From TPI (Titleist Performance Institute):
“Lower back pain is by far the most common ailment suffered by golfers of all ages. Based on data collected at TPI from over 31,000 golfers, 28.1% of all players deal with lower back pain after every round.”

Types of Back Injuries
There are a variety of back injuries ranging from damage to the nerves, herniated discs, degeneration of vertebrae, stenosis, arthritis, bulging discs, sprained ligaments and or muscles, inflammation…and the list goes on.  Severe injuries may need surgery or other medical intervention whereas others like disc degeneration and arthritis often result in chronic pain that is managed under the care of a medical professional.  Less severe (but sometimes equally as painful) injuries like muscular and ligament inflammation or strains and sprains can come and go with activity or flare up under certain conditions.  

It’s important to know the source of a back injury – don’t ignore pain!  Having an understanding of where your pain originates allows it to be managed correctly.  Arthritic, nerve and disc injuries should be managed under the care of a medical professional who gives you guidance and restrictions (if needed) so your injury is not further exacerbated.  

Causes of Lower Back Pain – General
In the absence of one of the previously mentioned severe forms of injury, the pain you may experience in the lower back is often “referred” pain.  Remember, in the body everything is connected.  If you imagine the human body is like a chain; each link is connected and impacted by the others.  If one part of the chain is deficient, the others parts of the chain experience more stress. and do more work than when all links in the chain are doing their job.  Referred pain is the result of reduced flexibility, mobility or strength or an imbalance in another part of the body that manifests.

Limitations in one part of the body lead to compensations in other parts of the body..often the lower back.  The most common limitations related to back pain are weakness in one set of muscles combined with tightness in the opposing set of muscles.  This combination of weakness/tightness can lead to recurrent injury and severe pain that can feel unbearable – even when the injury does not need a surgical intervention.  And while this type of pain may come and go without the need for intervention, it can result in scar tissue and adhesions which can further limit your mobility and often lead to chronic pain (now your back pain doesn’t seem to ever really go away).

The best plan is to understand the origin of your pain and have a plan for either eliminating it permanently or managing it using the guidelines of a medical professional.

Causes of Lower Back Pain In Golfers
Muscular Imbalances Tightness on one side of the body combined with weakness on the opposite side.  Lower Cross Syndrome (LCS) is a medical term used to describe an extremely common source of back pain in the L4-L5 area.  LCS is the result of tightness on one side of the body (hip flexors and thoracolumbar extensors) combined with weakness on the opposite side (deep abdominal muscles and glutes).

Posture Deficiencies – Poor posture in daily life often translates into poor golf posture. Often the result of weakness in the glutes, core, neck and upper back.

The most common postural deficiencies are the “C” or “S” pattern in the spine.  Both of these posture can result in rotational movement in the lumbar spine instead of the hips and thoracic (mid) spine which is where it is supposed to occur (too much movement at the wrong link in the chain because of a restriction in another).  Rotation of the lower back causes pain because the lumbar spine is not designed to rotate, only to flex and extend.

Poor Motor Patterns– There is an ideal order for muscles to fire to move body parts but alternate patterns can also develop as protective mechanism or a limitation in mobility.  When a new pattern occurs, the lumbar spine moves differently (less than ideal) because different muscles are firing or they are firing out of order.

Poor Swing Mechanics The three previously described causes of back pain often result in compensations during the swing.   Physical training, and treatment that allows for the management and healing of injury can restore proper motor patterns and allow you to implement proper swing mechanics that keep you free from golf related back pain.


Managing Back Pain
Muscular injuries such as strains, pulls or chronic soreness should focus on controlling inflammation and allowing time for healing.  Once healing takes place, you can work to restore proper function.  If you have disc or nerve issues, I encourage you to seek the help of a medical professional.  Typical treatments include some combination of:

Manual Therapy – Chiropractic, physical therapy and massage to reduce recovery time and stimulate the healing of muscle and ligament strains and sprains.

Cold Therapy – Apply ice to reduce inflammation and potentially relieve muscle spasms.

Heat Therapy – Apply heat to increase blood flow and temporarily reduce stiffness, pain and spasms.

Acupuncture – A professional treats various points using the insertion of thin needles.

Rest & Recovery – Often, muscle strains just need a few days of rest.  Be aware, unless it is excruciating to move, you should not remain 100% bedridden.  Light activity (e.g. walking) while avoiding shoveling, lifting or anything else strenuous will facilitate the body’s healing mechanisms.

Medications-  Anti-inflammatory and muscle relaxant medication should be regarded as a last resort.  While these medications can be helpful in reducing inflammation and muscles spasms (and therefore pain), they do not fix the damaged tissue that resulted from the injury.

Exercises For Preventing Back Pain
If you are someone that deals with chronic or golf specific back pain it’s likely there is an explanation for why this problem re-occurs.  You have likely developed a habitual way of moving joints, ligaments and muscles in a different manner than they were designed for, and this has lead to a chronic issue.  This is called an altered movement pattern.

Core Strength Exercises

  • transverse abdominis activation
  • plank
  • side plank
  • hip rotations

Lower Body Flexibility

  • single leg to chest
  • pretzel stretch
  • hamstring stretches (standing & lying hamstring/downward dog)
  • piriformis stretch

T- Spine Flexibility & Mobility

  • Twist stretch
  • Reachbacks – Quadruped with ER
  • A-frame stretch
  • Helicopters, Standing Reachback & Windmills

Glute Activation Exercises

  • hip lift
  • figure 4 hip lift
  • squat

References

  1. http://www.mytpi.com/articles/health/the_golfer’s_guide_to_lower_back_pain_part_1
  2. http://www.muscleimbalancesyndromes.com/janda-syndromes/lower-crossed-syndrome/#sthash.ILoADuhg.dpuf