The Body Swing Connection: Top 3 Swing Characteristics related to Lower Back Pain

Lower back pain is the number one injury sustained in the golfing population for both professionals and amateurs. It can be very complex in its nature, but my goal for today is to help provide you with a better understanding of what can be the underlying issue. We will then discuss the top 3 swing characteristics that need to be addressed if you are suffering from lower back pain when playing golf.

When it comes to the lower back or the lumbar spine as it is anatomically named, a fellow PT I follow in the world of golf by the name of Chris Finn likes to call it the "friendly neighbor." What he means by this, is that as other areas of the body become limited in their normal use, the lower back will "lend a hand" to make sure the desire movement is completed. This can go on for years if there is no treatment or workouts occurring to address the limited areas but will eventually lead to break down at the lower back as it can no longer withstand this increased load.

From a medical stand point, the lumbar spine is the area of the pain or discomfort now, but the root cause is the surrounding limitations. In the golf swing we commonly see these limitations as a lack of hip rotational mobility and thoracic (upper back) rotation that will lead to the increased stress to the lower back. Since golf is a repetitive movement flowing in one direction, overtime the wear and tear can lead to the break down and subsequent injury. The injured tissues can range from a disc herniation, nerve root irritation, or a facet joint dysfunction.

Once we have arrived at this point, we HAVE to address those surrounding areas to improve their function to allow the lower back to return to its' normal job of providing stability.

Our previous blog here goes over some great exercises to address those areas that generally get stiff in the golf swing to help take some pressure off the lower back. Check it out below:

Improve Your Golf Longevity with These Key Mobility & Stability Exercises

When it comes to the golf swing itself, there are 3 swing characteristics that I look for during an assessment that can generally contribute to having lower back pain:

1. Reverse Spine Angle

2. S-Posture

3. Early Extension

The Titleist Performance Institute (TPI) has evaluated tens of thousands of amateur and professional swings finding these characteristics to be at the top of the list for those suffering from lower back pain. All three of these characteristics involve limitations in some of the structures that we have already mentioned earlier concerning the lower back trying to work too hard. Let's take a look at them individually.

1. Reverse Spine Angle

   

   Coming in at # 1 on our list, this swing characteristic is a ticking time bomb. If this is seen during your swing assessment, it is a "when" not "if" situation for having lower back pain.

   
   

   Generally caused by limitations in hip internal rotation on the trail side and poor thoracic rotation to the backswing, to obtain a full turn, the player now gets their upper body leaned toward the target. This will lead to increased stress to the facet joints on the trail side of the lumbar spine during the downswing (think Will Zalatoris) as the player tries to sync everything back up.

2. S-Posture

This characteristic is one that can be identified at the address position. Here we will see the lumbar spine in an excessive amount of extension with the pelvis rotated anteriorly. Sometimes this posture could be a result of being told to stick your butt out more at address versus a true physical limitation.

But I generally see it more as a result from one having tight hip flexors and a weak core with a poor understanding of what a neutral pelvis would feel like.

3. Early Extension

   
   

   The last swing characteristic here can be a killer to not only the lower back, but the swing in general.

With early extension, we will see the player's pelvis move towards the ball in the downswing, invading the space where the arms need to be. This can lead to the player complaining of feeling "stuck" as well as a two-way miss.

The most common areas that I see be involved with this characteristic are poor hip mobility on the lead side and the inability to disassociate the pelvis from the upper body. Poor core and lateral hip stability can lead to some issues here as well.

If you have a history of lower back pain, and any of these characteristics are found during your evaluation, they will need to be addressed as they are likely contributing to the issue.

Generally this is something that I would collaborate with a swing coach on as I try not to cross-over into their lane and trust their expertise.

When it comes to treatment for the lower back, this can be very complex due to the many structures that can be involved. With that said, if it appears to be a mechanical issue (joint/muscular injury), treatment will likely include manual therapy and follow up exercises to address mobility limitations and then transition into core stability. If there appears to be a larger neurological component (pain/numbness/tingling down the leg below the knee) the treatment may likely include some other activities. But as I mentioned earlier, the lower back is complex and each treatment will need to be individualized to truly eliminate the pain for good.

If you're a golfer suffering from lower back pain, don't hesitate to reach out or get in contact with your local physio as they will likely be able to make some significant changes that will not only improve your game but overall quality of life!