Golf and Your Back: Making Them Compatible

by Lawrence W. Frank, M.D.

Golf is a game of both fun and frustration. For patients with low back pain, frustration may not only come from the normal challenges of the game, but also may be compounded by back pain. At CINN, we realize that patients recovering from back problems not only wish to be free of pain, but also wish to return to enjoyable activities, such as golf.

Golf requires significant motion of the back and neck. For golfers with back problems, it is best to analyze the golf swing with emphasis on the various stresses placed on the spine during phases of the swing. The golf swing can be broken into phases including the address, top of swing, impact, and follow through.

Addressing the ball requires the golfer to bend slightly over the ball with the back, hips, and knees slightly bent.

At the top of swing, the head is still over ball, with full rotation of shoulders, thoracic spine and lumbar spine. Heels are on the ground.

At impact, the head is over the ball, the spine is bent sideways, and the club contacts the ball.During the follow through, the head points toward the trajectory. The back is fully rotated and arches.

As is clearly seen, the golf swing takes the spine through almost its entire range of motion. In fact, the power and accuracy of the swing depends on the storing and releasing of energy by the entire body, with the spine being an essential transmitter of energy from the ground to the club head.

If the spine is not capable of properly transmitting this energy, both pain and a bad shot will result. Problems with the lumbar spine may entail pain emanating from the discs, joints, or muscle. Abnormal spine curvatures including “sway back” or “flat back” and poor strength of muscles such as the abdominals and gluteals (buttocks) may also impede a proper shot. Abnormal motion of the hips and knee may also result in excess stress to the spine during the swing.

The treatment of acute back injury may involve the usage of anti-inflammatory medicines or muscle relaxers, if appropriate. Additionally, treatment with RICE (Rest, Ice, Compression, and Elevation) may be helpful for a low back strain or sprain caused in the course of golfing.

For golfers with chronic back pain, the cornerstone of treatment is always a specific therapeutic exercise program. Goals of such an exercise program include flexibility and muscle strengthening exercises, as well as endurance training for the entire body. Exercises are initially performed with the aid of specially trained CINN physical therapists, and a tailor made program is designed for each individual, depending on their diagnosis. Eventually, these exercises are performed independently by the golfer. The benefits of such an exercise program include independent control of symptoms, no toxic side effects, and prevention of further instances of pain and injury.

Certainly, if the problem is severe enough, the full complement of treatments for spine patients is available at CINN including fluoroscopically guided spinal injections, minimally invasive surgery, and innovative treatments including disc replacement surgery.

When returning to golf after a layoff due to back injury, slow and gradual is the rule. A warm shower and some pre-round stretching are always good advice for golfers of all ages and conditions. Putting practice and half swings with irons at the driving range is a good starting point, as these swings do not subject the golfer to extremes of spinal range of motion. Gradually lengthening the stroke allows the body to become accustomed to the stresses of the swing on the back.

When on the greens, use irons initially and try nine holes first. If your swing is still not where it needs to be, you may need to adjust your stroke. This is best done by working with a golf professional, ideally a professional with training in biomechanics of the spine.

Having a back problem does not preclude a golfer from returning to the game. At CINN we believe the only frustrations of returning to the links after a back problem should be those darn sandtraps!