:194. doi: 10.1186/s12913-020-5013-1.

2. Kaye AD, Edinoff AN, Rosen YE, Boudreaux MA, Kaye AJ, Sheth M, Cornett EM, Moll V, Friedrich C, Verhagen JS, Moser B, Navani A. Regenerative Medicine: Pharmacological Considerations and Clinical Role in Pain Management. Curr Pain Headache Rep. 2022 Oct;26(10):751-765. doi: 10.1007/s11916-022-01078-y. Epub 2022 Sep 8. PMID: 36074255; PMCID: PMC9453705.

3. McCarroll et al. Injuries in the Amateur Golfer. Phys Sports Med. 1990;18:122-26.

4. TPI unpublished data of over 7000 amateur golfers. Accessed via mytpi.com Oct. 27, 2023.

5. Biering-Sorensen F. Physical Measurements as Risk Indicators for Low Back Trouble Over a One-Year Period. Spine. 1984;9:106-119.

6. Frost D, Andersen J, Lam T, Findlay T, Darby K, and McGill SM. The Relationship Between General Measures of Fitness, Passive Range of Motion, and Whole Body Movement Quality. Ergonomics. 2012; 1-16. et al 2011, 2012, 2014, 2015

7. McGill SM, Frost D, Crosby I. Movement Quality and Links to Measures of Fitness in Firefighters. Work. 2013;45(3):357-366.

8. Luoto S, Heliovaara M, Hurri H, Alarenta M. Static Back Endurance and the Risk of Low Back Pain. Clinical Biomechanics. 1995;10:323-324.

9. Potvin J, Norman RW, McGill S. Reduction in Anterior Shear Forces on the L4/L5 Disc by the Lumbar Musculature. Clinical Biomechanics. 1991;6:88-96.

10. McGill SM, Karpowicz A. Exercises for spine stabilization: Motion/motor patterns, stability progressions and clinical technique. Archives of Physical Medicine and Rehabilitation. 2009;90:118-126.

11. Brown S, McGill SM. How the Inherent Stiffness of the In-Vivo Human Trunk Varies with Changing Magnitude of Muscular Activation. Clinical Biomechanics. 2008;23(1):15-22.

12. Benson RT, Tavares SP, Robertson SC, Sharp R, Marshall RW. Conservatively Treated Massive Prolapsed Discs: A 7-year follow-up. Annals of the Royal Collage of Surgeons of England. 2010; 92:147-153.

13. McGill SM, Marshall L, Andersen J. Low Back Loads While Walking and Carrying: Comparing the Load Carried in One Hand or in Both Hands. Ergonomics. 2013;56(2):293-302.

14. Adams MA, Hutton WC, Stott JRR. The Resistance to Flexion of the Lumbar Intervertebral Joint. Spine. 1980;5:245.

15. Martin S, Tallian K, Nguyen VT, van Dyke J, Sikand H. Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain? Ment Health Clin. 2020 Jul 2;10(4):215-221. doi: 10.9740/mhc.2020.07.215. PMID: 32685332; PMCID: PMC7337997.
    

This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before beginning any new treatment.