Michael Edwards: Low Back Pain – A Golfer’s Nightmare

This is sponsored content from Shore Golf Performance.

We’ve all heard that before! The chances of a golfer having low back pain (LBP) at some point in their career is about as high as Tom Brady having another career best year in passing yards and TD’s. The chances are high! So, why is LBP one of the most common issues with golfers? Well, for many reasons which we will dive into in this article.

For the purposes of understanding, and an easier read, we are going to assume that we are talking about a right-handed golfer since that is the majority of players. You know what!? In my last blog post, I talked about how following the majority and the norm isn’t always in our best interest. So, let’s go against the norm and assume the player we are talking about in this article is a lefty. I know a guy nicknamed “Lefty” and he definitely went against the norm and pocketed at least $200,000,000 (yes that says 200 million dollars!) simply to show up, not perform. That’s a conversation for another article!

Michael Edwards

Okay, in all seriousness, let’s assume righty. Your thought process while reading this will thank me! Mine will too!

Recently, Will Zalatoris had to pull out of the Tour Championship with 2 herniated discs which ended his run at a chance to win the FedEx Cup and the coveted $18,000,000 prize. I’d say he still did pretty well by cashing in at $500,000.  

So, what is it about LBP in golfers!?

Well, one of the main reasons, if not the most important, is the fact that your golf swing is a by-product of your biomechanics. If your biomechanics are off, and physical limitations are present, then you are 100% guaranteed to alter the way you move. These alterations in movement patterns then predispose you to injury, unless you swing within your limitations. Even then, risk of injury is still high.

I always say that the body is a master compensator. It’s going to find some way to get to the top of the swing. So, the question becomes “what compensations had to occur in order for you to get to the top of your swing, down to impact, and into your follow-through?” Did you sway, slide, early extend? If so, I definitely have some usual suspects I guarantee are playing a role in these swing faults.

So, let’s say you come to visit me with right LBP, you are a right-handed golfer, and the pain is reproduced every time you play golf (and likely with other activities, too). There could be many underlying physical limitations that could be contributing to your pain. Areas of focus I would want to screen, evaluate, and assess include: 

1.   Right and left hip mobility, specifically internal rotation (IR) of each hip,

2.   Right and left hip strength AND stability,

3.   Right thoracic spinal rotation (which is made up by many factors that we’ll touch on in a later article).

Another point to note is that the player may not know how to properly load into their hips at the top of their swing or at impact or they may not even be aware of what positions they should be in throughout the golf swing. I can definitely help with the former, but the latter on the other hand I would refer you to the PGA teaching professional. Their knowledge of the golf swing and their understanding of the relationship between the body and club throughout the swing is priceless if you truly are looking to invest in improving your game. I work alongside a great one named Todd Campbell. Check him out.

For all my non-golf people reading this, thanks for getting this far. Beware though, the biomechanical golf nerd is about to come out.

For this article we are going to highlight the first point… hip mobility. We will touch on the others in future articles.

Let’s talk hip mobility. The hip joint, like the shoulder joint, is a ball-and-socket joint meaning that it has many degrees of freedom and can access multiple planes of motions. For example, the hip moves internally and externally (transverse plane), through flexion and extension (sagittal plane), and through abduction and adduction (frontal plane). Now, think about around that ball-and-socket joint is a joint capsule which provides stability for the joint and prevents the ball from dislocating from the socket. Joint capsule mobility, or how “elastic” the joint capsule is when accessed or stressed via movement, is imperative for full range of motion (ROM) to occur.

In regards to the golf swing, the right-handed golfer needs adequate R hip IR in order to properly load into the hip and get to the top of the backswing. See, when you rotate into your backswing your pelvis is actually rotating over your stable femur/ thigh which passively is creating IR. In other words, your femur is going internally in relation to your pelvis as you rotate into your backswing.

“What’s adequate hip IR ROM,” you are probably thinking. Well, we are looking for at least 30 degrees, but 40 degrees is really nice. “How do I figure out what my IR ROM is?” Well, check out my recent workshop (link below) and see how!

Let’s say you have 10 degrees of R hip IR active range of motion (AROM) and 20 degrees of passive range of motion (PROM). 

“Wait, what!? You threw ROM and IR at me and now you’re throwing AROM and PROM at me too!?”

Yes! You’ll be fine! Until I drop this little nugget, maybe. If you only have 10 degrees of AROM, but I can passively get you to 20 degrees then we call that a stability motor control dysfunction.

“Say what!?”

In this case, your hip has access to 10 more degrees of ROM, however your body can’t actively access it because you haven’t “owned” those extra degrees. In other words, there is likely not many things you do on a daily basis that requires you to access that range.

Now, in the golf swing you passively access that ROM due simply to your weight and momentum taking you into your full available range (thus accessing your PROM). This is where potential injuries may occur. If you can’t actively access this range in a non-loaded position, how do you think your body will hold up when it is forced into that position under load such as in the backswing. This is typically where compensations occur and, you may have guessed it, injury. 

This goes for both your backswings and your follow-through. At impact and follow-through, the same is true, only now it’s your left hip. If you lack mobility or stability in your left hip then subconsciously your body isn’t going to want to load into your lead side which can lead to a multitude of compensations/ swing faults with the most common being sliding, hanging back, and early extension. 

Therefore, having the needed hip mobility and stability requirements that the golf swing demands will minimize your risk for injury. Also, knowing how to properly load into your hips at the top of your backswing, down into impact, and into your follow-through will further decrease your risk of low back pain and/ or any other injury.

If you found this helpful, please share with others and as always you can reach out to me via various ways and platforms noted below! I would love to connect with you and help you anyway I can!

About Edwards

Edwards is a Doctor of Physical Therapy who recently moved from North Carolina where he has practiced for 5.5 years. 

He is an orthopedic physical therapist who specializes in golf injury rehab and prevention/ performance. He is TPI Medical 2 certified and certified in dry needling. 

Edwards has worked with golfers of all ages and skill levels, from juniors to recreational golfers to even PGA professionals. 

He is a proud supporter of the Rex Hospital Open and the Korn Ferry Tour where he served as a physical therapist for the players in 2019 and 2021.

Leave a Reply