Treating Low Back Pain and Back Injury from Golf

Treatment options are mainly guided by the type and the severity of the injury that is sustained in the lower back. Three common types of injury from golf that need treatment include:

• Muscle strains. Rough, forceful golf swings or sudden shifts during the downswing can lead to strained muscles.

  See Pulled Back Muscle and Lower Back Strain

• Muscle and tendon attachment. Excessive muscle use, accidents, or swing irregularities tend to cause this type of injury.
• Disc injuries. Swing irregularities aggravate pre-existing disc problems, leading to disc injury.

Treatment for the above common sources of golf-related pain usually includes a focus on relieving the acute pain and rehabilitation to prevent future injury.

Pain Relief After Low Back Pain Occurs

For relief of the acute pain and to promote healing from golf-related muscle strains and low back pain, it is generally advisable to rest for a day or two, apply heat and/or ice, and take pain medication.

• Ice packs decrease inflammation from overworked muscles and are often used immediately after exercise or onset of pain, for about 15 minutes at a time.
• Rest from pain-inducing activities will allow the muscles to heal quickly. It is generally not advisable to further stress inflamed muscles by continuing to play golf through an episode of low back pain. However, excessive rest beyond 2 days can prolong recovery.
• Hot packs soothe muscle tension and are best used after a day or two of rest, for about 15 minutes at a time.
• Non-steroidal ani-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen help decrease inflammation.
• Acetaminophen may be taken in conjunction with NSAIDs to help reduce low back pain and other types of pain.

Deep tissue massage and acupuncture by trained professionals are additional options for reducing low back pain for tense or strained muscles, after initial pain relief is achieved with ice, heat, or medication.

• For more in-depth information, see The P.R.I.C.E. Protocol Principles on Sports-health.com.

Gentle Stretches for Flexibility

Routinely performed stretches provide flexibility in the key muscle groups involved in turning and twisting forces. Individuals with chronic low back pain tend to lose flexibility, and if a stretching program is not maintained on a daily basis, the resulting loss in flexibility will lead to further low back pain.

The following stretches can be performed in between golf sessions. To work on the hip, stretch the hip flexor:

1. Kneel one knee on a pillow or pad on the floor, with the opposite foot about 6 inches ahead of the pillow.
2. Extend the hip of the kneeling side backwards, while shifting the body weight forwards onto the opposite leg. Allow the hip to fully relax.
3. Hold for 10 to 15 seconds and repeat 7 to 10 times for each leg

The stretch will be felt in the front of the leg that is kneeling. Position the foot farther away if the stretch is felt in the wrong leg.

Stretching the hamstrings also helps hip mobility. To stretch the hamstrings:

1. Lie in an open doorway, keeping one leg flat on the floor and the other leg stretched up against the doorframe
2. Gradually straighten the knee against the doorframe
3. Hold for 10 to 15 seconds and repeat 7 to 10 times for each leg

The stretch will be felt most in the back of the leg and the calf.

Hip flexibility is important to the golf swing, as is the rotation of the upper back. To practice the correct rotation of the torso:

1. Hold onto a large exercise ball with both hands
2. Replicate the motion of a golf swing, keeping the abdomen tight and engaged
3. Focus on turning only the upper back portion of the spine
4. Turn the hips (not the lower back) during the follow-through
5. Repeat until comfortable and try the drill with a golf club

Stiff hips force the body to rotate from the lower back instead of the upper back. Thus, improving hip mobility and practicing upper back movements are both essential to reducing golf-related muscle strains in the lower back. Consider cross-training with yoga or Pilates to improve hip mobility and flexibility.

See Stretching for Back Pain Relief

Exercises for Muscle Strength and Endurance

Golfers with low back pain tend to rely more heavily on the erector spinae muscle before the swing, rather than on the transversus abdominis and the multifidus.¹Cole MH, Grimshaw PN. Trunk muscle onset and cessation in golfers with and without low back pain. J Biomech. 2008;41(13):2829-2833. doi:10.1016/j.jbiomech.2008.07.004 This tendency may be the cause of low back pain or may compensate for the weakness in the transversus abdominis or multifidus. It is important to resolve muscle imbalances by engaging and strengthening the right muscles.

To strengthen the abdominal muscles, including the transversus abdominis:

1. Lie on the back, keeping the knees bent and the feet flat on the ground
2. Engage the transversus abdominis by tightening the abdomen
3. Gently lower one knee towards the ground, without moving the pelvis or hip bones
4. Slowly bring the knee back to the original position and relax the abdomen
5. Perform the same exercise with the other knee
6. Repeat 5 to 10 times

To strengthen the multifidus and other muscles surrounding the spine, one effective exercise is the bird dog pose:

1. Start on the hands and knees, with the shoulders squarely over the wrists, the hips over the knees, and the face towards the floor
2. Engage the multifidus by tightening the abdomen, without moving the back or pelvis
3. Slowly lift one leg straight into the air, then lift the opposite arm
4. Hold for 5 seconds and repeat 3 to 5 times on each side

It may help to place a cushion under the knees.

In addition, staying well-conditioned aerobically lessens discomfort so that the game can be enjoyed. Low-impact aerobic exercise, such as walking or stationary biking, is gentle on the back and usually well tolerated for golfers with low back pain. It is recommended to perform aerobic exercises for 30 to 40 minutes a day, 3 days a week.

See Low-Impact Aerobic Exercise

When to See a Physician for Low Back Pain

A specific and definable problem may be the cause of the back pain, in cases of severe pain that interferes with daily life, or cases of low-grade pain that persists for more than 2 to 6 weeks.

Consultation with a medical professional will help identify the true cause and the best course of treatment. About 70% of injured recreational golfers seek treatment with a general practitioner, and 40% or more follow up with a physical therapist or a chiropractor.²McHardy AJ, Pollard HP, Luo K. Golf-related lower back injuries: an epidemiological survey. J Chiropr Med. 2007;6(1):20-26. doi:10.1016/j.jcme.2007.02.010