Chiropractic Tips & Advice to Improve Your Golf Game & Save your Back

Many avid golfers contort their bodies into oddly twisted postures, generating a great deal of torque. Couple this motion with a bent-over stance, repeat 120 times over three or four hours, add the fatigue that comes with several miles of walking, and you’ve got a good workout-and a recipe for potential lower-back trouble.

As America’s love affair with the game continues to grow, the American Chiropractic Association (ACA) has advice on how to take a proactive approach that will prepare your body for many years of pain-free play. “Most golfers go until they get hurt, then look for help,” says Dr. David Stude, member of the ACA Sports Council and founding fellow of the National Golf Fitness Society. “Back pain is a warning sign that there is an underlying problem responsible for a
symptom that will likely get worse. Doctors of chiropractic look for the cause of the symptom and help reduce the likelihood of future injury.”

If you take the chiropractic approach, you’re in good company. According to Dr. Stude, Tiger Woods says that lifting weights and visiting his chiropractor regularly have made him a better golfer. Dr. Stude and the ACA suggest these simple measures to help you avoid back pain or injury and improve your game:

  • Purchase equipment that fits. Don’t try to adapt your swing to the wrong clubs: A six-footer playing with irons designed for someone five inches shorter is begging for back trouble.
  • For the women in golf: If you have “inherited” your husband’s or significant other’s golf clubs, they might be difficult for you to use. Not only are the clubs
    often too long, but the shaft is often not flexible enough for a woman’s grip. Women typically play better with clubs that are composed of lighter, more flexible material, such as graphite.
  • For the men in golf: It is a good idea to spend some extra time performing quality stretches-before and after your game-to increase your trunk flexibility. While men are traditionally stronger than women, they usually aren’t as flexible. Men need to improve their flexibility to maintain a more even and consistent swing plane and thus improve the likelihood of more consistent performance.
  • For senior golfers: If you show some signs of arthritis in the hands, consider a larger, more specialized grip for added safety and performance.
  • For all golfers: For some, scores may not be as important as enjoying the social benefits of the game. Having clubs that are comfortable will increase the chances of playing for a long time without significant physical limitations.
  • Take lessons. Learning proper swing technique is critical. At the end of the swing, you want to be standing up straight; the back should not be twisted.
  • Wear orthotics. These custom-made shoe inserts support the arch, absorb shock, and increase coordination. “Studies show custom-made, flexible orthotics
    can improve the entire body’s balance, stability and coordination, which translates into a smoother swing and reduced fatigue,” Dr. Stude says. While the upper part of a shoe may score style points, what the foot rests on affects your game.
  • Warm up before each round. “Stretching before and after 18 holes is the best way to reduce post-game stiffness and soreness,” says Dr. Stude. Take a brisk
    walk to get blood flowing to the muscles; then do a set of stretches. To set up a stretching and/or exercise routine, see a doctor of chiropractic or golf pro who can evaluate your areas of tension and flexibility.
  • Pull, don’t carry, your golf bag. Carrying a heavy bag for 18 holes can cause the spine to shrink, leading to disk problems and nerve irritation. If you prefer to ride in a cart, alternate riding and walking every other hole-bouncing around in a cart can also be hard on the spine.
  • Keep your entire body involved. Every third hole, take a few practice swings with the opposite hand to keep your muscles balanced and even out stress on the back.
  • Drink lots of water. Dehydration causes early fatigue, leading you to compensate by adjusting your swing, thus increasing the risk of injury. Don’t smoke or drink alcoholic beverages while golfing, as both cause loss of fluid.
  • Take the “drop.” One bad swing-striking a root or a rock with your club-can damage a wrist. If unsure whether you can get a clean swing, take the drop.

There are some 25 million golfers in America. A significant percentage of them suffer with chronic back pain. Many golfers pop aspirin and over-the-counter anti-inflammatory drugs like candy. What about chiropractic care? Surprisingly, less than two percent of golfers chose to visit a chiropractor.1 The same source revealed that MDs and PTs treat most golfers. This information is somewhat shocking considering that back pain is the most common problem among golfers.

Although the percentage of golfers who see chiropractors may be higher, it is safe to say that chiropractors have yet to make a significant dent in the golf market. A quick glance at Golf Magazine’s website illustrates this fact. Their fitness section recommends many fitness experts with whom golfers should consult, the majority of which are physical therapists; none are chiropractors (see www.golfonline.com/fitness).

Why golf has seemingly to overlooked chiropractic is unclear. Considering that golfers suffer mainly with spinal nociceptive pain, i.e., mechanical back pain, one would think that DCs would be the caretakers of choice.

Swing Myths that Promote Injury

One of the biggest myths involves the notion that club head speed at ball impact is dependent on maximum spinal rotation during the backswing. In this regard, the term “xfactor” has been coined to describe the difference (in degrees) between hip position and shoulder position at the top of the backswing. Many instructors advocate this theory and recommend that golfers keep their pelvis as stationary as possible while the spine is maximally rotated. These swing positions are popular because it is believed that maximal spinal rotation somehow engages the “big” muscles of the back, allowing for a sling-shot effect during the downswing, i.e., the modern golf theory of power generation.

With respect to the “big muscle” theory, we are never told how maximal spinal rotation helps to engage spinal muscles or muscles such as the latissimus dorsi. Nonetheless, it is difficult to understand why modern golf instruction would promote such concepts. Regarding spinal muscles, it is known that they provide only five percent of the torque generated during spinal rotation, the abdominal obliques doing nearly all the work.3

Like the spinal muscles, the latissimus dorsi have nothing to do with generating spinal rotation. Nor is maximal spinal rotation necessary for the latissimus dorsi to perform its normal function, i.e., adduction, medial rotation and extension of the humerus.4 The true source of power generation in the golf swing involves the creation of elastic energy, which is thought to be the power generator for most athletic maneuvers.2 Briefly stated, elastic energy is created by imparting a short, quick stretch on the muscles involved in performing a particular movement. In the case of the golf swing, it is generally thought that the rotator cuff, latissimus dorsi and pectoralis major muscles are the “power muscles,”2 as well as the muscles of the arm and forearm. To effectively prestretch these muscles, no spinal rotation is needed.

The only purpose for pelvic and spinal rotation in the backswing is to achieve a body position that al

  1. A short swing with less spinal rotation gives a golfer more control of the golf club
    and club head throughout the swing, which translates into better control of the
    golf ball.
  2. Research has demonstrated that short backswings achieved the same clubhead
    speed at ball impact as long backswings.2
  3. A short backswing will help to minimize the torsional stress in the lumbar spine.

Watkins explains that golfers should keep their shoulders and pelvis parallel to each other throughout the majority of the golf swing. He calls this rigid parallelization, the loss of which can generate rotational strain in the lumbar spine.5 With this information in mind, you can imagine how stressful and injurious the golf swing can be when golfers try to achieve a large x-factor. This swing method is dangerous and should be abandoned.

Chiropractic Intervention

There are several avenues of care that chiropractors can offer golfers, including spinal adjustments, preventive swing advice, rehabilitation exercises and anti-inflammatory nutrition. As most DCs know, spinal adjustments are known to be effective in reducing pain and improving spinal mobility. While the adjustment provides these beneficial outcomes, it is important to realize that adjustments cannot prevent injury. For this reason, DCs need to urge their golfing patients to reduce spinal rotation during the swing to lessen the chance of torsional injury. Golfers should be urged to adopt the principle of rigid parallelization throughout the golf swing, which requires rigid abdominal control.5

As previously alluded to, an aggressive lumbar spine rehabilitation program should be instituted as both a therapeutic and preventive measure. The golf swing is inherently stressful and injurious to the lumbar spine. Thus, it is very important to make sure the lumbar spine’s stabilization mechanism is well trained. Treating golfers without taking this into consideration can lead to reinjury and dependence on passive care. Research has recently demonstrated that lumbar stabilization exercises can reduce pain and disability in patients with spinal instability caused by spondylolysis and spondylolisthesis. 6 McGill has recently discussed the stabilizing exercises that impart the least amount of stress on the lumbar spine, which included the cat stretch, curl-ups, isometric horizontal side support, and the quadruped track of exercises.7 These exercises will also help golfers develop the rigid abdominal control needed to maintain pelvis and shoulder parallelization during the swing to reduce torsional strain.

Nutritional factors should also be considered when treating golfers. As mentioned earlier, golfers commonly self-medicate with aspirin and NSAIDs to help deal with inflammation and pain. These medications are known to cause gastrointestinal ulceration and reduce connective tissue healing. It would be wise for golfers to adopt a diet that is rich in dark green and other colorful vegetables, which are known to be sources of anti-inflammatory omega-3 fatty acids, bioflavonoids and other phytochemicals. Supplementation with omega-3 fatty acids, flavonoids, ginger, turmeric, Boswellia and bromelain can add additional anti-inflammatory support,8 while supplemental glucosamine and chondroitin sulfate are useful for enhancing the repair of connective tissues.8,9 Very few golfers hit the fairways armed with the modest amount of information presented in this article. Even if you do not play golf that should not stop you from engaging the golf market, as golfers desperately need the services provided by chiropractors.

References

  1. McCarroll JR, Mallon WJ. Epidemiology of golf injuries. In: Stover CN, et al. eds. Feeling up to Par: Medicine from Tee to Green. Philadelphia: FA Davis; 1994: p.9-13.
  2. Seaman DS. Back pain in golfers: etiology and prevention. J Sports Chiro Rehab 1998; 12(2):45-54.
  3. Macintosh JE, Bogduk N. The axial torque of the lumbar back muscles: torsion strength of the back muscles. Aust N A J Surg 1993; 63(3):205-12.
  4. Cramer GD, Darby SA. Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS. St Louis: Mosby; 1995: p.73.
  5. Watkins RG. Lumbar spine injury in the athlete. In: Liebenson C (ed.) Rehabilitation of the Spine. Baltimore: Williams & Wilkins; 1996, p.341-54.
  6. O’Sullivan PB et al. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic evidence of spondylolysis or
  7. spondylolisthesis. Spine 1997; 22:23959-67.
  8. McGill SM. Low back exercises: evidence for improving exercise regimens. Phys Ther 199; 78:754-65.
  9. Seaman DR. Clinical nutrition for pain, inflammation, and tissue healing. Hendersonville, NC: NutrAnalysis, 1998.
  10. Bucci LR. Nutrition Applied to Injury Rehabilitation and Sports Medicine. Boca Raton: CRC Press, 1995.