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As amateur golfer's, many of us have something in common with
Jack Nicklaus and Lee Travino - a bad back. If you are among
those who have already experienced a bout with this affliction,
then you know how debilitating it can be. Low back pain
accounts for almost 25% of all athletic injuries. In the
western world, 80% of the population will experience disabling
low back pain during their lives. Back pain is now second
only to the common cold as a cause of employee absenteeism
and, in 1992, cost the U.S. economy $60 billion. A 1989
workers' compensation study from Liberty Mutual revealed
the average cost of a low back pain case was $8,321. Low
back pain clearly represents the single greatest and most
inefficient expenditure of health care resources in our
society today.
Understanding the anatomy of the back will help you understand
why and how back problems occur. The spine is composed of 24
bones called vertebrae. The lower back or lumbar spine has
five vertebrae. In-between each pair of vertebrae are
cushions called discs. The main responsibility of the
disc is to absorb the compressive forces to which the
spine is subjected.
There are three main muscle groups of the back. The muscles
which parallel the spine are called the erector spinae.
They, as the name suggests, keep the spine erect. They
lift you up from a bent forward position. The quadratus
lumborum is a deep muscle which runs from the lower ribs
to the hip bone on each side. It helps you breath in air
and side bends you. The hip flexors, or iliopsoas, run
from the front of the lumbar spine to the thigh bone or
femur. This muscle helps lift the knee up and is used
when doing a full sit-up (more on this later).
Most back pain is preventable and often is caused by too
little exercise, over exertion, overuse, poor form, lack of
flexibility, and poor posture. Smoking and obesity are also
implicated. These may result in arthritic or degenerative
changes in the spine, disc herniations (commonly called slipped
discs), muscle spasms, spinal joint irritation and dysfunction
and nerve irritation. Non-musculoskeletal and potentially
more serious problems like cancer, kidney disease, gallbladder
disease, prostate disorders (all men over 40 should have a
prostate examination yearly), ovarian and uterine disorders
and aortic rupture may also cause back pain. A thorough
examination to properly diagnose back pain is essential.
When golfer's think of the golf stance they don't realize how difficult
it is to maintain the proper stance over 18 holes. A poor stance puts
tremendous stress and strain on the lower back. Bending at the hips, not
bending foward at the lower back is the key to preventing lower back pain.
Strengthening the core muscles (abdominals, obliques, lower back, gluteal
muscles and hamstrings) should be part of your golf
fitness program. If you don't have a strong core you are in for big problems
as well as poor performance. Flexing the knees requires strong quadriceps or front
thigh muscles. If your quadriceps are weak you will fatigue more easily
resulting in mishits and shorter distance. If your calves are too tight you
will find it difficult to stay down at the ball.
The golf swing requires a repetitive, one-sided torquing of the spine.
This eventually expresses itself as "Golf Body," or a change
in one's posture due to muscular imbalances and lack of
flexibility. This problem is actually worse in amateurs
because of poor swing mechanics thus causing a greater load
or stress on the lumbar spine. Remember, the average golfer
will hit 50 full swing shots in a typical 18 hole match.
In his book, The Egosque Method of Healing In Motion,
Peter Egoesque writes, "unless golf faces up to the indifference
it has traditionally shown to the body and its proper functioning,
the booming interest in golf won't last. The sport will be
swamped in pain. Thirty and forty-year-olds who are now heading for
the fairways in droves are the least functional generation
who has ever teed up a golf ball. They bring dysfunction...
by playing hour after hour, day after day, and this repetitive
compensation motion injures them."
Over time these changes may cause spinal arthritis may develop.
The discs narrow and wear out
and the verebrae crumble often forming spurs which narrow and
compress the area through which the spinal cord and nerves pass.
A disc herniation occurs when the outer wall of the disc
weakens and the jelly like middle causes that outer wall to
bulge out. The middle may even squirt out and form a separate
fragment, like a piece of floating cartilage in the knee.
This bulging may "pinch" the nerve exiting from the spinal cord
or the spinal cord itself.
Most commonly, lower back pain is caused by a sprain and strain
of the ligaments and muscles of the back causing spinal joint
irritation and dysfunction and muscle spasm. Most of these
injuries may be prevented by making some changes in your
lifestyle and golfing habits.
If you are overweight, you must lose the spare tire.
This additional weight puts tremendous pressure on the
spine and discs. Recently, I had the opportunity to spend
a day with Rocco Mediate at the TPC course at Sawgrass in
Jacksonville, Florida. He had lumbar disc surgery one and
a half years ago and underwent a rigorous rehabilitation
program which included losing 50lbs.!
Smoking, believe it or not, may increase the risk of lower
back problems because nicotine decreases the blood supply to
the spine. Which is more important, your golf game or smoking?
Maybe this can be your impetuous for quitting.
Many golfers are simply out of shape. Too many of us play a
sport to get or stay in shape. It should be the reverse- you
must get in shape to play a sport and this includes golf.
This means a complete exercise program including aerobic
exercise (20 minutes a day, three times a week), strength
training (twice a week working on all the major muscle groups)
and stretching.
A critical area for golfers is the midsection meaning the
abdominals, the twisting muscles or obliques and the lower
back muscles. Strengthen all of these, not only the
abdominals, as a strong midsection will be able to handle all
the torquing of the golf swing. See the exercises described
at the end of the article.
Avoid the golf cart as the sitting position puts 40% more
pressure on the discs than standing. It also causes you to
cool down after each shot. Walk the course with a pull-cart
as this will keep you warmed-up.
One thing which I find is almost never done by both
professionals and amateurs is a proper warm-up or more appropriately put, proper
prepartation. Don't confuse stretching and warm-up. They are BOTH part of
preparation. Start by walking for at least five minutes. Then try some dynamic
stretching of the calves, hamstrings, quadriceps, torso, shoulders, arms and neck.
After this you may start swinging a club gently. Try gently swinging from the
opposite side 10-20 times to balance the one-sidedness of your
regular stroke. Proper preparation is crucial to injury prevention.
If you have back problems, you may want to try a long putter. The bent over
and crouched position of putting puts much stress on the back.
Try cutting down on your swing in the more classic swing
style. The "caddie swing" allows more control and puts less
strain on the lower back.
Initial treatment for lower back problems is to stop your
activity and ice the lower back for 20 minutes. Lie on your
back with your knees bent directly on the ice pack. Gently
try pulling one knee to your chest and hold that position for
five seconds. Repeat this five times with each leg.
If the home care does not work, you may want to see a
chiropractor. Chiropractic is a natural health care method
that stresses the importance of keeping all the systems of
the body functioning efficiently so the player enjoys peak
performance, a minimum injury risk, and fast recuperative
powers. The primary treatment of the Doctor of Chiropractic
is an adjustment (manipulation) to those areas of the spine or
surrounding joints which are slightly displaced and fail to
function normally. Given by hand (the word chiropractic means
"done by hand"), the adjustment will restore proper alignment
and function to the spinal joints, thereby restoring the normal
nerve transmission and healing potential to the vital
structures of the body.
Just correcting the joint misalignments is not enough, however. You must
see a chiropractor skilled in manual muscle therapies like
Active Release Techniques®
and Graston Technique. Any muscle tightness must be corrected
by these techniques to allow the proper functioning of the joints AND for you to be able
to get your body in the position your golf instructor wants you to be in.
Finally, the chiropractor must have knowledge in golf specific rehabilitation techniques
which are part of a complete treatment and performance program.
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GOLFER'S BACK
