Golf is a popular sport that many people gravitate to with the idea that it’s leisurely. Images of the sun, beautiful green grass, and even cruising from hole to hole in a golf cart belie the fact that many injuries can develop from playing the game. Unfortunately, too often players have to throw out their clubs due to common injuries, like golf back pain or wrist issues. This may come as a surprise to those who fail to regard golf as an athletic endeavor. The numbers beg to differ! Rotational forces, impact stresses, overuse, inadequate warm-up, poor mechanics, bad posture, inflexibility, and pre-existing orthopedic conditions all appear to increase the incidence of musculoskeletal injury in golfers of all ages, sex, and ability level. Here’s what causes these injuries and how you can avoid these issues.
What are the most common golf injuries?
Despite the possibility of injury that exists with sports, as it does with all types of physical fitness, golf continues to attract a growing number of players. There are tens of thousands of golf courses across the U.S., and nearly 28 million people who consider themselves golfers. About 13 million adults are considered core golfers, which means they play more frequently, according to the American Orthopaedic Society for Sports Medicine (AOSSM).
On average, golfers play about three times each month. And during each of those rounds, a golfer will attempt up to 70 violent swings every five minutes. Each swing can reach up to 100 miles per hour. Combine the high velocity with often-poor posture and swing mechanics, a lack of flexibility, and equipment that doesn’t fit properly, and the likelihood for injury or golf back pain is high.
Common golf injuries include:
- Lower back pain
- Knee pain
- Elbow tendinitis
- Rotator cuff injuries
- Wrist sprains or strains
- Neck sprains or strains
- Injuries to hands or fingers
- Hip pain
- Ankle injuries
Why do golf injuries develop?
The sheer action of swinging a golf club, which happens countless times during the course of a game by players who don’t necessarily have the ideal amount of hip and back flexibility, can create pressure and result in golf back pain, one of the more common golf-related injuries.
The force of impact when a golfer misses the ball and instead strikes the ground can also set the stage for injury. Meanwhile, some golfers carry their own bags, and this can result in back, shoulder, and ankle pain.
Elbow injuries are the second most common for golfers, according to AOSSM. These are related to poor form while swinging, which can result in hitting the ground before striking the ball or over-swinging. Frequent golfers and older ones are most at risk for elbow pain.
Wrist pain is also common, especially among professional golfers, however this type of pain can develop in anyone. Most times, wrist pain results from overuse.
Shoulder injuries may develop from using muscles that aren’t warmed up yet. Shoulder muscles used during golf include the rotator cuff muscles, pectorals, and latissimus, also known as the lats.
What about golf back pain, specifically?
When evaluating back pain in golfers, one can look first at severity of injury. Men with pre-existing lower back pain are more likely to experience disabling pain from golf. A study in the American Journal of Sports Medicine looked at severity of injury in 526/703 golfers. During a two year time period:
- 82.6% reported overuse injuries
- 17.4% reported single traumatic injury events
- 51.5% of injuries were mild
- 26.8% were moderate
- 21.7% reported severe injuries
An interesting fact was the number of injuries attributed to carrying one’s golf bag! So, why do golfers hurt their backs other than carrying a golf bag? The most obvious reasons among amateurs are poor posture, poor technique, and inadequate warm-up, while professionals are more likely to experience pain due to overuse or subtle imbalances in core muscles or lack of lumbar pelvic flexibility.
The force of the game
Air swings on the first tee are the most common form of warming up, but force studies reveal this is a bad idea.
The compression force on the left leg at impact during this is often two-three times a person’s body weight. Those who straightened the knee just prior to impact have tremendous shear forces transmitted through the knee. Higher forces correlated directly with increased distance. In addition to substantial ground reactive forces acting on the lower extremities, there are forces acting directly on the lumbar spine due to axial rotation, compression, lateral bending, and shear. Flexion, rotation, and lateral bending are the most common biomechanical forces associated with lumber disc herniation and injury to lumber facet joints. It should come as no surprise then, why golfers with pre-existing back conditions find golf painful.
If you still don’t believe golf is an athletic sport, consider this: biomechanical studies show that your lumbar spine can sustain compression loads upwards of eight times your body weight during a golf swing. Various studies estimate these forces at almost the same level as an NFL lineman hitting a blocking sled!
Those forces are in the range of 6000- 8000n. Cadaver studies reveal lumbar disc prolapse can occur at force levels below 6000n. Compression is not the only form of stress. Anterior to posterior shear on discs has been measured at 500-600n during a golf swing. Forces of that magnitude on cadavers can actually fracture facet articulations. Pain management centers treating low back pain see a lot of patients with lumbar facet disease, including golfers for this very reason.
What golf back pain looks like
The facet joints play an important role in load transmission and stabilization of motion segments in flexion and extension. Facet joints also restrict your ability to rotate. Pain can originate from the joint capsule, subchondral bone, and joint synovium. Degenerative changes in the facet joint with associated deterioration of joint cartilage lead to development of erosions and joint space narrowing, further restricting pain free range of motion.
Golfers with spine stiffness typically overcompensate with exaggerated motions that actually lead to further stress on and deterioration of those joints.
Degenerative disc disease causes further narrowing of disc spaces, placing more weight-bearing stress on facet joints. This predisposes the aging golfer or the younger golfer with a pre-existing injury to golf back pain either during or after the game.
If you have pain during back extension and lateral bending to one side or the other, you have an increased risk of back pain playing golf.
What can you do to avoid golf back pain?
Assuming you do not have a medical condition that stops you from swinging a golf club, studies are clear where to start. Warm up before you play. Shorten your swing. Bend from the hips, not the back. Maintain a “neutral” curve in the lumbar spine. Keep your head and neck in alignment with your spine. Rotate your shoulders around a fixed spine angle. Work on hip and spine flexibility and core strength. Here’s how to reduce the risk of injuries and golf back pain.
1. Warm up
Warming up before starting the game is one of the simplest, most important ways to reduce the chance of injury. However, 80% of golfers spend less than ten minutes preparing their bodies for the game, according to AOSSM.
Try this warm-up, which starts off with stretching the low back by squeezing alternate legs into the chest. Then, interlace your fingers and send the palms up to the sky, stretching the shoulders. Take your time, breathing deeply and really opening up the muscles while encouraging blood flow.
Warm up the spine with a few twists. Take a club and rest it behind your neck, along the shoulders. Grab each end of the club and twist the torso, as you would while swinging. Be sure to engage the core. Hold the top of the stretch at the maximum range of motion for a few seconds before turning toward the other side.
Stretch the hamstrings with a few toe touches, bending the knees as much as necessary to keep a pain-free range of motion. Also take a few practice swings, focusing on proper alignment.
It’s also a good idea to extend and flex the wrists. Take one hand and bend the palm toward the inside of your forearm, gently pressing with the other hand. Then, bend the wrist the other way, so the palm faces in front of you, while gently pressing the hand backward with the opposite hand. Repeat on the other side, holding each portion for about ten seconds.
2. Exercise to improve the game
Golf uses a specific set of muscles in a combination that’s not typically used in other sports or areas of life.
Improve your game and protect your health by building core muscle strength. Exercises like holding the top of a pushup, known as a plank, are both gentle and strength building. Strong core muscles, including those in the back, support the entire body and protect against injury.
Stretching the shoulders and hips when off the course also helps to improve mobility and reduce strain that occurs while swinging the club. Including a few gentle spinal twists in your routine to improve back flexibility also prepares the body for swinging and is a good balance for core strength building exercises.
3. Wear proper equipment
It can be worth the time and investment to make sure your equipment fits your body. Simple things like using a longer putter can reduce stress on the back and encourage a more upright posture when swinging. Equipment that fits well encourages proper form when swinging.
4. Take golf lessons
If your pain interferes with consistency of play, take lessons! You will be amazed at all those bad habits that reflect your unconscious adjustments to accommodate pain.
Not only will this improve your game, but also markedly reduce the risk of injury. Golfing with proper form reduces the toll the game takes on your muscles and ligaments.
Since you can’t watch your swing, it’s a good idea to learn from someone who can, someone with the expertise to offer modifications and help you learn what good form feels like so you have the ability to self-correct later on.
5. Figure out your flexibility
Biomechanical studies of the golf swing clearly establish flexibility is more important than strength. Studies in back rehabilitation indicate core muscle strength is important, but not as important as core muscle endurance. Researchers of this opinion base it on the fact muscle strength is not a reliable predictor of who will have future back pain. Studies of core stabilization conclude that muscular endurance is more protective of the lumbar spine than muscle strength.
Your best bet is to get a professional assessment of your back and your golf swing. However, in the meantime, here is a quick way to assess your golf flexibility:
- Stand upright and place your driver behind your back along your spine from buttocks to head
- Holding the driver in place, bend forward from the hips maintaining contact between the driver and your spine until you feel a stretch in your lower back and buttock muscles
- Knees should be approximately 15-20 degrees of flexion with weight balanced over toes, not back on heels
- Your straight spine should be flexed forward at the hips about 30 but no more than 40 degrees
- The neutral position of the lumbar spine in this posture is defined as a slight extension, not forward flexion
This is your basic athletic position from which to rotate around a fixed spine. If you are unable to rotate so that your left shoulder points at the ball in the middle of your stance (90 degrees), you need to either work on flexibility or consider another hobby! If unable to accomplish this, you will either be tempted to get by with bad mechanics.
6. See a doctor early for golf back pain
If you’re feeling pain or dealing with a nagging injury, see a doctor. Getting proper treatment early in the injury helps it fully heal. Seeking attention early also means injuries will respond to more gentle treatments. If your golf back pain is constant, see a competent physician with expertise in spine care. If pain is episodic only when playing golf, see a therapist or trainer knowledgeable in golf biomechanics and get started on an exercise program tailored to flexibility and strength for golf.
You may even respond well to visiting a physical therapist who can address your body’s specific muscular imbalances, offering a customized set of exercises to keep you in tip-top shape.