Why Does Your Low Back Hurt While Golfing?

This week, let’s dive into the biomechanics of the golf swing. We’ll discuss how extra or missing motion from key joints can lead to tissue overload. Tissue overload leads to pain and inflammation, along with recurring cycles of tightness. This can inspire someone to get treatment or take a break from activity, which sometimes improves pain levels. Unfortunately, many golfers seek treatment that is not comprehensive and misses the true causes of the tissue overload. It typically follows the following pattern… Low back tightness, low back pain and aching, feeling better until resuming activity... low back tightness, low back pain, feeling better, start golfing again, low back tightness, low back pain… and so on.

First, we need to understand the requirements from the golf swing from a biomechanics stand point. Check out the video below for a better understanding of which joints are partaking in the backswing and downsing…

Pathomechanics of the golf swing

What I’m referring to in this section are the faulty timing or sequencing of the golf swing that leads to pain and injury. Why do swing mechanics become faulty? Because of mobility, strength, and motor control deficits. It is only after these components are addressed that swing instruction becomes significantly effective and lasting. As demonstrated in the above video, we need full access to numerous joints at their full range of motion. Then, we need to learn to be strong in these joint actions. Last, we need to learn to sequence explosiveness and movement with strength and stability, altering which joints are expressing which at exceptionally high speeds (motor control). When these things go wrong, we have a golf swing that leads to pain, injury, and underperformance (pathomechanics).

Low back pain

Often times, the cause of low back pain is elsewhere, but we inevitably end up with the pain located in the lumbar spine. We have a good understanding of why this could be happening as a result of the surrounding joints, but what is happening in the low back?

The low back is being called up, in most cases, to rotate excessively. Though the lumbar spine has the capacity to rotate, the architecture of the low back is mostly designed to flex and extend (bend forward and backward). The boney architecture is oriented in the sagittal plane, meaning rotation causes the facet joints of the vertebrae to spin into each other, essentially blocking their motion after a certain amount of rotation. So, when we demand the low back rotates more than it should need to in the golf swing, we are jamming and cranking these facet joints together, often causing facet joint pain. Or, the small muscles of the lumbar spine become irritated from the stress of the excessive rotation. In both cases, we are left with an aching pain in the low back.

Further, we can injure the disc of the lumbar vertebrae, resulting in disc bulges or protrusions that create an aching sensation and an inflammatory response in the low back. If these disc injuries encroach on a nerve root, we can also experience pain that shoots down the leg, even into the calf or foot sometimes. We may even have symptoms that are only present in the calf, foot, or thigh without low back pain, even when lumbar disc encroachment on the nerve IS the primary cause of the pain. For this reason, even in the absence of low back pain, we must always rule out the spine as a cause of the distal leg, calf, or foot pain.

True causes of low back pain in golfers

So what are the big physical issues leading to pain and injury of the low back in the golf swing?

1.        Hip internal rotation

2.        Pelvic flexion/ extension and motor control

1.Hip internal rotation

We must coil into our back side hip for a powerful and compensation free golf swing (check out the article here where I touch on this concept more… article). If we are missing back side hip internal rotation mobility or the strength to rotate on a closed chain femur, than we WILL compensate and achieve our “desired” back swing position through other mechanisms. These other mechanisms often include excessive low back rotation or tibial rotation at the knee and ankle. As a result, we either get knee pain or low back pain… So, it is critical to address the asymptomatic yet highly involved hip mobility to help alleviate low back pain, long term.

The same goes for the downswing and the lead side leg. We are creating and expressing outrageous levels of force in the golf swing. This force ends up in the lead side edge of the body, especially the lower extremity. We must be able to use the full depth of mobility in our hip joint to help absorb these forces or we WILL experience pain and injury in the hip or surrounding joints. This includes, again, the low back and knee. When the hip is being dodged because it cannot handle the full amount of force we need to place through it, then the low back and the knee pay the consequence.

Pelvic flexion/ extension and motor control

A significantly important test we do at IRPC is the pelvic tilt test. Though a simple test, the motion of tilting the pelvis forward and backward, or more importantly, the ability to control this motion, is essential in the golf swing. To create this motion, we need to use the rectus abdominis (6 pack muscle) and other core muscles alongside the glute maximus muscle to contact and relax, coordinating what we call anterior and posterior tilt of the pelvis. In the golf swing, we need to be able to move between a posterior and anteriorly tilted pelvis while rotating on the legs. If this test is proving difficult to perform smoothly, we know that we are either missing low back flexion and extension mobility and/or motor control over the pelvis. If we are missing the ability or strength to control these motions, we are leaving ourselves susceptible to excessive forces through the low back as we miss the opportunity to orient the pelvis and therefore the low back in the most ideal position (for injury prevention AND performance).

Conclusion

Low back pain in golfers has many physical causes. The pain can come from the lumbar facet joints, the intrinsic lumbar spine muscles, lumbar discs bulges, and lumbar discs protrusions with spinal nerve encroachment. Beyond the pain generators, the true causes of low back pain often come from joint restrictions or joint motor control deficits Addressing both the pain generators AND the functional limitations leading to the pain and inflammatory responses is critical for long term and effective treatment in golfers.

-Dr. Nick DC, MS, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.

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