Golf and Low Back Pain

Golf is a favorite sport and pastime among many. However, the torque and force applied across the lower back pain creates a significant risk for developing or worsening lower back pain. People who suffer from chronic or recurrent episodes of low back pain can be frustrated because the pain hinders their ability to play golf.

The Golf Swing Stresses the Lower Back

The force, torque, and twisting of structures in the lower back creates a significant risk of injury to the lower back. The swing of a golf club naturally involves an incredible amount of force from only one side of the body, unevenly placing pressure on the spine. During a golf swing, the lower back sustains a compressive force of ¹ Gluck GS, Bendo JA, Spivak JM. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine J. 2008;8(5):778-788. doi:10.1016/j.spinee.2007.07.388 :

• About 1370 pounds for amateur golfers
• About 1700 pounds for professional golfers

For comparison, college football players experience a compressive force of about 1950 pounds while hitting a football blocking sled. ² Gatt CJ Jr, Hosea TM, Palumbo RC, Zawadsky JP. Impact loading of the lumbar spine during football blocking. Am J Sports Med. 1997;25(3):317-321. doi:10.1177/036354659702500308 Approximately 1220 pounds of force are needed for a disc to herniate. ¹ Gluck GS, Bendo JA, Spivak JM. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine J. 2008;8(5):778-788. doi:10.1016/j.spinee.2007.07.388

Mechanics of incorrect swing techniques and habits that pose a risk to the spine include ¹ Gluck GS, Bendo JA, Spivak JM. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine J. 2008;8(5):778-788. doi:10.1016/j.spinee.2007.07.388 ^{, 3} Lindsay DM, Vandervoort AA. Golf-related low back pain: a review of causative factors and prevention strategies. Asian J Sports Med. 2014;5(4):e24289. doi:10.5812/asjsm.24289 :

• Bending too far to the trailing side during the forward swing, placing excessive force on the trailing side
• Prolonging the swing by rotating the body beyond its range of motion, increasing the risk of injury
• Engaging muscles inadequately or engaging the wrong muscles, making the muscles prone to tearing
• Rotating the leg inward at the hip with a narrow range of motion, risking injury to the hip
• Having weak core muscles, increasing the risk of muscle strain
• Playing golf for extended periods of time, leading to muscle fatigue

Simple solutions to address these risk factors will prevent or reduce episodes of back pain. For example, learning the mechanics of the swing helps players with any level of experience in golf. Professionals are usually available for assistance at golf courses.

Symptoms of Golf-Related Low Back Pain

Symptoms may arise gradually or suddenly, and may include one or more of the following:

• Dull ache on one side of the lower back. Lower back pain from golf may be felt on the right side for the right-handed golfer and the left side for the left-handed golfer. The trailing side typically experiences the greatest force during the swing.
• Pain that extends to the hip or thigh. Common spinal disorders, such as facet joint syndrome or sacroiliac joint dysfunction, can be exacerbated by golfing and result in additional dull pain below the lower back.
• Nerve pain in the leg. Sharp, electric pain or numbness can occur in the leg when a herniated disc presses on a nerve.
• Stiffness in the lower back. Low back pain often limits the range of motion in the lower back and/or the hips, leading to difficulty with bending or walking uphill.
• Lordosis. The natural inward curve of the lower back can deepen when core muscles are strained. Such an arch leads to worsening low back pain.

 Weaker core and pelvic muscles that are the source of low back pain can be identified by accompanying symptoms. For example, the transversus abdominis (TVA) lies deep in the abdomen and envelops the left and right flanks in the lower back. Low back pain from a weak transversus abdominis may coincide with a slouched posture, weak balance, or a bulge in the stomach when performing abdominal exercises.

See Lower Back Muscle Strain Symptoms

Golf-related pain is not limited to the lower back. Middle back (thoracic) pain from golf and upper back pain from golf may also occur without warning, even on the golf course. The sudden pain may be described as sharp or stabbing, and is usually a result of overworked muscles. Pain in the middle or upper back may be related to an overworked erector spinae, a set of 3 muscles that start near the sacrum and run upward along the sides of the vertebral column. When faced with physically demanding movements, the erector spinae compensate for weakness in the larger core muscles and lower back muscles, and are prone to muscle strain anywhere along the back as a result.

See Causes and Diagnosis of Lower Back Strain

Health Benefits of Regular Golfing

For avid golfers with recurring episodes of back pain, continuing to play the sport is usually possible and, when done correctly, can be an excellent part of an ongoing exercise program.

Benefits of playing golf include:

• Improved cardiovascular health. ⁴ Murray AD, Daines L, Archibald D, et al. The relationships between golf and health: a scoping review. Br J Sports Med. 2017;51(1):12-19. doi:10.1136/bjsports-2016-096625 Golf makes an excellent low-impact aerobic exercise, which is often recommended for individuals with back pain. The average golfer may have a driving distance of about 200 yards, which is the size of 2 football fields. So, by the time the course of 18 holes comes to an end, players have usually walked 3 or more miles.
• Fresh outdoor air. Older adults in particular may relish golf as an outdoor activity. Golf is a way to exercise outside of a stuffy, crowded gym and to enjoy time outside of the house. Naturally, the fresh air helps with reducing anxiety and depression, and the sunlight exposure provides much-needed vitamin D.
• Social interactions. The sport can be enjoyed as a family, group of friends, or business. Golfers that arrive at the golf course alone have the ability to join other groups and find new company, as well.

Many golf enthusiasts find that the health benefits of golf outweigh the risk of back pain, which can be managed and even prevented.