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Comparison of spine motion in elite golfers with and without low back pain

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  • Canadian Sport Institute Calgary

Abstract and Figures

Low back pain is a common musculoskeletal disorder affecting golfers, yet little is known of the specific mechanisms responsible for this injury. The aim of this study was to compare golf swing spinal motion in three movement planes between six male professional golfers with low back pain (age 29.2+/-6.4 years; height 1.79+/-0.04 m; body mass 78.2+/-12.2 kg; mean +/- s) and six without low back pain (age 32.7+/-4.8 years; height 1.75+/-0.03 m; body mass 85.8+/-10.9 kg) using a lightweight triaxial electrogoniometer. We found that golfers with low back pain tended to flex their spines more when addressing the ball and used significantly greater left side bending on the backswing. Golfers with low back pain also had less trunk rotation(obtained from a neutral posture), which resulted in a relative 'supramaximal' rotation of their spines when swinging. Pain-free golfers demonstrated over twice as much trunk flexion velocity on the downswing, which could relate to increased abdominal muscle activity in this group. This study is the first to show distinct differences in the swing mechanics between golfers with and without low back pain and provides valuable guidance for clinicians and teachers to improve technique to facilitate recovery from golf-related low back pain.
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Comparison of spine motion in elite golfers with and
without low back pain
D. Lindsay; J. Horton
To cite this Article: D. Lindsay and J. Horton , 'Comparison of spine motion in elite
golfers with and without low back pain', Journal of Sports Sciences, 20:8, 599 - 605
To link to this article: DOI: 10.1080/026404102320183158
URL: http://dx.doi.org/10.1080/026404102320183158
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Comparison of spine motion in elite golfers with and
without low back pain
D. LINDSAY* and J. HORTON
University of Calgary S ports Medicine Centre, 2500 University Drive NW, Calgary, Alberta T3A 0P8, Canada
Accepted 8 February 2002
Low back pain is a common musculoskeletal disorder aþ ecting golfers, yet little is known of the speci® c
mechanisms responsible for this injury. The aim of this study was to compare golf swing spinal motion in three
movement planes between six male professional golfers with low back pain (age 29.2 ±6.4 years; height
1.79 ±0.04 m; body mass 78.2 ±12.2 kg; mean ±s) an d six with out low back pain (age 32.7 ±4.8 years;
height 1.75 ±0.03 m; body mass 85.8 ±10.9 kg) using a lightweight tri axial electrogoniometer. We found that
golfers with low back pain tended to ¯ ex their spines m ore whe n addressing the ball and used signi® cantly
greater left side bending on the backswing. Golfers with low back pain also had less tru nk rot ation (obtained
from a neutral posture), which resulted in a relative `supramaximal rotation of their spines whe n swinging.
Pain-free golfers demonstrated over twice as much trunk ¯ exion velocity on the downswing, which could relate
to increased abdominal muscle activity in this group. This study is the ® rst to show distinct diþ erences in the
swing mechanics between golfers with and without low back pain and provides valuable guidance for clinicians
and teachers to improve technique to facilitate recovery from golf-related low back pain.
Keywords: golf, injury, posture, technique.
Introduction
Low back pain is the most common musculoskeletal
disorder ecting amateur and professional golfers
(McCarroll et al., 1990; McCar roll, 1996; Thériault
et al., 1996; Sugaya et al., 1999). Although the incidence
of back problems among golfers is fairly well docu-
mented, less is known of the speci® c mechanisms
responsible for these injuries.
Hosea et al. (1990) calculated the compressive, shear,
lateral bending and rotational loads on the L3± L4 seg-
ment of the lumbar spine during golf swings using a ® ve
iron. Kinetic, kinematic and surface electromyographic
(EMG) data were collected from four professional
(mean age 37 years) and four amateur (mean age 34
years) golfers. The authors concluded that, except for
compressive load, professional golfers produced less
spinal loads than amateur players. Compressive loads
for both groups peaked at about eight times body mass.
The complex, rapid and intense nature of the spinal
loads associated with the golf swing led Hosea et al. to
* Author to whom all corresponde nce should be addressed. e-mail:
dlindsay@ucalgary.ca
conclude that pre-participation conditioning, reason-
able practice habits and a proper warm-up are impor-
tant for preventing low back pain from golf.
Morgan et al. (1997) analysed spinal motions and
velocities in Japanese collegiate golfers using a three-
dimensional motion analysis system. They reported
the golf swing produced a distinctly asymmetric trunk
motion, involving a combination of left axial rotation
and r ight lateral bending (right-handed golfers). Both
axial rotation velocity and right side bending angles
reached peak values almost simultaneously and just
after ball impact. Morgan et al. used the ter m `crunch
factor’ to describe the instantaneous product of lumbar
side bend angle and axial rotation velocity. They postu-
lated a high crunch factor was damaging to the lumbar
spine (i.e. during the impact phase), resulting in injury
and pain. In a follow-up study, Morgan et al. (1999)
examined lumbar spine mechanics in healthy golfers of
diþ erent age categor ies. College-age golfers (age 18± 21
years) exhibited a signi® cantly greater `crunch factor’
than senior golfers (over 50 years). The authors com-
mented that low back pain and the `crunch factor’ were
probably interrelated, in that both parameters exhibit a
consistent (and signi® cant) decrease with increasing age.
Journal of Sports Sciences ISSN 0264
-0414 print/ISSN 1466-447X online Ó 2002 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
Journal of Sports Sciences, 2002, 20, 599± 605
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Sugaya et al. (1999) conducted a two-part study
examining low back pain among elite Japanese golfers.
In the ® rst part of their study, they sur veyed Japanese
tour professionals at four diþ erent tour naments. The
authors reported that 55% of the players who responded
to the sur vey had a history of chronic low back pain. Of
those suþ ering from low back pain, 51% identi® ed trail
(i.e. right) side low back symptoms, compared with 28%
left side and 21% central or no laterality. The second
part of the study involved radiographic investigation of
10 elite male amateur, 14 male professional and two
female professional right-handed golfers, all presenting
with low back symptoms. The results revealed a signi® -
cantly greater change in right side vertebral body and
facet joint arthritis than age-matched controls. Sugaya
et al. concluded that both the repetitive and asymmetric
nature of the golf swing contributed to low back pain
and injur y in elite golfers.
Although the above studies have presented valuable
infor mation regarding the relationship between the golf
swing and low back pain, none has speci® cally com-
pared swing characteristics between golfers with and
without low back pain. Documentation of spinal motion
from golfers with and without low back pain would
allow a better understanding of the stresses associated
with the golf swing and could lead to technique modi® -
cations that would minimize low back stress and injury
risk. The aim of the present study was to compare
maximum spine angles and velocities in three move-
ment planes during the execution of full golf swings
between professional golfers with and without low back
pain. Demographic and golf activity pro® les between
the same two groups were also determined.
Materials and methods
Participants
Altogether, 54 male professional golfers belonging to
the Alberta Professional Golf Association completed a
questionnaire asking how often they experienced low
back pain when playing or practising during the past
golf season and whether they felt the pain was related
speci® cally to golf. Six response categories were pro-
vided: `Always’ , `Frequently’, `Occasionally’ , `Rarely’ ,
`Never’, `Don’ t know/Not Applicable’ . Six golfers each
indicated that they either `always or `never’ experienced
low back pain from golf. These 12 golfers were inter-
viewed further by one of the investigators to ensure their
interpretation of the questionnaire response categories
matched those of the investigator. The six participants
who `never’ experienced low back pain after playing or
practising were classi® ed as controls (age 32.7 ±4.8
years; height 1.75 ±0.03 m; body mass 85.8 ± 10.9 kg;
mean ±s). The six participants who `always’ experi-
enced low back pain after playing or practising were
classi® ed as low back pain individuals (age 29.2 ±6.4
years; height 1.79 ±0.04 m; body mass 78.2 ±12.2 kg).
No attempt was made to diagnose or categorize the
nature of the low back pain. However, all of the par-
ticipants with low back pain felt that golf was a direct
cause of their pain and all continued to play and practise
despite the discomfort.
Apparatus
Spinal motion characteristics during the golf swing were
assessed using a lightweight device known as a Lumbar
Motion Monitor (Wellness DesignÔ, Chattanooga
Group Inc., Hixson, TN). The Lumbar Motion
Monitor is a triaxial electrogoniometer capable of
assessing the instantaneous three-dimensional motion
of the thoracolumbar spine. Measurements recorded by
the monitor include ¯ exion, extension, side bending and
axial rotation ranges of motion, as well as the velocity
and acceleration of these motions. The monitor is
attached to the back by a chest harness and pelvic strap
(Fig. 1) and measures the movement occurring between
the mid (thoracic spine) and lower (pelvic) parts of the
back. The outputs from the sensors are transm itted to
an analog
-to-digital board in a portable computer, in
which instantaneous position, velocity and acceleration
of the lumbar spine were calculated. The position
accuracy of the Lumbar Motion Monitor compared
with a three-dimensional reference frame has been
repor ted as being over 98%, while the correlation co-
cients for velocity using high-speed motion analysis
for comparison also show very high agreement (r>0.95,
P<0.0001) (Marras and Fattalah, 1992). Pilot trials
and interviews using the Lumbar Motion Monitor
indicated that the apparatus did not restrict a player’ s
normal movements during the golf swing.
Test procedures
The test procedures were consistent for all partici-
pants. The ® eld tests, which lasted about 30 min, were
carried out at a local driving range; the participants
used their own golf club. The test session began with an
explanation of the procedures, followed by a war m-up
consisting of stretching exercises and several practice
swings. The Lumbar Motion Monitor was then attached
and the par ticipants were instructed to strike golf
balls until they felt comfortable. These practice swings
allowed the par ticipants to become familiar with the
apparatus and per mitted the investigator to check the
operation of the monitor.
After the warm-up, the monitor was calibrated with
the par ticipant standing in an upright, anatomically
600 Lindsay and Horton
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neutral position. The angles measured during testing
were therefore a representation of movement from this
anatomically neutral position. After the monitor was
calibrated, the par ticipants were asked to assume their
normal address position (Fig. 2). Spine angles in the
address position were then recorded.
After the measurement of the address position, the
participants were required to perfor m three maximal
ort shots with a driver. Spinal position and velocity
were recorded during each of the three shots. After
recording the golf swing spinal measurements, the parti-
cipants were asked to move their torso through maximal
range of motion (without a golf club), from an upright
neutral posture, in a total of four diþ erent directions
(right and left side bending and right and left rotation).
This allowed the investigators to make comparisons
between the maximum spinal angles recorded during
the golf swing and the maximal available neutral posture
Fig. 1. T he Lumbar Motion Monitor (Wellness DesignÔ,
Chattanooga Group, Inc., Hixson, TN).
range of motion. Maximum neutral posture motion was
measured using a relatively slow (in comparison to a golf
swing) and steady movement speed. Maximum neutral
posture ¯ exion and extension ranges of motions were
not recorded, as these directions were not expected to
approach maximum dur ing the golf swing.
Statistical analysis
Non-parametric statistical methods were used because
of the small sample size in each group. Statistically
signi® cant diþ erences in maximum spinal angles and
velocities between professional golfer s with and with-
out low back pain were determined using the Mann-
Whitney U-test. The statistical analyses were performed
using SPSS.
Ethical considerations
Since the activities perfor med in this study were neither
excessive nor any diþ erent from nor mal golf swings, the
risk of injury during the test procedure was considered
to be low. All participants completed a Physical Activity
Readiness Questionnaire and a sport-speci® c activity
pro® le questionnaire and gave their informed consent
before testing. Ethics approval was granted by the
University of Calgar y Conjoint Faculties Research
Ethics Committee.
Fig. 2. Typical address position.
Spine motion in elite golfers 601
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Results
No signi® cant diþ erences in address position, ¯ exion,
right side bending or left rotation were noted between
the golfers with and without low back pain (P>0.05)
(Table 1). The maximum spinal angles recorded in the
Table 1. Static spinal angles during address position with a
driver (mean ±s)
Flexion
Right side
bend
Left
rotation
Without low back pain
(n=6)
25.3 ±6.6 8.7 ±3.4 6.7 ±1.5
With low back pain 37.0 ±11.4 8.5 ±4.7 7.7 ±1.8
(n=6)
P=0.09 P=0.94 P=0.32
diþ erent movement directions during swings with the
driver are shown in Table 2. The only signi® cant dif
-
ference between the controls and those with low back
pain was for maximum left side bending. Table 3 com-
pares the average maximum side bend and rotation
angles recorded during the golf swing and expressed
as a percentage of the respective maximum neutral
posture range of motion. No signi® cant diþ erences were
obser ved, although golf swing axial rotation consistently
exceeded the neutral posture maximum voluntary
rotation among the low back pain participants. The
spinal velocity results are shown in Table 4. Signi® cant
diþ erences in ¯ exion velocity (P=0.01) and left side
bend velocity (P=0.04) were noted between golfers
with and without low back pain. Table 5 compares the
golf activity pr les of the two groups. The participants
were asked to report the average rounds played per
month as well as the time spent practising full golf shots
Table 2. Maximum spinal angles recorded during golf swings with the driver (mean ±s)
Flexion Extension
Left side
bend
Right side
bend
Right
rotation
Left
rotation
Without low back pain (n=6) 50.7 ±7.2 -10.2 ±8.0a0.5 ±3.1 29.9 ±3.2 34.8 ±7.3 49.2 ±11.3
With low back pain (n=6) 44.0 ±5.3 -2.3 ±8.5a6.7 ±3.2 28 .8 ±5.8 35 .6 ±4.2 50.3 ±5.0
P=0.15 P=0.15 P=0.01 P=0.58 P=0.81 P=0.87
aAverage maximum extension values were negative, indicating the spine did not reach an extended position at any time during the golf swing.
Table 3. Frontal and transverse plane maximum obtainable neutral posture angles (NPA) and maximum
golf swing angles (GSA) expressed as a percentage of NPA (mean ±s)
Left side
bending
Right side
bending
Right
rotation
Left
rotation
Without low back pain (n=6)
NPA (°) 32.7 ±6.2 38.2 ±4.2 41.8 ±12 50.0 ±5.9
GSA/NPA (%) 0.4 ±9.8 79.6 ±15.5 88.0 ±24.9 99.6 ±24.6
With low back pain (n=6)
NPA (°) 29.7 ±6.2 35.5 ±6.7 34.8 ±5.0 44.0 ±5.2
GSA/NPA (%) 23.4 ±12.6 82.1 ±11.0 108.3 ±20.0 116.4 ±4.4
Table 4. Maximum spine motion velocities (rad´s-1) during golf swings with the driver (mean ±s)
Flexion
velocity
Extension
velocity
Left side
bend velocity
Right side
bend velocity
Right rot.
velocity
Left rot.
velocity
Without low back
pain (n=6)
1.56 ±0.45 2.01 ±1.05 0.56 ±0.17 1.86 ±0.25 1.33 ±0.26 3.18 ±1.62
With low back pain 0.73 ±0.33 2.41 ±0.9 9 0.78 ±0.1 6 1.88 ±0.4 3 1.61 ±0.3 0 3.25 ±0.5 8
(n=6)
P=0.01 P=0.75 P=0.04 P=0.87 P=0.13 P=0.87
602 Lindsay and Horton
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Table 5. Comparison of self-reported golf activity pro® les for golfers with and without low back pain (mean ±s)
Average
rounds played
per month
Average full-swing
practice sessions
per month
Average balls struck
per full-swing
practice session
Average putting
practice sessions
per month
Average time (min)
spent per putting
practice session
Without low back
pain (n=6)
7.3 ±3.0 6.7 ±2.3 66.7 ±66.5 7.2 ±1.2 29.2 ±17 .4
With low back pain 9.4 ±5.2 12.3 ±5.4 94.2 ±64.4 11.5 ±7.6 17.5 ±9.9
(n=6)
P=0.50 P=0.10 P=0.48 P=0.31 P=0.18
and putting. No signi® cant d erences in practice and
playing habits were noted between professional golfers
with and without low back pain.
Discussion
The main aim of this study was to compare the spinal
motion (i.e. maximum angles and velocities) of male
professional golfers with and without low back pain
during golf swings with a driver. No signi® cant dif
-
ferences in address position spinal posture (P>0.05)
were noted between the two groups. Although not statis-
tically signi® cant, the golfers with low back pain tended
to address the ball with considerably more spinal ¯ exion
than the controls (Table 1). The average ¯ exion angle of
the healthy controls (25.3 ±6.6°) was consistent with
the results of McTeigue et al. (1994), who observed
forward ¯ exion of 28 ±8° among Professional Golf
Association (PGA) Tour players. The average address
position ¯ exion angle recorded from the golfers with low
back pain was 37.0 ±11.4°. Since increased ¯ exion is
associated with increased lumbar disc pressure and risk
of injury (Kumar et al., 1998), this diþ erence in set-up
posture could contribute to low back pain from golf.
Left side bend was the only maximum spinal angle
found to be signi® cantly diþ erent between the two
groups during the golf swing (Table 2). Left side bend,
which occurs on the backswing (right-handed golfer),
was signi® cantly greater (P=0.01) for the golfer s with
low back pain. It is not known whether the increased left
side bend observed in this study is an important con-
tributing factor to low back pain, since the maximum
amount of left side bend dur ing the swing was relatively
small (6.7 ±3.2°). Also, other researchers have identi-
® ed the downswing, rather than the backswing, as the
key part of the swing during which most stress and
injuries occur (Hosea et al., 1990; Sugaya et al., 1999).
A comparison of the results in Tables 1 and 2 shows
that, although ¯ exion in the static address position
was greater among the golfers with low back pain
(37.0 ±11.4 vs 25.3 ±6.6°), maximum ¯ exion angle
during the swing was higher for the golfer s without low
back pain (50.7 ±7.2 vs 44.0 ±5.3°). Peak ¯ exion
occur red on the downswing (i.e. before the club con-
tacted the ball). By subtracting the start (address
position) ¯ exion from the maximum (downswing)
¯ exion, it would appear that spinal ¯ exion of the golfers
without low back pain increased by just over 25° on the
downswing compared with just 7° for the golfers with
low back pain. However, empirical observations of both
groups of professional golfers showed that the trunk
maintained a consistent angle with the ground through-
out the entire backswing and downswing (golf teachers
often refer to this as maintenance of a consistent `spine
angle’ ). M cTeigue et al. (1994) also obser ved con-
siderable changes in spinal ¯ exion during the down-
swings of elite professional golfers, although they did
not comment on the cause. One possible explanation for
the apparent disparity between the instrumented spinal
¯ exion results and empirical observations may relate
to localized movement created by the anterior trunk
muscles. Powerful anter ior tr unk muscle contractions
on the downswing may cause an initial posterior tilting
of the pelvis and an apparent increase in localized spinal
¯ exion rather than tr ue ¯ exion of the entire tr unk. If
this is the case, it is possible that golfers without low
back pain may use their anterior trunk muscles more on
the downswing than golfers with low back pain. Watkins
et al. (1996) speculated that abdominal muscle activity
might be diþ erent in golfers suþ er ing with low back
pain. Evans and Oldreive (2000) reported that golfers
with low back pain have a reduced ability to maintain a
static contraction of the transverse abdominal muscle,
although it is unclear whether this translates to dif-
ferences in golf swing activity patterns. Recently,
Horton et al. (2001) used oblique abdominal muscle
activity collected during a standardized movement
(double leg raise in supine) as the reference signal for
compar ing electromyograms (EMG) from the same
muscles during golf swings in player s with and without
low back pain. No signi® cant diþ erences were found for
the golf swing and standard movement EMG ratio
between groups; however, the onset times were delayed
Spine motion in elite golfers 603
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in the group with low back pain. Clearly, additional
research is required to examine d erences in abdom-
inal muscle recruitment patterns between golfers with
and without low back pain.
Although no signi® cant d erences in the maximum
axial rotation angles were obser ved between groups
during the golf swing (Table 2), we noted that the golfers
with low back pain tended to use considerably more
rotation in their swings than the maximum rotation
range they were able to obtain from a neutral posture
and controlled speed (Table 3). This resulted in the golf
swing producing `supramaximal’ rotation in the golfers
with low back pain. Sugaya et al. (1999) have suggested
that spinal injur y and pain are partly related to the
extreme ranges of motion placed on the spine while per-
form ing the golf swing. In a case study of a professional
golfer, Gr imshaw and Burden (2000) repor ted that
decreasing the amount of spinal rotation during the
swing was bene® cial for reducing his low back pain. The
results in Table 3 would appear to lend support to
the observations of Sugaya et al. (1999) and Grimshaw
and Burden (2000). In addition to controlling spinal
rotation during golf swings, players with low back pain
should work on improving their general trunk rotation
¯ exibility. Further more, all golfers should stretch and
warm-up properly before swinging aggressively.
Spinal velocity was also signi® cantly d erent
between the two groups in the present study. Golfers
with low back pain demonstrated signi® cantly lower
¯ exion and higher left side bend velocities than golfers
without low back pain. (Table 4). As already mentioned,
left side bending occurs on the backswing and may not
be an important factor in the aetiology of low back pain
from golf . The ver y large diþ erence in ¯ exion velocity
between the two groups may again be related to dif-
ferences in anterior trunk muscle contractions. Pink
et al. (1993) and Watkins et al. (1996) have shown that
the oblique abdominal muscles on both sides of the
trunk are very active in golf swings of healthy elite
players. It is possible that the considerably lower ¯ exion
velocity observed for the golfer s with low back pain
in this study was due to diþ erences in the force of
contraction of the abdominal muscles.
Combinations of lumbar right side bend spinal angle
and left axial rotation velocity (right-handed golfers)
have been identi® ed as important contributors to low
back pain and injury among elite golfers (Morgan et al.,
1997). The ter m `crunch factor has been used to
describe the asymmetric forces arising from these
localized side bend and rotation motions about the
lumbar spine (Morgan et al., 1997; Sugaya et al., 1999).
Morgan et al. (1999) reported the average maximum
crunch factor of eight elite collegiate golfers (age 19 ±1
years) to be 45.1 ±21.7 rad ´s-1. We are unaware of any
previous study that has compared the simultaneous
product of axial rotation velocity and side bending angle
in golfers with and without low back pain. Although the
methods used in the present study did not allow lumbar
motion to be isolated from thoracic motions, an overall
trunk `crunch factor’ could be measured. Peak trunk
`crunch factors’ for par ticipants with and without low
back pain were calculated as 82.4 ±21.9 and 87.7 ±
28.4 rad ´ s-1, respectively. If one assumes that the com-
bination of thoracic and lumbar motions provides a
representation of the lumbar `cr unch factor , then it
would appear that factors other than the `crunch factor’
must be responsible for the diþ erences in low back pain
perception identi® ed by the two groups in this study.
Another diþ erence between the two groups of golfers
(although not statistically signi® cant) was the time
spent playing and practising. Golfer s with low back pain
practised full-swing shots, on average, almost twice as
often and hit more balls per practice session than the
golfers without low back pain. (Table 4). Combining
data from these two categories shows that golfer s with
low back pain tended to hit 2.5 times more balls per
month than the golfers without low back pain. Golfers
with low back pain also tended to play more rounds per
month. Both groups spent about the same total time
practising their putting (sessions per month multiplied
by putting time per session). Obviously, the more time
spent perfor ming the asymmetrical golf swing motion,
the greater the likelihood of suþ ering an overuse injury
to the lower back. The results from this study lend
support to the empirical observations of others who
have identi® ed overuse as a risk factor for low back pain,
especially among professional golfers (Batt, 1992;
McCar roll, 1996).
Although the results of the present study er
valuable insight into the relationship between low back
pain and golf, there are several limitations. Because
spinal motion measurements were made on participants
who had existing chronic low back pain, we cannot
conclude whether the position or velocity diþ erences
between the professional golfers with and without low
back pain were a cause of, or a result of, the pain. Also,
numbers were relatively low, making true associations
less clear than would have been seen with a larger pool
of par ticipants. In light of these limitations, this study
is one of the ® rst to make direct comparisons between
the swing mechanics of elite golfers with and without
low back pain and provides interesting ® ndings that may
er solutions to a widespread problem in a highly
popular spor t. Recommendations for future research,
in addition to addressing the limitations outlined above,
would be to compare abdominal muscle forces of con-
traction during the swings of golfer s with and without
low back pain to determine if diþ erences exist in the
ability to protect the lower back between these groups.
The in¯ uence of fatigue (i.e. repetitive ball striking) on
604 Lindsay and Horton
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spinal motion should also be investigated. Prospective
long-term studies are needed to determine if spinal
motion characteristics or abdominal muscle activity are
ected by, or contribute to, the onset of golf-related
low back pain.
Conclusions
In this study, golfers with low back pain tended to ¯ ex
their spines more when addressing the ball than golfers
without low back pain. Golfers with low back pain also
used signi® cantly more left side bending on the back-
swing than those without. Although the golf swing
maximum rotation angles did not vary between the two
groups, maximum rotation range of motion (obtained
from a neutral posture and at controlled speed) was
more restricted in the group with low back pain. This
resulted in these player s using relative `supramaximal’
rotation of their spines when swinging, which, in turn,
could contribute to ongoing irritation of the spinal
structures. Pain-free golfers demonstrated over twice as
much trunk ¯ exion velocity on the downswing, which
could relate to increased abdominal muscle activity in
this group. No diþ erences in peak `crunch factor’ were
obser ved for the tr unk region between the golfers with
and without low back pain. Other researchers have
speculated that the lumbar `crunch factor’ , which is
the instantaneous product of side bend angle and axial
rotation velocity, contributes to the degenerative
changes seen in the lumbar spines of elite golfers. A
further risk factor for low back pain observed in this
study may be the increased golf-speci® c activity patterns
demonstrated by the injured golfers. The results of this
study suggest that golfers with low back pain should:
warm-up properly before playing as well as engage in
regular stretching exercises to improve their maximum
available trunk range of motion; improve their posture
when addressing the ball; develop better abdominal
muscle function during the downswing; and reduce the
overall time they spend playing and practising.
Acknowledgements
Financial assistance was provided by the Ted Rosza Foun da-
tion and the Seaman Brothers Sport Science Fellowship.
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... Most golf-induced overuse injuries affect the back, shoulder, knee, or elbow, with the lower back being the most common. 15,[36][37][38][39] Because of differences in swing intensity and training frequency, injury mechanisms differ between professional and amateur golfers. ...
... 63 It has been suggested that golfers with LBP have less abdominal muscle activity during the golf swing, which possibly results in less trunk flexion during the downswing. 38 Interestingly, in healthy individuals increasing trunk flexion angle from 0° to 45° resulted in an increase of trunk rotation ROM of 19%, while pelvis rotation ROM decreased by 45% between the two trunk flexion positions. 63 In golfers with LBP, a combination of less abdominal muscle activity with less trunk flexion could lead to less total trunk ROM and more pelvic ROM and require more rotation to be facilitated by the lumbar vertebrae. ...
... Golfers with LBP move through dynamic ROMs in the golf swing, specifically trunk rotation ROM, that exceed passive ROMs limits. 38,69 Excessive trunk rotation may indicate an effort to increase pelvis and torso separation for power generation; however, dynamically moving outside of active ROM could be detrimental to spinal health. Individuals with LBP, both golfers and non-golfers, ten to move with less trunk flexion. ...
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Golf is an international sport played by a variety of age groups and fitness levels, and although golf has a low to moderate aerobic intensity level, injuries are common among professional and amateur golfers. High amounts of force experienced during the golf swing can lead to injury when golfers lack appropriate strength or technique with the lower back most commonly injured. Research has indicated that trunk muscle activation, hip strength and mobility, and pelvis and trunk rotation are associated with low back pain (LBP). Based on anecdotal evidence, golf practitioners specifically address issues in weight shift, lumbar positioning, and pelvis sequencing for golfers with LBP. This review aims to elucidate the effects of proper and improper golf swing technique on LBP and to help golf practitioners understand how to approach the alleviation of LBP in their clientele.
... They found that the golfers with low back pain had a greater maximal lateral flexion toward the lead side (which is the side closest to the target) during the backswing and increased peak trunk lateral flexion angular velocity when compared with the uninjured golfers. 8 The golfers in the Lindsay and Horton 8 study's mean age was 29 years in the low back pain group and 33 years in the uninjured group; therefore, their results may not be generalizable to younger elite male golfers. ...
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Context: Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. Design: Prospective longitudinal cohort study. Methods: Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6 months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. Results: Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = -0.64), and 6° more trail hip adduction at the end of follow through (P < .00; effect size = 1.00). Conclusion: Golfers who developed low back pain during the 6-month monitoring period displayed distinct differences in biomechanics at baseline when all golfers were injury free. These biomechanical differences may be considered a precursor to injury. Three-dimensional motion analysis may indicate whether elite golfers are at risk of developing low back pain. Research is needed to assess whether targeted exercise and sports drills aimed at addressing the biomechanical risk factors identified may prevent low back pain in elite golfers.
... From a methodological point of view, it appears that there is currently no consensus on the crunch factor; to date, five studies have used 10 different computational methodologies. In particular, [80] indicated values in rad·s −1 , which appears to be a problem of units, as the correct unit is rad 2 ·s −1 . ...
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... Reverse spine angle (RSA) presents with greater left side bending during the back swing (for a right-handed golfer), which has been observed in professional golfers with LBP. 10 Pain will generally occur in the right lower back with this population as the facet joints on that side are repeatedly compressed during the downswing. ...
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Background and purpose: Low back pain is one of the most common conditions occurring in the golfing population. Many approaches have been utilized throughout the years to address this condition including the concept of regional interdependence. The purpose of this case report is to describe the evaluation process and treatment approach of a golfer with low back pain using the principles of regional interdependence. Case description: A thirty-year-old male with right-sided low back pain was evaluated using a comprehensive approach including golf specific movement screening and a swing evaluation. The patient had mobility restrictions in his thoracic spine and hips that appeared to be contributing to a hypermobility in the lower lumbar spine. Based on the evaluation, he was placed into the treatment-based classification (TBC) of stabilization but would also benefit from mobilization/manipulation techniques. Outcomes: After seven visits over a four-week span, the patient's mobility and core stability both improved and he was able to play golf and workout pain free. His outcome measures also improved, including the revised Oswestry Disability index from 26% disabled to 10%, the Fear Avoidance Behavior Questionnaire (FABQ) Work from 10/42 to 3/42, and the FABQ Physical Activity from 19/24 to 6/24. Discussion: Evaluating and developing a plan of care to address low back pain in an avid golfer can be challenging as a variety of demands are placed on the spine during the movement. This case report describes the evaluation process and treatment approach to specifically target the demands that are required during the golf swing. Utilizing a targeted approach that includes golf specific movement screening and a swing evaluation can help guide the therapist in their treatment and improve the patient's outcome. Level of evidence: Level 4.
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... Asymmetries and high muscle stiffness can decrease physical characteristics such as strength or sport performance (Bae, Kim, Seo, Kang & Hwang, 2012, Kim & Sung, 2009Rojas-Valverde et al., 2018), hip and lumbar muscle coordination (Lindsay & Horton, 2010), hip and lumbar rotation and extension (Vad, Bhat & Basrai, 2004) among others. ...
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