GOLF AND THE SPINE

Low back pain is the most common injury/complaint among both amateur and professional golfers.(1,2) Golfers bend over and twist to hit a ball repetitively and generate a lot of torque at the same time. Based on what we know about the biomechanics of the spine, this type of motion is inherently stressful on the lower back. And to make matters worse, most golfers have weak abdominal and back muscles, tight hips, are in poor cardiovascular condition, don=t warm up, play sporadically, and don=t have very good technique.

The modern golf swing, in particular, imposes additional stress on the spine, as compared to the Aclassic@ swing of Bobby Jones and Walter Hagen. The classic swing involved the hips turning almost as much as the shoulders, thus minimizing the torque on the spine. The modern swing, such as demonstrated by PGA stars Tiger Woods, John Daly, and David Duval, involves maximally turning the shoulders while minimizing the turning of the hips. This causes a tightly coiled torso, which results in maximum acceleration of the club head through impact. This is one reason why these modern golfers can routinely hit drives greater than 300 yards. This is also one of the reasons for there being such a high incidence of back problems.(3) Research has found rotational forces to be associated with lumbar spine injury.(4,5)

What can be done to minimize the potential for back problems in golf?

1. Get in good physical condition. This will decrease the risk of back injury. Lose weight if you are overweight. Perform regular aerobic exercise, such riding a cycle, walking or running on a treadmill, using a stairmaster, etc. 30 minutes of aerobic exercise at least twice per week is recommended. Stretching should be done on a daily basis, with emphasis on the hamstrings and other hip muscles. Engage in moderate weight training exercises to strengthen your abdominal, back, shoulder, forearm, and other muscles, esp. those involved in golf. 2 to 4 times per week is probably best. Perform some balance exercises as part of your routine, such as using a wobble board, as this helps you develop a smooth, coordinated swing.

Your best bet is for a good physical therapist, chiropractor or trainer to set up a golf conditioning program for you. This should include exercises for stabilizing and strengthening the back and other trunk muscles.

2. Take lessons from a PGA pro and try to improve your technique. Poor technique results in wasted effort and additional stresses on your back and other joints. Avoid the reverse AC@ finish (where the back is hyperextended), which is more harmful to your back. Finish your swing in a more upright posture.(6) Consider techniques that involve less spinal rotation, such as taking a 3/4 back swing, or the Anatural golf@ technique developed by PGA pro Moe Norman.

3. Maintain proper posture while being bent over to strike the ball, putt, and even when bending down to pick your ball up. Keep your normal lordosis (backwards curvature) by bending at the hips rather than at the spine. When putting, think of maintaining the hollow in your back and avoid hunching over the ball. When bending down to pick up your ball or clubs, bend with the knees and use your legs rather than your back.

4. Warm up with some light movement and stretching prior to your round. When you go to the driving range, start with your shorter clubs (such as your nine iron) that you tend to take shorter and easier swings with. Start with some easy half swings and work up to a full swing. Gradually work up to your long irons and woods.

5. Use a pull cart rather than carrying your clubs.(7) Carts are not as Ahip,@ but they avoid the spinal compression associated with strapping your clubs to your back for four or five hours. Walking with a cart is good exercise and is preferred over riding in an electric cart. Sitting and bumping up and down over the bumps of the course in a cart may not be the best thing for your back.

6. Take some swings in the opposite direction every few holes to even out the stresses to your spine.

7. Consider using a long putter as this avoids the bent over position in conventional putting that is so stressful on the back. When bending over your putts, bend at the hips and not at the spine. That is, do not hunch over and round your back.

QUESTIONS:

1. What about golf techniques that involve limited rotation of the spine, such as the natural golf swing? Are these safer for the back and are they recommended?

Such swing techniques appear to be less stressful on the spine. But you will sacrifice quite a bit of distance and with today=s longer courses, this may decrease your enjoyment of the sport. On the other hand, if you are able to hit the ball straighter, it may be worth the tradeoff. And if you don=t miss any golf due to fewer lower back problems, then it is certainly worth it. But you might try perfecting your conventional swing with the help of a teaching PGA pro. Despite hitting the ball much further, pros put less stress on their spines than amateurs.

2. If I hurt my back playing golf, what should I do?

As soon as you get home, you should put some ice on your back for approximately 15 minutes to reduce the inflammation. After you strain the tissues to the point where pain occurs, inflammation (microscopic swelling) starts to build up. This will increase the pain. Ice can help to minimize the amount of the inflammation.

You should see a good sports chiropractor or sports medicine physician as soon as possible after the injury. Let your physician help you decide when it is o.k. to go back to playing golf. When you do go back, you might try some analgesic balm on your back prior to the round to help keep your back warm. Make sure to warm up and stretch both prior to and during the round. Put some ice on your back after the completion of your round.

3. What about the back braces with magnets in them?

There is no research to show that magnets can help your back. In fact, there is very little research to back up the benefits of magnets for any injury. On the other hand, it is unlikely that putting a magnet against your back can cause you any harm either. Except for the $80 price tag. You would be better off going to a sports chiropractor or physical therapist and getting a back exercise program to do on a daily basis. This will quite likely help you with your chronic back problem much more than magnets.

REFERENCES:

1. McCarroll JR, Gioe TJ. Professional golfers and the price they pay. Physician and Sportsmedicine. 1982. 10:64-70.
2. McCarroll JR, Rettig AC, Shelbourne KD. Injuries in the amateur golfer. Physician and Sportsmedicine. 1990. 18:122-126.
3. Stover CN, Wiren G, Topaz SR. The modern golf swing and stress syndromes. Physician and Sports Medicine. 1976; 4:43.
4. Kelsey JL, Githens PB, White AA, et al., An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. Journal of Orthopaedic Research. 1984; 2:61-66.
5. Farfan HF, Cossette JW, Robertson GH, et al., The effects of torsion on the lumbar intervertebral joints: The role of torsion in the production of disc degeneration. The Journal of Bone and Joint Surgery. Vol.52A: 495.
6. Fischer B., Watkins RG. Ch. 47: Golf in The Spine in Sports. New York: Mosby: 1996, p.505.
7. This tip and some of the others were suggested by Dr. David Stude at his Biomechanics of Golf seminar given San Diego on April 17 and 18, 1999.