Preventing low back pain from golf

As with so many health conditions, a little effort to prevent back injury and low back pain goes a long way. Four key areas of prevention for the sport of golf include: warm-up, swing, bio-mechanics, and carrying the golf bag.

1. Warm-up before playing golf to prevent low back pain
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 result in low back pain. Instead, a thorough warm-up before starting to golf—including stretching and easy swings—is critical for the muscles to get ready for the game.

First, start with stretching before beginning to play golf. 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. Golf 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 while playing golf and can take more stress before either being strained or sprained.

2. Practice swinging before playing golf to prevent low back pain
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 low back. Golfers should emphasize a smooth, rhythmic swing, as this produces less stress and less low back pain (such as minimizing muscular effort and disc and facet joint loading).

With a proper swing, the shoulder, pelvis (hip), and thoracolumbar 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 while golfing 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 and preventing low back pain, this is often easier said than done. To avoid a low back injury, 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.

Most conditions that affect the L5-S1 level are more common in the younger population of golfers (30-40 year olds), such as degenerative disc disease or isthmic spondylolisthesis, and this younger age group also tends to swing the hardest while playing golf. For these individuals, an easy and fluid golf swing is a must if they are to avoid low back pain and enjoy the game. The young golfers 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 (see also

4. Carrying the golf bag safely to prevent low back pain
Repeated bending over to pick up a golf bag can stress the low back and lead to a muscle strain. An integrated golf bag stand that opens when the bag is set on the ground can eliminate the need to bend over. Some individuals like to carry their own golf 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 on the golf bag to evenly divide the weight across the back and reduce the chances of developing low back pain from an uneven load.

The images in this section have been reproduced with permission from The Spine in Sports, edited by Stephen H. Hochschuler, MD. You can visit Dr. Hochschuler's web site at The Texas Back Institute at www.texasback.com.