1. Low Back Pain and Golf Mechanics
Mohamad Zein
DPT

2. Back Pain in the general population
Affects 50-80% of population
40% have back pain in any one year
15-33% have point incidence at any given time
Adams, et. Al (1999)

3. Causes: Internal vs. External Forces
Internal Causes
Joint Fixations forcing motion into
hyper-mobile segments
Improper usage of muscles for
stability (imbalance)
External Causes
Posture
Repetitive bending
Prolonged flexion
Poor workout regimes
Trauma

4. LBP Related Golf Injuries
Main Causes:
Overuse
Technical errors during the swing
Physical fitness deficiencies: Aerobic, muscular strength, flexibility…
No pre-game warm up
Natural environmental conditions (uneven course surface, wet grass, thunderstorms)
Sports Med 1998 Jul; 26 (1)

5. Overuse Golf injuries originate from an
overuse or from a traumatic origin
(Theriault, Lachance)
Amateur golfers were
prevented from playing
golf for an average of 5.2
weeks per year due to chronic back
injuries sustained while golfing
(US, McCarroll et al)

6. Overuse
Amateurs desire to hit the ball as vigorously as the professionals but without the same technical refinement
Most common area affected in the lumbar region:
Paraspinal muscles, intervertebral disks, vertebral ligaments, facet joints and posterior arc (spondylolysis)
(Theriault, Lachance- Golf Injuries)

7. The Swing Phase
Preparation
Backswing
Downswing
Impact
Follow through

8. Biomechanics of Golf Balance Accuracy Summing Momenta
Generating Momentum
Swing plane
Common errors
Swinger

9. Biomechanics of Golf Balance
Height of the Centre of Weight also determines the security of the balance
The lower the centre of weight, the greater the stability of the body
The higher the centre of weight, the less stability of the body

10. Biomechanics of Golf Balance
Centre of Weight is found directly in the centre where the weight around it is the same
The Centre of Weight changes as the body changes position
The Size of the Base of Support determines how stable the body will be in a given position
If the Centre of Weight moves outside the
Base of Support then the body will become more unstable

11. Biomechanics of Golf Accuracy
Sideways Accuracy can be achieved if the arc of the swing is kept in vertical alignment with the target.
Errors in sideways accuracy
Unintentional Slice – open clubface
Unintentional Hook – closed clubface
Errors caused by swing plane of
club and club face angle

12. Biomechanics of Golf Accuracy
Height Accuracy in a golf swing can be achieved if impact is made at any point on a straight or direct line to the target.
Errors in height accuracy
Topping/thin contact
Fat contact – hitting ground b4 ball
Errors caused by change in height of center of gravity

13. Biomechanics of Golf Momentum Summing Momenta Generating Momentum
Use of Body Segments
Optimum Stretch
Sequence of Movement of Body Segments
Optimum Contribution of Body Segments
Range of Motion

14. Biomechanics of Golf Momentum
Time
Velocity
trunk
upper arm
forearm
hand
To get the maximum momentum from a golf swing a large number of body parts are required.
“Starting with the major body parts → smaller parts until just before impact.”
(B. Abernethy, 2000)
This increase the acceleration and therefore force on the ball.

15. Biomechanics of Golf Swing Plane
The swing plane of the golf club follows a circular path.
Errors in swing plane cause errors in:
Height accuracy
Sideways accuracy
“Poor balance will always alter a
golfer's swing plane, causing many
errant shots”
(Steve Bishop, 2008)

16. Kinetic Chain (system of links)
Specific motions at certain segments of the kinetic chain have a dramatic effect in movement of other joints (or lack there of), and the turning on or off of certain muscles
(Gray seminar 2005)

17. Biomechanics of Golf Common Errors Biomechanical Principles
The No power/distance
Topping/Fatting the ball
Air swing
Incorrect flight path of the ball
Lifting body
Feet Move
Summation of Forces & Generating Momentum
Height Accuracy & Height of Centre of Weight
“same as above”
Stance & Sideways Accuracy
Height of CoW
Base of Support

18. Technical Errors during the swing
Observe
Detect
Assess
Correct
RE-Assess
C Posture
S Posture
Sway
Slide

19. C Posture
Slumped shoulders at address and roundness to your thoracic spine
Limited thoracic extension
Upper cross syndrome-muscle imbalance, tight pecs, lats, upper traps, elevator scapula and weakness in mid scapular muscles, lower traps, and deep neck flexors
Instability of core muscles causing poor posture and a slouched forward position at address
Lack of thoracic spine extension relates to increased lumbar and cervical spine motion

20. C Posture Functional Screens Exercise Examples
Thoracic Extension/ Wall Angle
Foam Roller/ Swiss ball extension

21. S Posture
Too much arch in the low back as a result of sticking your tail bone out too far (“J-Lo booty”)
Lower cross syndrome- tightness in the hip flexors and lower back and weakness in the abdominals and glutes
Lack of abdominal endurance/ strength
This excessive curvature in the low back puts abnormally high stress on the lumbar joints, disks, and musculature
You can successfully stick your butt out at address and keep your spine in a neutral position if you hinge from your hips. This requires good core strength and proper stabilization, the problem arises when this isn’t true and the force is generated in to the lumbar spine.

22. S Posture Functional Screens Exercise Examples Core endurance test
Thomas test
Side bridge
Tri planar psoas stretch

23. Sway
Excessive lower body movement away from the target during your back swing that forces your weight to the outside of your back foot
Very difficult to attain proper weight shift during the transition and the downswing
Proper rotation around the back hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern
Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility
Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

24. Sway Functional Screens Exercise Examples Hip rotation test
Thoracic Rotation test
Glute stability test
Hip mobility/ stretching
Foam roller/ Swiss ball
Glute bridge

25. Slide
Excessive lower body lateral movement towards the target during your downswing
Stability on the lower body is crucial in order to accelerate during the downswing
Once the lower body starts its forward shift into the downswing its job is to transfer energy to the upper body and stabilize the extreme rotary forces that are created in the upper body. If there is no stable platform to rotate around, players will lose power and try to develop speed in an inefficient sequence

26. Slide
Proper rotation around the front hip is only possible if adequate amount of internal rotation exists. If the body is unable to rotate around this hip then lateral movements will dominate the pattern
Secondly the ability to separate your upper body from lower body allows the lower body to laterally stabilize while rotating during a large shoulder turn. Limited trunk to pelvis is usually caused by reduced spinal mobility
Finally, the ability to laterally stabilize your right leg during the downswing is directly dependant on the strength and stability of your gluteal musculature

27. Slide Functional Screens Exercise examples Hip rotation test
Thoracic Rotation test
Glute stability test
Hip mobility/ stretching
Foam roller/ Swiss ball
Glute bridge

28. Functional Screens Core Endurance Test
Side Bridge >70 seconds linked to less injury
(McGill 2010)

29. Thoracic Extension (Wall Angle)
Functional Screens
Thoracic Mobility
Thoracic Extension (Wall Angle)

30. Hip Mobility (internal/external rotation)
Functional Screens
Hip Mobility (internal/external rotation)
Ideal hip rotation 45º internal 45º external rotation
Artifically increasing hip stiffness in normal subjects caused profound changes in the profile of trunk movements and balance control (Gruneberg, 2004)
“I am continually surprised at the number of people with back troubles who also have hip troubles” (McGill, 2005)

31. Functional Screens Glute Stability test
Proper activation of the posterior
chain is initiated by glute activation
Weak/Inhibited glutes (Glute Amnesia) will be
evident by over action of the lumbar
extensor muscles or hamstrings

32. Thomas Test (hip extension)
Functional Screens
Thomas Test (hip extension)
Hip extension is directly related to lumbar spine function
If tightness is present in the hip flexors (psoas muscle) in order to get extension, the lumbar spine has to continually over extend to compensate= excessive wear on the posterior elements of the lumbar spine

33. Treating functional findings
Lumbar aliments commonly seen in golfers will be clinically improved by rest, manipulation, traction, and a good lower back rehabilitation program designed to regain maximal flexibility and strength (Sports Med 1998 Jul; 26 (1)

34. Exercises
Thoracic Mobility and Thoracic Extension

35. Exercises
Core Endurance

36. Exercises
Hip Mobility

37. Exercises Tri-planar psoas stretch
Tri planar stretching allows the muscle to be stretch in all planes where as static stretching only accounts for one plane

38. Exercises Glute Bridge Poor Pattern Ideal Pattern
Over-activation of lumbar muscles and hamstrings
Poor control
Ideal Pattern
Core activation and Glute activation simultaneously
Good control

39. Exercises Golf Squat Over Head Lunges Quads Hams Glutes Core Torso
Shoulders: stability/strength
Triceps
Grip

40. Take Home Message
“Exercise programs should be started until joints have a normal end feel” (Mennel)

41. THANK YOU!