Lower Quadrant Swing Biomechanics Identifies Golfers With Increased Risk of Low Back Pain: A Prospective Longitudinal Cohort Study

Abstract

Context: Elite golfers have a high incidence of low back pain. Recent reviews have emphasized the need for investigation into how to prevent low back pain in golfers, prompting the current study. Design: Prospective longitudinal cohort study. Methods: Forty-one injury-free golfers were included in this study. At baseline, lower quadrant joint angles and club and ball performance were measured while each golfer performed 10 drives. The golfers were then monitored for 6 months and were allocated into 2 groups depending on whether or not they developed low back pain. The initial, baseline kinematic variables of the low back pain group and the uninjured group were then compared. Results: Over the 6-month monitoring period, 17 (41%) of the golfers developed low back pain. At baseline assessment, the low back pain group had 4° less lead ankle dorsiflexion at setup (P = .01; effect size = 0.82), 6° less lead knee flexion at the top of the backswing (P = .05; effect size = 0.64), 6° less lead ankle dorsiflexion at the top of the backswing (P = .01; effect size = 0.82), 6° more trail hip adduction at the top of the backswing (P = .02; effect size = 0.79), 9° more trail knee flexion at impact (P = .05; effect size = −0.64), and 6° more trail hip adduction at the end of follow through (P < .00; effect size = 1.00). Conclusion: Golfers who developed low back pain during the 6-month monitoring period displayed distinct differences in biomechanics at baseline when all golfers were injury free. These biomechanical differences may be considered a precursor to injury. Three-dimensional motion analysis may indicate whether elite golfers are at risk of developing low back pain. Research is needed to assess whether targeted exercise and sports drills aimed at addressing the biomechanical risk factors identified may prevent low back pain in elite golfers.

Injury Profiles of Elite, Semielite, and Recreational Golfers, and Their Associated Risk Factors: A Systematic Review

“…Data from 10,437 subjects were extracted across the 58 studies included in this systematic review (1)(2)(3)(4)11,12,14,19,20,(23)(24)(25)(26)28,(30)(31)(32)(33)(35)(36)(37)(38)(39)(40)(41)(42)(43)(45)(46)(47)(48)(49)(50)(51)(52)54,56,59,(62)(63)(64)(65)(66)(68)(69)(70)(71)(72)(73)(76)(77)(78)…”

“…x em Self-perception of being overweight (62) x r Golf play per week (25,26,62,71,79) ? r ↑↑ se Golf practice per week (25,40,62,68,69) ? r o em o r Golf rounds per week or month (42,(68)(69)(70) o em Full-swing practice sessions per month (42) ↑↑↑ em Balls struck per full-swing practice sessions (42) o em Range practice per week (70) ↓↓ em Putting sessions per week or month (42,(68)(69)(70) o em Time spent per putting sessions (42) o em Short game practice per week (70) x em Warm-up before play or practice (26,28,50,71) o r Resistance training per week (68)(69)(70) x em Cardiovascular training per week (68)(69)(70) x em Mobility or flexibility training per week (68)(69)(70) x em Postural training per week (68)(69)(70) o em Carrying golf bag (50) o r Accuracy from tee to green (% in regulation) (32) x e Golf club changes (50) o r Golf club shafts used (50)…”

“…In elite players, there was large practical significance for reduced lead hand speed torsional load at L5/S1 during transitional phase (N/kg) ( (68,69) o em Driving distance (yards) (32,66,68,69,85) ↓↓ em , o rm Carry distance (metres) (68,69) x em Roll distance (metres) (68,69) o em Smash factor † (66)…”

Etiology and Prevention of Common Injuries in Golf

“…During the golf setup, flaring the lead foot to externally rotate the lower limb at setup may provide a golfer with increased allowance for hip IR throughout the swing, naturally decreasing forces through, and injury risk to, the lumbar spine. In addition, there is evidence that increased trail hip adduction at the top of the backswing (correlating with the common golf fault of “swaying”) is correlated with increased risk of LBP (27).…”

“…Those with decreased ankle ROM and stability may tend to place increased stresses on other joints as previously detailed. For example, a 2022 study by Quinn et al (27) found that golfers with less dorsiflexion in the lead ankle at the top of the backswing are more likely to develop LBP. As emphasized throughout this review, many swing faults, biomechanical compensations, and injuries may be a result of deficiencies more proximal in the kinetic chain.…”