Golf & Low Back Pain

Does your low back hurt at the end of your round? Does it hurt with every swing? Do you have low back issues that prevent you from playing at all? Over 80% of adults experience an episode of low back pain in their lifetime, with low back pain being a major cause of disability across the globe. The low back is the leading site of injury in golfers and could have any number of causes: irritated disks, facet joints, muscles, ligaments, etc. While there are many potential causes for low back pain, it is often helpful to look at the low back’s neighbors (the hips and thoracic spine) for mobility restrictions that might relate to the painful tissues in the low back.  

HIPS

The hips are highly mobile joints and hip mobility is critically important for the golfer during both the backswing and follow through. For a right handed player, the right hip internally rotates on the backswing and externally rotates on the follow through. Conversely, the left hip externally rotates on the backswing and internally rotates on the follow through. For left handed players, it’s the reverse. For many individuals (especially those with aging hips), there is usually more of a limitation with internal rotation compared to external rotation. While there are some stance modifications that may help while playing golf, such as increasing the amount of “toe out” at address, a better approach may be to identify where you are stiff and improve your baseline mobility in order to improve not only your golf game, but potentially day-to-day activities as well. 

THORACIC SPINE 

The spine is divided into three sections: the cervical spine (neck), thoracic spine (mid-back), and lumbar spine (low back). There are some distinct anatomical differences in each section and the shape of the bones and their connections can affect how far they are able to move in a particular direction. The neck moves well in all directions. The thoracic spine is mobile with rotation, but not as mobile with side bending or backward bending. The lumbar spine is mobile with forward & backward bending, but less mobile with rotation. It’s more important that the lumbar spine provide a stable foundation around which to swing, than to provide the rotational motion itself.

Since rotation is such a critical component of the golf swing, it is important to maximize the available rotation from the hips and thoracic spine so that we don’t place too much rotational demand onto the lumbar spine. If the hips and thoracic spine won’t fully rotate, the body might make up for it at the lumbar spine, an area without much rotation to give. See the exercises below to work on improving your hip and thoracic mobility and hopefully your golf game at the same time.

Hip & Thoracic Spine Mobility Routine For Golfers

-Matt Kooy, DPT

The Hip Hinge

The hip hinge is a biomechanically efficient way of lifting or picking things up from the floor, particularly when those items are heavy. The movement pattern involves bending forward at the trunk while pivoting at the hips, all while keeping the spine neutral. Practicing the hip hinge reduces the load at the neck, back and shoulders, primarily employing the posterior chain, which is composed of the gluteus maximus, back (erector spinae muscles) and hamstrings to bring about the movement. Therefore, performing a hip hinge on a regular basis will strengthen these muscles, allowing one to lift heavier weights over time. The hip hinge is a foundational movement pattern for many functional exercises, such as deadlift, kettlebell swing, power clean.

Technique - With your feet approximately shoulder width apart, bend/hinge forward at the trunk (from the hip joints) while pushing your hips backward. The knees can remain soft during the movement, letting the length of the hamstrings take control of their position. While reversing the movement, contract your gluteals to bring yourself back to an upright position. Here are some additional helpful tips to keep in mind:

1. Keep the weight/load being lifted as close to the body as possible.

2. Avoid rounding or excessively extending the back. 

3. If needed, bend your knees a bit more to lift the weight from the lowest position. However, one must remember that this is not a squat so avoid excessively lowering the hips during the movement.

4. Engage the core and keep the pelvis in a neutral position. 

As demonstrated in the video above, using a dowel / stick can be a helpful tool when practicing the hip hinge. Align it over the back so that it is touching the back of the head, upper back and the sacrum (tailbone). Hold it with either one or two hands (one at each end if using both), while making sure the contact between the stick and the three points is maintained throughout the movement. Once you are able to perform the movement with the dowel, try lifting a kettlebell or any weighted object accessible to you, using the same technique. 

Performing the perfect hip hinge is a skill and may take several attempts to learn the correct technique so stick with it. If you need any help, please contact us through our “Ask A PT” feature on our website.

Good luck!

-Ishi Upasani, PT, MS

Pregnancy-Related Sacroiliac Joint Pain

The sacroiliac joint (a.k.a. “S.I.” joint) is located at the junction where the spine meets the pelvis. Pain in this joint is often described as a shooting, stabbing, and occasionally burning. Pain may be felt in the back of the pelvis, buttock(s), groin, or inner thigh(s). Pain typically worsens with activities such as standing on one leg, walking, stair climbing, prolonged standing, rolling in the bed, and/or getting up from a low chair.

The pregnancy hormone Relaxin is responsible for increasing the laxity (looseness) of ligaments in order to accommodate the growing fetus and prepare the body for childbirth. Consequently, increases in this hormone can lead to instability in the joints. This instability may be more pronounced in women with already existing hypermobility. The altered biomechanics and muscle imbalances that occur during pregnancy further contribute to the symptoms listed above. Approximately 16-25% women experience pelvic girdle pain (PGP) during pregnancy, with some studies revealing rates as high as 76%. It is estimated that 93% of women with pregnancy-related pelvic girdle pain experience recovery six months postpartum[1].

POSTURES RELATED TO SI JOINT SYMPTOMS:

• Excessive anterior pelvic tilt

• Shallow breathing with flared ribs

• Forward head posture

• Jaw clenching

• Butt clenching

• Supinated or pronated foot/feet

• Sway forward

• Sway to one side

ROLE OF PHYSICAL THERAPY

• Prevention of the symptoms

  • Maintain good breathing pattern

  • Shallow breathing is a sign of inefficient diaphragm function

  • Maintain the strength in the core, hip and pelvic floor muscles

  • Maintain thoracic mobility

  • Avoid sudden and drastic change in the footwear or supports

  • Avoid single leg standing exercises especially if the SI joint symptoms start to appear

• Treatment

  • Patient education regarding the condition and prevention of the aggravating factors

  • Assessment of the breathing pattern and teach appropriate corrections

  • Guide the patient in proper muscle balance around the SI joint. Due to altered biomechanics, some muscles need to be activated whereas some may need to be relaxed or temporarily shut down while doing particular movements.

  • Foot assessment with subsequent arch strengthening and foot mobility exercise as they can have an impact on the hips and thereby influence the SI joint.

  • Manual therapy in the form of myofascial release and muscle energy techniques (MET) may be beneficial.

  • Use of SI joint stabilization belts have been shown to improve the symptoms[2].

  • Heat or ice packs for local pain relief.

If you are experiencing similar symptoms, please get in touch with a women's health physical therapist. Together, we can make your pregnancy a comfortable experience.

-Ishi Upasani, PT, MS

References

1. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Medicine.

2. https://www.ncbi.nlm.nih.gov/pubmed/16214275

"Move Better" Series: Exercises To Improve Thoracic Rotation

Yesterday’s “Move Better” post on the Thoracic Rotation Test presented a way to assess your thoracic rotation mobility at home.

The thoracic spine is the mid-region of the spine that consists of twelve thoracic vertebrae (T1-T12) that are attached to the ribs posteriorly.  The orientations of the joints in the thoracic spine allow for motion in several planes, including flexion, extension, rotation, and sidebending.  

Sufficient thoracic rotation is important for sporting activities like golf, throwing sports, swimming, tennis, and kayaking/rowing.  A lack of thoracic rotation mobility may impact someone's performance with these activities.  Impaired thoracic mobility may also cause increased stress through the shoulders, hips, and lower back, especially with activities that require repeated rotational movements.  A sedentary lifestyle, including prolonged periods of sitting with poor posture, may increase the risk of losing thoracic mobility.     

Exercises to improve your thoracic rotation are included in the video below:

If you are interested in other ways to improve your thoracic spine mobility, specifically thoracic spine extension, CLICK HERE.

Questions?  Contact sean@salmonbaypt.com.

-Brian Collins, DPT & Sean Tyler, DPT

"Move Better" Series: Thoracic Rotation Test

Test the mobility of your spine with the Thoracic Rotation Test:

Tomorrow’s “Move Better” blog post will include content to improve your thoracic spine mobility.

-Brian Collins, DPT & Sean Tyler, DPT