Golfers & Low Back Pain

Part 3

Over the past couple of blog posts in this series, we have been examining low back pain prevalence in golfers, what can go wrong in your swing as a result, and how to begin recognizing there may be some underlying issues we need to address. In this blog post, we are going to look at two very common limitations I see in golfers and the general population, and how they can be identified and corrected.

Perhaps the most common issue I see in golfers and athletes is a lack of thoracic rotation and extension. The thoracic spine is your middle back and runs from the base of your neck down to your last ribs. This is so crucially important because nearly all of your spinal rotation comes from the thoracic spine. And we have already talked, in previous posts, about how this can influence your swing. The low back will always pay the price for your lacking thoracic spine mobility. When we are trying to get to the top of the backswing, and generate as much torque as possible, the thoracic spine must be fully rotated and partially extended to achieve this. If you do not have the prerequisite mobility, you will substitute with lumbar extension or sidebending – and this is bad news bears. We need the lumbar spine to stay stable and rigid to generate power. When it compensates, we lose.

How can you check your lumbar spine mobility for your swing? Easy! Follow these steps:

1. Grab your 6 iron and sit in a chair.

2. Place your knees together, and legs crossed at the ankles.

3. Hold your iron on the back of your shoulders as if you were going to do a squat.

4. Without moving your legs, try to rotate your breastbone 45 degrees in each direction (make sure you are looking at your breastbone, and not just the club).

Were you able to achieve 45 degrees in each direction? It is very common to be limited more in one direction than the other. While this assessment does not specifically look at thoracic extension, it is a good litmus test for rotation. Let’s say you were only able to achieve 30 degrees to each side. What should you do? Well, now is when we start to look for corrective exercise to improve function. Our friends over at The Rack Athletic Performance Centerhave some excellent resources for these corrections, and here is onethat specifically targets the thoracic spine.

Next, we are going to examine ankle dorsiflexion, or the ability for your knees to track out over your toes. This is often times very stiff with the general population due to our frequency of sitting and lack of squatting. You may be asking yourself, “Well, how can my ankles make an impact on my golf swing? It’s not like I’m squatting during the swing.” Well actually, sufficient ankle dorsiflexion is crucial for your ability to stay in posture during your downswing. This means that all of the torque we generated at the top of your backswing can then be directly translated into the golf ball. If you cannot do this, you will have what we call loss of posture or early extension: both of these will travel – you guessed it – straight to the lumbar spine. Once again, we need this lumbar spine to stay stable and controlled during your swing, and not move to compensate for other issues. Here’s how you can test ankle dorsiflexion:

1. Find an open wall and kneel down in front of it.

2. You will have your right knee flexed up facing the wall and your left knee down on the floor behind you (think of a lunge position).

3. While keeping your right heel on the ground, slide your right knee over your toes toward the wall.

4. If you are able to touch the wall, move your foot back and try again.

5. When you can no longer keep your heel on the ground to reach the wall with your knee, that is the end of the test.

6. Measure the distance from your right toes to the wall.

7. Repeat on left.

Were you able to achieve a four-inch distance from toes to wall while keeping your heel down? If not, then you have an ankle dorsiflexion limitation. Again, this will travel up the chain and will affect your low back if left untended. So let’s again turn to our colleagues at The Rack to see what we should doabout this.

So after checking out your thoracic spine and ankle, you may be questioning if anything else may be contributing to your back pain. Maybe you just aced both of these tests and you still have low back pain with golfing. This would be the time to give me a call or shoot me an email to get in and perform the full Titleist Performance Institute 16-point exam. This will complete the picture of your limitations and how they are impacting your game.

Talk to you soon,

Ryan

Dr. Belmore is a doctor of physical therapy, Certified Strength and Conditioning Specialist and Titleist Performance Institute Certified golf specialist.