Low Back Pain and Golf
Low back pain is very common in all walks of life and inevitably all of us will experience at least one bout of it in our lifetime, especially those of us that play golf. How we manage low back pain, especially acute low back pain can determine how big of an effect it may have on our lives and our golf game. Even persistent or long term low back pain can be reduced and better managed to allow the people who suffer with it return to the activities they enjoy including playing golf.
Pain itself is a very individualized experience. According to the great pain researcher G. Lorimer Moseley there are four key points we need to keep in mind when it comes to pain.
Pain does not provide an accurate measure of the state of the tissues. This means that the level of pain is not equal to the level of tissue damage.
Pain is an output of the brain that is modulated by many factors from across biomechanical, somatic, psychological and social domains. Things like tissue damage, stress, fear, anxiety. memory, relationships, sleep, overall health can all have an effect on the pain we feel.
The relationship between pain and the state of the tissues becomes less predictable as pain persists. This means that the more persistent the pain the less likely it is due solely to tissue damage.
That pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger. I.E. Pain is an alarm, it tells us that something might or has already happened that is harmful to our body. It is a call to action, not strictly evidence of damage.
It is important to understand that low back pain is rarely associated with serious pathology or structural damage and evidence shows that “abnormal” findings such as disc bulges and degenerative changes can be perfectly normal in both people with and without pain and have no relation to low back pain especially as we age. Changes in low back pain can be influenced by a number of factors including activity levels, sleep patterns, fear, mood, worry and stress, habitual postures and overall strength and conditioning levels.
My approach to addressing low back pain
1. Clear red flags
As noted above most low back pain is not related to serious tissue pathology or injury. As a medical professional, I am trained in looking for signs and symptoms that may warrant further testing to rule in or out a serious issue. My job is to spot those and refer out to the proper medical professional as needed
2. Educate and keep active
Understanding what pain really is and that most non-traumatic pain is not related to serious tissue damage is the first step. The best thing that I can do for a client or patient is to reassure them that nothing serious is going on and give them permission to keep moving and staying active. You may have to avoid some things and make modifications early on but the goal is to maintain as normal of a lifestyle as possible while getting your pain calmed down. Below are some tips I generally give out:
Move early and move often. Gentle movement early on in the process that does not increase symptoms is key.
While there is no such thing as an ideal posture, varying postures throughout the day and avoiding aggravating postures early on can help.
Rest, avoidance of activity and taking a lot of time off are generally not helpful for low back pain in the long run. With this being said, you may want to cut back practicing and playing until the symptoms have calmed down.
3. Assess and address limitations
This is where a proper medical and movement evaluation from a qualified professional as myself comes into play. I will look for what movements and positions relieve or aggravate your pain as well as assess the entire body for limitations. Common limitations that I see in golfers that can potentially lead to increased stress on the lumbar spine are reduced mobility in the hips and thoracic spine. General weakness and deconditioning of the entire body especially the muscles of the trunk and back can cause the body to be less tolerant of the stress placed on it. Lastly, certain swing characteristics can cause excess stress to be placed on the lumbar spine which can eventually lead to pain.
4. Load the spine in various ways that are tolerable
This is where strength training comes in. Finding ways to tolerably load the back and surrounding areas via strength training is the ultimate road back to recovery. There is a lot of support in the research showing that strength training can make a big difference in reducing the repetitive movement and overuse injuries common to golf, low back pain being one of those. My favorites are the hip hinge patterns such as deadlift, good mornings, pull through and bridge/hip thrust variations. On top of that, continuing to strength train the other basic movement patterns, squat, push, pulls and carries as well as anti movement trunk training while restoring pain-free ROM through the spine all will have a benefit as well. The key is finding ranges and variations that you can tolerate and start there. Then progress back to normal training as the pain decreases.
5. Reduce aggravating factors and slowly reintroduce them
For golfers, this may mean putting the clubs down for a short period or at least reducing the number of swings you are taking since this is usually the main aggravating factor of low back pain in golfers. The goal here is to resume golf activities as soon as possible but sometimes a short break is needed to get pain calmed down and under control. Resumption may involve starting with putting and chipping and progressing back to full swings at full speed over time. Managing the number of swings you take overall is a good way to mitigate stress on the body and minimize the chance of pain and injury. A good coach can help you create a plan to do this.
How to reduce to chance of pain returning
Regular physical activity, maintaining a positive mindset about low back pain and pain in general, maintaining good sleep patterns and healthy stress management can lead to better outcomes for low back pain.
Manage the number of swings you are taking. Practice smart don’t just go out and beat balls.
Participating in a consistent strength and conditioning program for the entire body will not only prepare your back and body to tolerate more loads but be beneficial to your overall health and well-being.
Getting evaluated by a TPI certified professional can help determine if you have any mobility restrictions, weakness or limitations that may be leading to your pain and/or negatively impacting your golf swing.
What if the pain doesn’t go away?
If your pain does not improve in a reasonable time frame, then give us a call at 337 274 3639. John Paul can provide a golf specific evaluation to help determine your limitations and get you feeling better and back to playing golf.
If you are feeling better but interested in improving your overall health or want help with learning a proper strength and conditioning program that will benefit you throughout your life we can help with that as well.
We offer a variety of in-person and online training options to fit your needs. Head over to our website at www.guidrygolfandsport.com and see what we have to offer.
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John Paul Guidry DPT CSCS TPI