Golf Data Links Pain to Lumbar Musculature

There are more than 25 million golfers in the United States. More than 34,600 persons are admitted to an emergency room in the United States each year for a golf-related injury. Amateur and professional golf injuries predominantly involve the back (especially amongst men). These injuries clearly occur during the golf swing. Biomechanically speaking, the golf swing is composed of 5 phases; the setup, backswing, transition, downswing, and follow-through. Different muscle groups are firing at each of these phases. The downswing is, logically, the phase of the golf-swing characterized by the most golf-related injuries; it is technically the “driving” phase of the swing. There are twice as many downswing injuries as backswing injuries. EMG (electromyographical activity) studies have demonstrated that during the downswing (for a right-handed golfer) activity in the right quadratus lumborum, gluteal muscles, hamstrings, left triceps, latissimus dorsi, and wrist extensors increases. The inverse is true for left-handed golfers. The first three of these muscle groups are involved in pelvic stability and spinal alignments, especially during highly dynamic activities – i.e. the golf swing.

Current studies, including one from the University of South Australia, have begun to investigate the theory that golfers with low back pain may be overly dependent on the erector spinae (ES) muscle group to stabilize the golf swing. Rather than distributing the load amongst the other lumbopelvic stabilizers (quadratus lumborum, transverse abdominus, multifidus, and the major hip extensors) the ES is required to provide relatively high levels of contractile force. Investigators studied the onset of paraspinal muscle activation in 12 male golfers with lumbar pain and 15 male golfers with no similar symptoms. The ES muscles were activated significantly earlier in the low-back pain group in comparison to controls during their swing. High EMG activity in these muscles was detected well before the start of the backswing indicating that these individuals were overcompensating for their instability with the ES.

A study by the same investigators earlier this year reported a relationship between these characteristics and golf handicap. In an article published in the Journal of Science & Medicine in Sport 12 symptomatic male golfers were compared to 18 asymptomatic controls. Low-handicap (defined as 12 or lower) golfers with low back pain were characterized by greater external oblique activity at the top of the backswing and at impact compared to low-handicap controls. High-handicap (13-29) golfers with low-back pain had more ES activity than their pain-free counterparts. This seems to indicate that the ES and the oblique muscles are used to compensate for weakness in the deep stabilizers of the trunk. Successful treatment of golf-related injuries (most of which occur within the lumbar region) will include modification of the golf swing apart from the rehabilitation that may be necessary. Maintaining strong stabilizers that are flexible and balanced (with regard to agonist-antagonist relations) will allow for the highest levels of performance. Proper mechanics and posture will reduce the occurrence of injury. (Journal of Science & Medicine in Sport, 2009)

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