Watch this video of David McCrea, Senior MSK Physiotherapist discussing ‘Injury prevention strategies for golf – low back pain.’
This video was recorded as a part of SSC Evening for Golfers in January.
David McCrea is a Senior MSK Physiotherapist at SSC.
My name is David McCrea and I am a Senior Physiotherapist working at the UPMC Sports Surgery Clinic. I’m here to talk to you about injury prevention strategies for golf with a particular focus today on low back pain in golf. I taught I would start by reviewing the physical activity guidelines published by the American College of Sports Medicine. The American College of Sports Medicine recommends 30 minutes of moderate-intensity exercise 5 days a week, which can also be referred to as well as 150 minutes of total exercise per week. On my next slide, you will see golf is considered a low-intensity exercise, so gold can help contribute to us achieving our physical activity guidelines in healthy adults. It doesn’t quite fit the category of vigorous-intensity exercise but definitely, it fits the category of moderate-intensity exercising can contribute to our health in that sense, at the bottom of the slide you can see they recommend resistance training 2-3 days per week, this can often be the forgotten piece for Golfers, the resistance training is going to be a particular point of focus for us today as this is often the piece that allows us to stay healthy and to improve performance in our golf.
I taught we would also start by looking at the demands of the sports of golf. Golf is often perceived as maybe a leisurely activity for many of us it’s a hobby and it’s a pastime we don’t often see it as a sport or a way of us achieving our physical activity goals. There have been some nice studies done where they analyzed golfers physiological data and you can see the top here so, in terms of the cardiorespiratory toll, the average heart rate during an 18-hole round of golf is approximately 60% of peoples max heart rates, so for someone like myself that might be averaging kind of 120 beats per minute for nearly 3 hours. Below you can see the average walking distance over an 18-hole round of golf is anywhere between 9.5-10.5 kilometer’s and obviously, that can be halved if you’re playing 9 holes, the average standing duration can be close to four hours so 3 hours 45 minutes.
Injuries in gold. Is it an issue? In the world of sports medicine and research, injuries are reported per 1000 hours of participation. If you were to participate in golf for 1000 hours the current injury rates are 0.28 to 0.6 injuries, seeing as golf is an individual sport a well, you can see here 1000 hours equates to nearly 250 rounds of golf and that’s not to say that if you play 250 rounds you’re going to get injured but at the moment among amateur golfers that’s the current injury rate being seen.
How does this compare to other sports? Golf reported injury rates are low to moderate when compared to other popular sports. Football reports up to 8 injuries per 1000 hours and running reports up to 2.5-12 injuries per 1000 hours. Overall golf can be considered very safe to participate in with a lower injury rate in comparison to other sports.
Low back in golf is consistently cited as the most common golf injury. Between 18-54% of all golf injuries are related to the lower back. Research shows it equally affects both young and old golfers and it also affects both high and low handicap golfers. How to prevent low back pain in golf, is worth having a look at some of the most common causes for back pain in golf. There has been research done in this area that showed consistent themes that emerge are displayed on the screen as you can see repetitive strain, trunk strength & control, and hip strength & control. We must look at the key physical qualities that underpin the golf swing. You can see here there are 3 pieces of the pie. I have prepared a video here of Rory McElroy swinging in slow motion.
We have trunk hip rotation, the mobility to allow us to access and get into these positions to generate some good speed and power, we have trunk muscle to be able to control that motion of decelerating the club and then re-accelerating the club and hip strength, to be able to decelerate the club and accelerate the club. For the next portion of the presentation what we will on is exercise strategies to try and maintain each segment from the pie. These can be incorporated into your pre golf warm-up or could be incorporated into your weekly routine.
We will start with trunk rotation, which is going to allow you to reach the top of your back-swing comfortably and follow through on your downswing comfortably. You can see that time has himself set up in a lunge position, he has a football squeezed between his knee and the wall and he is set up with his hands in front as if he is holding a gun, his goal here is to keep his knee squeezed against his football, not to let the football drop away from the wall. If you have a football you can use a cushion or a foam-roller, whatever suits. He is then trying to maintain good contact with his knee to rotate and open up his chest.
The video Tim is lying on his side in a similar position and again his knee is squeezing down the football down onto the floor and that is going to fix his hips in one position. Then from here he is trying to wrap his hand all the way around the floor to the other side, then bring it back until his hand is on top of the other hand. He is working on his trunk rotation here. The few videos show other examples of exercises for trunk rotation or pre golf warm up. Tim here is again is lying on his back, he is pinning his upper body and arms to the floor, he is then rocking his knees side to side like a windscreen wiper to create good rotation through the lower back. In this video Tim is using a speed stick, you could be using your driver or broomstick at home for example, Tim is setting himself in a almost golf position, he has a slight bend in his knees and slightly bent forward as he is standing over a ball, from there he has his speed-stick crossed across his chest and what hes really focusing on doing is pinning his hips in one position but trying to encourage as much trunk rotation as possible.
The faster clubhead speed you have, the lower handicap you’ll have. We see long game performance improves and your distance will improve both your carry and your run as well. It is important once we get you strong to do a little bit of transfer work and I’m going to show you videos of that tonight, different ways you can transfer this once you have strength, you can transfer this onto your swing. When we strike the board with the driver there are massively high forces its similar to that of throwing a javelin actually believe it or not and so having that level of strength protects you against injuries when you’re using the driver and this young man on the right-hand side he’s got about 133 miles per hour clubhead speed can probably strike the ball into the mid to low 300 yard kind of range.
We have a continuum that we use here at the clinic and it goes from the high force on the left-hand side to higher velocity on the right-hand side. I have got a few videos here to show you. These are clips of our training. So then it brings us on to our swing speed progressions, once we have the prerequisite strength and we want to try to improve the actual speed of our swing. There is a couple of different progressions that we use that you can do down the range as well, In this video, we are using a swing speed stick that helps us, gives us a little bit more speed not swinging but using different clubs so you can use your lighter clubs such as your pitching wedge or heavier clubs as well such as your fire burn to do this with. We’re not focusing on hitting the ball here, we’re just focusing on swinging as fast as we can so it’s far removed from actually hitting practice on the range.
That concludes today’s talk, hopefully, you have learned something a little bit about back pain in golf, in terms of how it happens and maybe some simple strategies to try and address it from happening in the first place or if you are struggling with back pain in terms of trying to resolve it as well using exercise as a tool to do so and if you’re unsure where to start, I’m more than happy for you to ask a question during a Q&A session. I or Luke Hart will be hopefully able to answer that for you. If you want to book in with a physio, please feel free to book in. Thank you for having me today.
Golf Lab is a testing service that we can then provide a personalized strength and conditioning program for to help your injury risk and your performance on the course, it involves strength testing for your gluteal muscles essentially the big muscles at the back of the body that is going to produce all the power for your swing, we look at how well you can rotate, we look at the amount of force you can produce into the ground which is really important for your clubhead speed but also protecting your lower back as well.
We look at how much power you can produce in both double and single-leg, then we go into a personalized program. Off the back of that, we can write a personalized program for you to suit where you are at. It really is for everyone, all kinds of levels, and every age demographic because we individualize the tests to whatever level you feel comfortable with and your injury history.
Firstly, these conditions can be quite painful, these can lead to some protbehaviorsaviours setting in, if they linger for a period of time, it can lead to a loss of mobility and range of motion which then can impede your swing, particularly the backswing. The golf swing is broken down into different components.
I think probably an important step for you, would be to break the golf swing down into different components and try to target each area to ensure that he is staying mobile in the right areas, that he can swing pain-free. If he is struggling and doesn’t know exactly where to start, I would probably recommend getting an assessment with a physiotherapist or S&C coach to give him some advice.
Yes, this is a common issue that physios encounter all the time, especially if a patient has spent time immobilizing a boot or in a cast or on crutches, they often lose a lot of strength and often lose a lot of muscle size so by working with the physio, we definitely can rebuild that muscle size and strength, it’s important that the exercises you’re selecting are appropriate and that the stimulus you’re getting from those exercises are sufficient to strength, difficult enough to build your strength back up again.
The first step would be to get an assessment to ensure this is si joint problem. Your back pain can be caused by all sorts of reasons but first and foremost you would look to rule out some of the more serious causes for the pain, an assessment with the physio can do that. You may or may not need a scan based on the findings or a rehabilitation program can be made for you.
Osteoporosis is a condition with reduced bone density and it’s a long-term condition that has to be managed I’m kind of an ongoing basis and the cornerstones for managing osteoporosis, one of them is weight-bearing exercise so if you see in my presentation and also my colleagues Luke’s presentation, there are lots of examples of good weight-bearing and resistance based exercises, a physio or an S&C coach can help you with that. While a doctor would help with the medication and diet aspect of managing osteoporosis.
Low back pain is often associated with sort of the repeated stress of the swing throughout the round so this might suggest that as the round progresses that he’s fatiguing, the fatigue is then causing him maybe a mechanical overstrain of his lower back so by improving your strength and control around your lower back, hips and pelvis area later in the range you might find the mechanical strain on your lower back is reduced and that sensation of pain or tightness is reducing as you go.
It is important to understand that PRP injections are done to help reduce inflammation and it might offer you a window of opportunity to engage in rehab more comfortably or less painfully. The exercises shouldn’t be painful to do but they should be reasonably hard to do as this is what is going to help you improve and strengthen the area.