Golf Science – Lower Back Pain Affecting Your Play?

At the end of the regular season, the top 72 players of the PGA Champions Tour compete in the Charles Schwab Cup playoffs — a three-event series. The second tournament in the series is the Invesco QQQ Championship, played at the beautiful Sherwood Country Club in Southern California. Only the top 36 of the final 54 players in the field proceed from this event to the final event that determines the winner of the championship. Thus, only the best remain to play by the end of the year-long season. So, it is interesting to see how these senior golfers fare, with respect to their performance and the injuries they sustain because of either over-use or poor mechanics.

But how can Tour professionals possibly have “poor mechanics”? Very easily. In most sports it is assumed that highly-skilled athletes merely have over-use injuries, while less skilled players have poor-mechanics injuries. Injuries are caused by many factors, including mechanical loads, which are associated with specific positions that all golfers can get into.

For instance, low back pain is the most commonly seen injury among golfers. The lumbar, or lowest part of the spine, has a design that allows from an upright posture, 50° of forward bend, 16° of side bend and only 8° of rotation (as seen in a study on a group of 30-year old males).

During the golf swing, Lindsay, Horton and Payley (2002) studied 44 young male professional golfers and found that the golfers of their study bent forward by a maximum of 46° with the driver and 51° with a 7-iron, on average – just within the maximum amount of forward bend that younger people are capable of. Trail-side bend during the downswing is greater, on average, than 25° for both clubs (more than the 16° that typical young people are capable of) and rotation towards target is greater, on average, than 40° for both clubs, while the lumbar spine can only rotate 8° in each direction!

The golfers of the PGA Champions Tour are much older and thus their movement capabilities are probably much smaller. Moreover, in general, forward bend (especially at address), side bend, and the X-Factor (the difference between the rotation of the shoulder compared to that of the pelvis) are known to cause lumbar spine injury in golfers.

Two very fine PGA Champions Tour players who participated in the Invesco QQQ event are Jay Haas and David McKenzie, and both have had episodes of back pain. Both Haas and McKenzie have similar swings, with respect to the causative factors of low back pain. They both have considerable forward bend of the lumbar spine (Haas perhaps has more) at address (Lindsay and Horton, 2002, found that golfers with low back pain had, on average, forward spinal tilt at address that was 12° greater than those without pain). Then they make a mostly-arms backswing, moving only the upper chest, while the pelvis does not rotate much at all (termed an X-Factor position, a risk-factor for low back pain).

The main backswing movement besides that of the arms is that the lead-side knee, hip and shoulder drop downwards. Thus, the trail hip is much higher than the lead one at the top of the backswing. So, both golfers drop their bodies vertically downwards to level the hips in order to facilitate torso rotation, which can only take place when the hips are level with one another (because the muscles that rotate the hip joint are able to pull in a horizontal direction only). After torso rotation begins, the trail arm has to help deliver the club to the ball, and to achieve that, the trail side bends to a considerable extent. As described earlier, all of those movements are risk factors for low back pain.

While there are, of course, many ways to treat low back pain, some swing changes can be of preventative value. Moreover, injury and performance are two sides of the same coin, so that a swing change that places important joints, such as the lumbar spine, in better positions might benefit both. Why not make a swing change that might improve performance and also reduce the loads on the lumbar (lower) spine? How would that work? Golfers would stand more upright at address. They would have a movement that keeps the pelvis level at all times. Also, they’d keep the trail side of the body lower than the lead side during the backswing, so that the trunk does not have to side-bend excessively during the downswing. One swing that does just that is called the Minimalist Golf Swing.