Golf is becoming more popular than ever. The increased popularity of golf may be due to demographics, with baby boomers having more time and disposable income, and may be due to the fact that technology is producing golf equipment that makes the game easier. Whatever the reason, golf is certainly enjoying a surge of popularity.

However, like any other sport, golf can produce injuries to the low back and spine. One very common golf injury is low back pain (usually due to muscle strains and sprains). Additionally, people who suffer from chronic or recurrent episodes of low back pain can be frustrated because the pain hinders their ability to play golf.

As with so many health conditions, a little effort to prevent back injury and low back pain goes a long way. Four key areas of prevention for the sport of golf include: warm-up, swing, bio-mechanics, and carrying the golf bag.

1. Warm-up before playing golf to prevent low back pain
Going directly to the tee at 7 a.m., pulling out the driver, and then proceeding to try to hit the cover off the ball is probably the surest way to sprain one’s back muscles and result in low back pain. Instead, a thorough warm-up before starting to golf—including stretching and easy swings—is critical for the muscles to get ready for the game.

First, start with stretching before beginning to play golf. Stretching should emphasize the shoulder, torso, and hip regions as well as the hamstring muscles.

• The shoulder and torso may be stretched by holding a golf club behind the neck and shoulders and then rotating the torso.
• The hips may be stretched by pulling the knee to the chest.
• The hamstrings maybe stretched by bending over and trying to touch the toes.

Next, gently swinging a golf club helps warm up the necessary muscle groups and prepares them for the torque (force) and torsion (twisting) that a golf swing produces. Time permitting, going to the driving range before a golf game is very helpful. Golf practice should begin with the smaller irons and progress up to the larger woods. This process allows the muscles to incrementally warm up.

Overall, muscles that have been stretched and gradually loaded are much less prone to being injured while playing golf and can take more stress before either being strained or sprained.

2. Practice swinging before playing golf to prevent low back pain

The objective of a golf swing is to develop significant clubhead speed, and to do this a lot of torque (force) and torsion (twisting) is applied to the low back. Golfers should emphasize a smooth, rhythmic swing, as this produces less stress and less low back pain (such as minimizing muscular effort and disc and facet joint loading).

With a proper swing, the shoulder, pelvis (hip), and thoracolumbar segments (chest and lower spine) rotate to share the load of the swing. The shoulder and hip turn, along with the wrist snap, will produce more clubhead velocity than a stiff arm swing.

Good balance while golfing is achieved by slightly bending the knees and keeping the feet approximately shoulder-width apart. The spine should be straight, and the golfer should bend forward from the hips. Weight should be distributed evenly on the balls of the feet.

As most golfers will agree, while developing an easy, fluid swing may be desirable in terms of reducing stress to the low back and preventing low back pain, this is often easier said than done. To avoid a low back injury, beginners would be well advised to work with a golf pro when starting out, since most aspects of a golf swing are not natural or intuitive. Additionally, golf lessons may be useful for senior golfers who have decreased flexibility and strength.

3. Carrying the golf bag safely to prevent low back pain

Repeated bending over to pick up a golf bag can stress the low back and lead to a muscle strain. An integrated golf bag stand that opens when the bag is set on the ground can eliminate the need to bend over. Some individuals like to carry their own golf bag to get more exercise, and while this may be a good idea, bag straps that place all the pressure on one shoulder can be hard on the back. It is advisable to use dual straps on the golf bag to evenly divide the weight across the back and reduce the chances of developing low back pain from an uneven load.

Most acute low back injuries that occur during a game of golf will get better over a couple of days to weeks. The most common injuries from golf include:

• Muscle strains: typically occurs with rough or forceful golf swings or a sudden shift during the downswing
• Muscle and tendon attachment: generally occurs due to excessive use, accidents, or swing abnormalities while playing golf
• Disc injuries: can occur from swinging abnormalities (note that this is usually due to a pre-existing disc lesion that is aggravated by golf)

It is generally not advisable to further stress inflamed muscles by continuing to play golf through an episode of low back pain. Taking time off from golf will allow the muscles to heal more quickly. Continuing to stretch between golf sessions is advisable, as is continuing a low-impact aerobic exercise program, such as walking for 30 to 40 minutes every other day. After the low back pain has stopped, slowly return to playing golf.

• Stretching and maintaining flexibility will be even more important to individuals with low back pain in order to prevent further injury or muscle strain related to golf. Individuals with chronic low back pain tend to lose flexibility, and if a stretching program is not maintained on a daily basis, the resulting loss in flexibility will lead to further low back pain.
• Staying well-conditioned aerobically will also help lessen discomfort and keep the individual more functional and allow them to enjoy golf. Low-impact aerobic conditioning, such as walking or stationary biking, are both gentle on the back and are usually well tolerated for golfers with low back pain. This type of exercise should be done for 30 to 40 minutes at least three times weekly.