Lower Back Pain: The Definitive Guide for Golfers

Almost every golfer has experienced lower back pain.

In fact, according to the Titleist Performance Institute, it’s something that nearly 30% of golfers experience after every round.

So, what makes lower back pain the most common injury in golf?

Unfortunately, the repetitive and asymmetric nature of the golf swing creates inherent risk to the lumbar spine (lower back).

The result is often tight, painful muscles that can eventually lead to serious conditions such as disc bulges, arthritis, stenosis, and more.

But that doesn’t mean injury to your back is inevitable. There are things we can do to prevent and relieve lower back pain associated with golf.

How do I prevent lower back pain when golfing?

Even though pain might be felt in the lower back, the underlying cause of that pain is often elsewhere in the body.

In this article, we will look at those causes and how to fix them.

I will show you how to test yourself for mobility issues, and then give you exercises to do if you fail the tests.

We will also look at swing characteristics and lifestyle factors that might be contributing to your lower back pain.

By the end of this article, you will have a personalised plan to help prevent and relieve lower back pain.

Part 1: The top 3 physical causes of lower back pain for golfers

Alongside each of the causes of lower back pain listed below are movement assessments that you can use to test yourself.

Each assessment is shown in a short video tutorial where I take you through the process step by step.

When performing the movement assessments, I suggest you get a family member or friend to film you. What you feel is happening can be very different to what is actually happening so the visual feedback is helpful.

Cause #1: Lack of thoracic rotation

The thoracic spine is located in the upper and middle part of the back.

On average, each of the 12 thoracic vertebra can rotate approximately 3 degrees, meaning the entire thoracic spine is capable of rotating 30-35 degrees to each side.

The 5 vertebra of the lumbar spine (lower back), on the other hand, are only capable of rotating 2 degrees. The total rotation of the lumbar spine is just 10 degrees.

In other words, the thoracic spine likes to rotate and the lumbar spine doesn’t.

But, if the thoracic spine is unable to rotate, then the lumbar spine is forced to compensate, increasing the risk of lower back pain or injury.

As Bogduk describes in ‘Clinical anatomy of the lumbar spine and sacrum’:

Rotation of more than 3 ° at any lumbar segment could damage the articular surface and tear collagen fibers that make up the disc between each vertebra.

What this means for the golf swing:

If you lack thoracic rotation, you are likely to find extra rotation through the lower back, increasing your risk of pain and injury.

How to test thoracic rotation

This is a simple drill to test your thoracic rotation that has the added bonus of testing your pelvic stability. The upper body should be capable of rotating without the lower body moving.

How to improve thoracic rotation

If you are unable to comfortably rotate the upper body without the lower body moving, here are 2 exercises to include in your routine.

Exercise #1: Shoulder Rolls

Exercise #2: Torso Rotation Drill

Cause #2: Lack of hip internal rotation

Hip internal rotation is the twisting movement of your thigh inward from your hip joint.

For a right-handed golfer, the right hip travels into internal rotation on the backswing, and then the left hip travels into internal rotation on the follow-through.

If you lack internal rotation in either hip, then you may compensate by finding that missing rotation through the lower back, which increases your risk of pain and injury (as discussed in the previous section).

Alternatively, you may compensate with a Sway, Slide or both.

A Sway is any excessive lower body lateral movement away from the target during the backswing and a Slide is any excessive lower body lateral movement toward the target during the downswing.

Not only do these swing characteristics rob you of distance and accuracy, but the lateral forces they produce put the lower back at greater risk of pain and injury.

How to test hip internal rotation

According to the Titleist Performance Institute, the average amount of hip internal rotation for PGA tour players is 60 degrees.

You can test yours by following the assessment video below:

How to improve hip internal rotation

If you were unable to pass the above test, here are 2 exercises to include in your routine.

Exercise #1: Supine Knee Drops

Exercise #2: Lateral Hip Swings

Cause #3: Lack of core stability

Data from Trackman shows that the club speed of the average male amateur golfer is 93.4mph. This translates to compressive forces on the lower back of up to 8x body weight.

To protect the lower back from pain and injury, adequate strength and stability in the surrounding musculature of the core is therefore essential.

These muscles include the abdominals, obliques and glutes.

While core strength refers to the ability of these muscles to produce force, core stability refers to the ability of these muscles to keep your spine from moving during physical activity.

While core strength is important, lack of core stability, in particular, is linked with lower back pain in golfers.

If you lack core stability then the abdominals, obliques and glutes have a reduced capacity to protect the lower back during the golf swing.

How to test core stability

This is a great test for stability in the core, especially the glutes. The goal is to hold the bridge position with each leg extended for 10 seconds.

How to improve core stability

If you failed the above assessment, here are 2 great core stability exercises to include in your routine.

Exercises such as these have been shown to reduce chronic back pain by as much as 39%–76.8%.

Exercise #1: Glute Bridge March

Exercise #2: Quadruped Hold with Shoulder Tap

Part 2: 3 swing characteristics linked to lower back pain

I have to preface this section by stating that, while I am TPI certified and an avid golfer, I am not a swing coach.

Therefore, the advice here should not replace that of your golf pro.

With that said, these are the 3 swing characteristics that, according to the Titleist Performance Institute, are most likely to lead to lower back pain and injuries.

Characteristic #1: Reverse spine angle

According to TPI co-founder Dave Phillips:

“Reverse spine angle is the number one cause of lower back pain in golf.”

For a right-handed golfer, reverse spine angle is characterised by any excessive upper body backward bend or excessive left lateral upper body bend during the backswing.

From TPI’s article on reverse spine angle:

Reverse spine angle puts excessive tension on the lower back due to a forced inhibition of the abdominal musculature during the backswing, and excessive compressive loads placed on the right side of the spine at impact.

Reverse spine angle has a number of causes, but the 3 main ones are the physical limitations described earlier in this article: lack of thoracic rotation, lack of hip internal rotation and lack of core stability.

If you failed the 3 assessments, then there is a good chance you will have difficulty maintaining a proper spine angle when you swing the golf club.

If you exhibit a reverse spine angle when you swing the golf club, then working on the exercises from the section above should be a priority.

Characteristic #2: S-posture

S-posture is characterised by an excessive arch in the lower back at address.

This position inhibits the musculature of the core which places excessive stress on the structures of the lower back.

It can often be resolved simply by not sticking your butt out too far when you set up to hit the golf ball.

But, in other cases, S-posture will be caused by ‘Lower Crossed Syndrome’.

From TPI’s article on S-posture:

[Lower Crossed Syndrome] is basically the combination of tight hip flexors and a tight lower back, paired with weak abdominals and weak glutes. This combination leads to an excessive arching or rounding up your lower back (swayback), a flabby or protruding abdomen, and a flat butt due to weakness in the glutes. This is a very dangerous combination of muscle imbalances due to the excessive stress that it places on the structures of the lower back.

Exercises that can help with this include the core exercises listed in part 1 of this article and stretches such as this one for your hip flexors:

Characteristic #3: Hanging back

A common complaint amongst golfers is getting ‘stuck’ on their trail leg during the downswing.

This is known as ‘hanging back’.

Hanging back refers to a lack of weight transference onto the lead leg in the downswing, so that weight remains predominantly on the trail side through impact.

Not only does hanging back result in loss of power and inconsistent ball striking, but it also creates unnecessary torque in the lower back that can lead to pain and injury.

According to TPI:

The third most common swing characteristic that can lead to lower back issues is called Hanging Back. Hanging Back can force a player to excessively right side bend through impact. This can put added stress onto the right side of the lumbar spine and lead to lower back injuries.

While hanging back is sometimes the result of subconsciously trying to get under the ball, the root cause is often a physical limitation.

The main causes of hanging back are a lack of core strength and stability, particularly in the glutes, as well as limited hip mobility.

Part 3: Lifestyle and other factors that cause lower back pain

Back pain used to be regarded as something related to the nature and severity of an injury or anatomical issue, but now it’s clear that other factors play a role, too.

As Roger Chou, a back pain expert and professor, explained in an article for Vox:

“Our best understanding of low back pain is that it is a complex, biopsychosocial condition — meaning that biological aspects like structural or anatomical causes play some role but psychological and social factors also play a big role”

Factors associated with back pain include age, physical inactivity, smoking, and poor diet. There is also evidence that stress, sleep, alcohol consumption and even job satisfaction affect back pain.

However, the 2 factors that have the strongest association with lower back pain are obesity and depression.

Obesity

A 2010 review published in the American Journal of Epidemiology assessed data from 95 high-quality studies and concluded that the risk of lower back pain was directly related to increases in body mass index (BMI).

It is generally thought that excess weight in the midsection aggravates the lower back by shifting the pelvis forward, causing the spine to curve excessively inward.

For help building weight loss habits that stick, read this.

Depression

In a study that included 23,109 participants, researchers found that people with depression are 60% more likely to develop lower back pain in their lifetime.

While it is clear that there is a link between depression and back pain, it remains unclear why. One theory is that depression is associated with things like lower activity levels, stress and poor sleep which, as mentioned earlier, are linked with back pain.

Where both depression and back pain are present, effective treatment often involves a two-pronged approach to tackle both issues simultaneously.

Part 4: Frequently asked questions

Below are the answers to some of the most common questions I asked get about golf-related lower back pain.

Why does golf hurt my lower back?

Unfortunately, the repetitive and asymmetric nature of the golf swing creates an inherent risk to the lower back. If you lack core stability or mobility in the upper back or hips, the lower back is forced to compensate which increases the risk of pain and injury.

How do you strengthen your lower back for golf?

In addition to establishing sufficient mobility in the upper back and hips, the best exercises to strengthen your lower back for golf are core stability exercises. Examples of these exercises include single-leg glute bridges, bird dogs, and Pallof presses. Exercises such as these have been shown to reduce chronic back pain by as much as 39%–76.8%.

How do I stop my lower back from hurting when I play golf?

Lower back pain associated with golf can be prevented and relieved by improving core stability and restoring mobility in the hips and upper back. The top 3 errors in the golf swing that can cause lower back pain are Reverse Spine Angle, S-Posture and Hanging Back.

Should I play golf with lower back pain?

In general, physical activity can help relieve back pain while inactivity can delay your recovery. However, if swinging the golf club causes your back pain to worsen even after a golf-specific warm-up, then it would be wise to take a break from playing and work on your mobility instead.

Can golf aggravate lower back pain?

If you lack the ability to rotate through the upper back or hips, you are likely to find extra rotation through the lower back, increasing your risk of pain and injury. Lack of core stability is also linked with lower back pain and injuries in golfers.

Conclusion

Back pain can ruin your enjoyment of golf.

But, in most cases, it can be prevented and relieved.

While certain swing characteristics increase your risk of lower back pain and injury, the root cause is often a physical limitation.

With that in mind, the first step in addressing your lower back pain should be to check your thoracic rotation, hip internal rotation and core stability using the assessments in this article.

If you are lacking in any of these areas then the recommended exercises will help. 1 set of 8-10 repetitions in the morning and repeated again in the evening would be a good place to start (for exercises like Knee Drops and Glute Marches, do 8-10 reps on each side).

If you would like more help with your lower back pain or any other golf-related injury, then you can book a Golf Fitness Assessment with me.

To learn more and book now, click here.

Images

1. Photo by Courtney Cook on Unsplash
2. Thoracic vertebrae via Wikimedia Commons
3. Photo by James Provost on Flickr