Golf Injury Prevention by Paula Pappalardo
Golf is a sport with a high occurrence of injuries. Predominantly these are overuse injuries, which are prevalent in both elite and amateur golfers. They are most common in females and can occur in the hand, wrist, elbow, and shoulder, but majority will occur in the lower back. These injuries occur for a variety of reason such as overuse, golf posture and too much tension of muscles, however, they will most commonly develop from suboptimal technique when performing the golf swing.
Understanding the Golf Swing
Treating a golfer involves an understanding of the golf swing movement. It is an incredibly complex movement and is considered one of the most difficult movements to perform in sport. To simplify the movement from a physiological perspective they have been broken up into four components. The address, where the golfer is facing the ball, static and preparing for movement. The backswing, where the golfer initiates their movement bringing the club up and back. The downswing, where the golfer accelerates the club forward and downward until it hits the ball. Lastly, the follow-through that starts just after the ball impacts the club and aims to stop the movement, that is, decelerating the club. Each of these components must be carefully analysed by assessing each joint separately.
The X-Factor.
Another important component related to the golf swing, which has been extensively researched, is the X-factor. The X-factor aims to describe how well a golfer can dissociate between the upper-torso and the pelvis during the transition between the backswing and downswing phase. It is created by two lines, one that runs through the shoulders and one through the pelvis. On the horizontal plane, the X-factor is the angle between these two projected lines. A greater X-factor has been shown to lead to better performance by increasing the speed at which you rotate on the downswing and therefore, hitting the ball at a greater velocity. However, a greater X-factor has also been correlated with increased low back pain due to insufficient strength and flexibility.
How much load goes through your lower back during the golf swing?
When performing the golf swing, you will put 7-8 times your bodyweight into your lower back. In comparison, running will put 3 times bodyweight. Therefore, the golf swing is putting a considerable amount of load on the lower back structures. Importantly, these loads have been shown to be higher in amateurs compared to elite golfers. This can lead to injury of several structures in the spine, including the disc, joints, ligaments, and muscles around the spine. If a golfer is consistently forcing excessive trunk rotation, the spine is subjected to excessive strain.
So, if a golfer does not have the necessary muscular and neural control to rotate their trunk at high speeds nor adequate flexibility, they will also place too much stress on the structures of the lower back, which can lead to injury. What is most concerning is that if a golfer is playing through a sore back, the muscles around the spine will over activate with rotation to stabilise the spine and this can place even more strain on your lower back structures. For these reasons it is highly recommended to not play with a sore back.
Physiotherapy injury prevention strategies
Now the golden question, how do you improve your golfing performance, ultimately reduce your handicap, and prevent the occurrence of lower back pain? The answer is, to strengthen and improve your flexibility. The most important phase to be strong and flexible in is the downswing. Research has found that muscle activity is at its highest during this phase.
So, where to strengthen? The muscles around your hips are important in stabilising the pelvis and creating a stable base for the spine to rotate around and generate power at impact. The muscles around the spine are important to help the spine maintain a forward tilt whilst rotating and laterally bending.
In terms of flexibility, having adequate flexibility with spine rotation and side bending are most important for your golf swing. Furthermore, adequate hip mobility in the leading hip is very important. Without good hip mobility, the body will compensate by further loading the lower back during the swing phase to achieve the same rotation. Lastly, we cannot forget about balance. The ability to balance on one leg has been linked with multiple components of the golf swing, including the backswing, impact, and a greater X-factor.
A quick and easy strategy to prevent injuries? Warm-up!
A quick and easy strategy that you can use, starting today to prevent injuries, is a proper a warm-up. Performing an adequate warm-up has been linked with an increase in the X-factor and reduction in injury. Research has shown that recreational golfers are 3.2 times more likely to experience an injury when they do not perform a warm-up. More specifically, a recent study that looked at 703 golfers found that golfers who stretched and performed a warm-up for at least 10 minutes before playing were 60% less likely to experience a lower back injury.
Below is outlined a warm-up that has been suggested based on evidence. It is easy to perform, can help to prevent golf-related injuries, improve performance by improving the X-factor, requires only a golf club and incorporates familiar movements specific to golf. There are six exercises that are performed 10 times on each side.
If you are someone that has experienced an overuse injury in the past or are currently experiencing pain or discomfort, it is never too late to start your recovery journey. Book a consult with your Physiotherapist to help you to implement a prevention program and reduce injuries on the golf course.