Golf is a sport that is enjoyed by 30 million people in the United States according to the National Golf Foundation. A third of these players are older than 50 years of age.
Not surprisingly, amateur golfers have a higher incidence of low back pain than professional golfers. However, professional golfers have the highest incidence of back injuries of all professional athletes.
Golf places some huge demands on the spine with the forces used to swing a golf club. These forces arise from a combination of compression, shear and rotational movements. When decreased flexibility and the degenerative changes of aging are mixed with these spinal loading forces, it seems natural for golfers to have some back pain.
It’s amazing that compression loads can reach up to eight times body weight during the swing. These forces are approaching those of a college football lineman hitting a sled. The facet joints of the lumbar spine normally bear 20% of the weight bearing forces (compression) that cross the lumbar spine while the other 80% of the weight bearing forces are transmitted across the intervertebral discs. These forces are increased with the rotation of the golf swing and these increased forces tend to accelerate the degeneration of the facet joints.
Degenerative changes of the facet joints are characterized by loss of the cartilage surfaces, thickening of the joint capsules, and osteophyte or spur formation. The degenerative changes of the facet joints can result in loss of motion and pain. Facet syndrome is the name given to a back with painful symptoms from the facet joints.
Interestingly enough, the swing you use may influence the amount of force the facet joints get exposed to. The “classic” swing has less trunk rotation and extension than the “modern” swing that finishes with a more arched back. If you have back pain that is related to the facets, perhaps using the “classic” swing might help reduce your back pain by reducing trunk rotation and increasing muscular control at the extremes of the swing.
The evaluation of back pain in the golfer needs to be comprehensive in the search for muscle imbalances and defects in the complicated range of motion required to swing a golf club correctly. Ankle and foot range of motion can even affect a golf swing!
If you have back pain that originates from the lumbar or thoracic facet joints that cannot be relieved by conservative measures, then a change in your golf swing may be necessary.
If you see a pain management physician, it is likely that some facet blocks (facet injection with local anesthetic) will be recommended to confirm the source of pain (facet joint) and possibly be injected with cortisone to reduce inflammation and prolong the pain relief.