Case report: reduction of low back pain in a professional golfer

Abstract

Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. Motion of the trunk was measured using three-dimensional video analysis and electromyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report.

Current golf performance literature and application to training

“…16 Optimal trunk activation and stabilization occurs with the spine in a neutral postion. 28 Golfers that exhibit poor posture with their setup and swing, especially those with prolonged flexion (C-posture) may lose the protective role of the multifidi and erector musculature. 69 Swing faults can be associated with poor instruction, or the lack thereof, and also by physical limitations.…”

“…There is evidence to show that both interventions together have successfully rehabilitated golfers. 27,28 Two published case studies of golfer rehabilitation following low back injury addressed transversus abdominis and multifidus activation during their program. 27,28 Activating the transversus abdominis occurred in supine with the knees flexed while performing the abdominal hollowing maneuver; Whereas the multifidus was activated in the prone, quadraped and supine positions.…”

“…27,28 Two published case studies of golfer rehabilitation following low back injury addressed transversus abdominis and multifidus activation during their program. 27,28 Activating the transversus abdominis occurred in supine with the knees flexed while performing the abdominal hollowing maneuver; Whereas the multifidus was activated in the prone, quadraped and supine positions. 27,28 These muscles were exercised with 10 repetitions performed 3 to 4 times per day, and the actions were held for five seconds while building up to 20 to 30 second holds.…”

“…27,28 Activating the transversus abdominis occurred in supine with the knees flexed while performing the abdominal hollowing maneuver; Whereas the multifidus was activated in the prone, quadraped and supine positions. 27,28 These muscles were exercised with 10 repetitions performed 3 to 4 times per day, and the actions were held for five seconds while building up to 20 to 30 second holds. The studies found that the golfers were able to return to golf pain-free following the program, which lasted for up to 12 weeks.…”

Lower back pain in golfers: a review of the literature

“…45 The effect of treatment on swing mechanics has been examined in a case study involving a professional golfer with chronic LBP. 46 The implementation of a 3-month exercise program and tuition of the swing was proposed to result in the reduction of pain and changes in muscle activity during the swing. Changes in activity included a decrease in left sided erector spinae (upper and lower) activity during the downswing, but increases in activity of both the left and right erector spinae muscles (lower thoracic, upper and lower lumbar) during the follow through.…”