Golf-related low back pain: a review of causative factors and prevention strategies

Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain

OBJECTIVES

To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures.

DESIGN

Single-session crossover study.

SETTING

Laboratory.

PARTICIPANTS

Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year.

INTERVENTIONS

Verbal cueing alone and verbal cueing with ultrasound biofeedback.

MAIN OUTCOME MEASURES

Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials.

RESULTS

Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally ( P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead ( P = 0.014) and trail ( P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 ( P < 0.001).

CONCLUSIONS

Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.

Return to sporting activities following long fusions to the pelvis in adult spinal deformity

BACKGROUND CONTEXT

Returning to recreational sporting activities after adult spinal deformity (ASD) correction may significantly impact the patient's perceived quality of life.

PURPOSE

This study sought to characterize participation in sporting activities before and after ASD surgery, and to identify factors associated with impaired return to sports.

STUDY DESIGN

Cross-sectional survey and retrospective review of prospectively collected data.

PATIENT SAMPLE

Patients who underwent posterior-only thoracolumbar ASD surgery between 2016 and 2021 with ≥1 year follow-up and ≥3 levels of fusion to the pelvis were included.

OUTCOME MEASURES

Preoperative and postoperative participation in sports, timing of return to these activities, and reasons for limited sports participation postoperatively were assessed.

METHODS

A survey was used to evaluate outcome measures. Differences in demographic, surgical, and perioperative variables between patients who reported improved, unchanged, or worsened activity tolerance were evaluated.

RESULTS

Ninety-five patients were included (mean age: 64.3±10.1 years; BMI: 27.3±6.1 kg/m2; median levels fused: 7). The survey was completed at an average of 43.5±15.9 months after surgery. Sixty-eight (72%) patients participated in sports preoperatively. The most common sports were swimming (n=33, 34.7%), yoga (n=23, 24.2%), weightlifting (n=20, 21.1%), elliptical (n=19, 20.0%), and golf (n=11, 11.6%). Fifty-seven (83.8%) returned to at least one sport postoperatively, most commonly 6-12 months after surgery (45%). Elliptical had the highest rate of equal or improved participation (53%). Patients generally returned below their preoperative level to all other sports. Reasons for reduced sporting activities included physical limitation (51.4%), fear (20.0%), pain (17.1%), and surgeon advice (8.6%). There were no differences in the demographic, surgical, or perioperative characteristics between those who returned to sports at the same or better level compared with those who returned at a lower level.

CONCLUSIONS

About 84% of patients successfully resumed sporting activities after undergoing fusion to the sacrum/pelvis for ASD. However, this return is typically at a lower level of participation than their preoperative participation, particularly in higher demand sports. Understanding trends in sporting activity may be valuable for counseling patients and setting expectations.

Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis

OBJECTIVE

To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency.

DESIGN

Systematic epidemiological review and meta-analysis.

DATA SOURCES

PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023.

ELIGIBILITY CRITERIA

Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites.

RESULTS

20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week.

CONCLUSION

Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies.

PROSPERO REGISTRATION NUMBER

CRD42023408738.

Does Overhead Squat Performance Affect the Swing Kinematics and Lumbar Spine Loads during the Golf Downswing?

The performance of the overhead squat may affect the golf swing mechanics associated with golf-related low back pain. This study investigates the difference in lumbar kinematics and joint loads during the golf downswing between golfers with different overhead squat abilities. Based on the performance of the overhead squat test, 21 golfers aged 18 to 30 years were divided into the highest-scoring group (HS, N = 10, 1.61 ± 0.05 cm, and 68.06 ± 13.67 kg) and lowest-scoring group (LS, N = 11, 1.68 ± 0.10 cm, and 75.00 ± 14.37 kg). For data collection, a motion analysis system, two force plates, and TrackMan were used. OpenSim 4.3 software was used to simulate the joint loads for each lumbar joint. An independent t-test was used for statistical analysis. Compared to golfers demonstrating limitations in the overhead squat test, golfers with better performance in the overhead squat test demonstrated significantly greater angular extension displacement on the sagittal plane, smaller lumbar extension angular velocity, and smaller L4-S1 joint shear force. Consequently, the overhead squat test is a useful index to reflect lumbar kinematics and joint loading patterns during the downswing and provides a good training guide reference for reducing the risk of a golf-related lower back injury.

Exploration of the Golf-Specific Low Back Pain Questionnaire

OBJECTIVE

The primary purpose of this study was to determine internal consistency and concurrent validity of the Golf-specific Low Back Pain questionnaire (GLBP).

DESIGN

Cross-sectional study.

SETTING

Online questionnaire.

PARTICIPANTS

Fifty-two adult golfers with a history of LBP.

INTERVENTIONS

GLBP, Oswestry Disability Index (ODI).

MAIN OUTCOME MEASURES

Cronbach alpha values for the GLBP and its 3 subscales. Pearson correlations between the ODI, GLBP, and the GLBP subscales.

RESULTS

Cronbach alpha for the GLBP was 0.94. Cronbach alpha for the 3 GLBP subscales ranged from 0.85 to 0.91. All Pearson correlations were significant at P < 0.05. The correlation between the ODI and GLBP was -0.64, and correlations between the ODI and GLBP subscales ranged from -0.53 to -0.63. Mean GLBP score was 72.01% ± 16.15%, and mean ODI score was 12.00% ± 7.98%.

CONCLUSIONS

The GLBP has excellent concurrent validity to quantify LBP in golfers. The GLBP total and each individual subscale have excellent internal consistency and a moderate inverse relationship with the ODI. The GLBP offers a more sport-specific patient-reported outcome measure for this population. The GLBP may more adequately quantify LBP-related disability, especially at lower levels of disability. Findings provide initial evidence that the GLBP may be a valid tool to quantify LBP symptoms and dysfunction in golfers.

CLINICAL RELEVANCE

Clinicians should consider using sport-specific outcome measures when evaluating for LBP-related disability.

Is Golf a Contact Sport? Protection of the Spine and Return to Play After Lumbar Surgery

STUDY DESIGN

Narrative review.

OBJECTIVE

To address the gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing.

METHODS

This review did not involve patient care or any clinical prospective or retrospective review of patient information and thus did not warrant institutional review board approval. The available literature of PubMed, Medline, and OVID was utilized to review the existing literature.

RESULTS

Studies have shown that the forces through the lumbar spine in the modern-era golf swing are like other contact sports. Methods of protecting the lumbar spine include proper swing mechanics, abdominal and paraspinal musculature strengthening and flexibility as well as physical fitness. There are a variety of treatment options available to treat lumbar spine pathology each with a different return to play recommendations from doctors in the field.

CONCLUSIONS

With the introduction of a high impact, modern-era swing to the game of golf, the pathology is seen in the lumbar spine of both young, old, professional, and amateur golfers with low back pain are similar to other athletes in contact sports. Surgery is effective in returning athletes to a similar level of play even though no protocols exist for an effective and safe return. There have been many studies conducted to determine appropriate treatment and return to play for these injuries, but there is a gap in the literature on specific return to play protocols and rehabilitation regimens for golfers undergoing lumbar spine surgery with a high impact swing. As return to competitive play is important, especially with professional golfers, studies combining the use of swing mechanics changes, rehabilitation regimens and the type of surgery performed would be able to provide some insight into this topic now that golf may begin to be considered a contact sport.

Injury risk-factor differences between two golf swing styles: a biomechanical analysis of the lumbar spine, hip and knee

The golf swing has been associated with mechanical injury risk factors at many joints. One swing, the Minimalist Golf Swing, was hypothesised to reduce lumbar spine, lead hip, and lead knee ranges of motion and peak net joint moments, while affecting swing performance, compared to golfers' existing swings. Existing and MGS swings of 15 golfers with handicaps ranging from +2 to -20 were compared. During MGS downswing, golfers had 18.3% less lumbar spine transverse plane ROM, 40.7 and 41.8% less lead hip sagittal and frontal plane ROM, and 39.2% less lead knee sagittal plane ROM. MGS reduced lead hip extensor, abductor, and internal rotator moments by 17.8, 19.7 and 43%, while lead knee extensor, abductor, adductor and external rotator moments were reduced by 24.1, 26.6, 37 and 68.8% respectively. With MGS, club approach was 2° shallower, path 4° more in-to-out and speed 2 m/s slower. MGS reduced certain joint ROM and moments that are linked to injury risk factors, while influencing club impact factors with varying effect. Most golf injuries are from overuse, so reduced loads per cycle with MGS may extend the healthy life of joints, and permit golfers to play injury-free for more years.

The Relationship Between the Golf-Specific Movement Screen and Golf Performance

CONTEXT

Golf requires effective movement patterns to produce an effective swing and performance.

OBJECTIVE

To determine the relationship between the Titleist Performance Institute golf-specific functional movement screening (GSFMS) composite and individual element scores and golf performance by assessing a player's handicap, clubhead speed, side accuracy, ball speed, peak pelvis rotation speed, swing sequence, and common swing faults.

DESIGN

Cohort study, clinical measurement.

SETTING

English golf club.

PARTICIPANTS

A total of 11 amateur golfers: 5 males (age: 37.2 [18.7] y, height: 184.4 [9.6] cm, body mass: 89.5 [13.4] kg, and handicap: 9 [6.6]) and 6 females (age: 53.7 [15.0] y, height: 166.8 [5.5] cm, body mass: 67.9 [16.6] kg, and handicap: 13 [6.1]).

MAIN OUTCOME MEASURES

GSFMS composite and individual element scores and golf performance variables.

RESULTS

Significant relationships existed between GSFMS composite scores and handicap (r = -.779, P = .01); clubhead speed (r = .701, P = .02); ball speed (r = .674, P = .02); and peak pelvis rotation speed (r = .687, P = .02). Significant relationships existed between 90°/90° golf position and clubhead speed (r = .716, P = .01); ball speed (r = .777, P = .01); seated trunk rotation and peak pelvis rotation speed (r = .606, P = .048); single-leg balance and handicap (r = -.722, P = .01); torso rotation and handicap (r = -.637,P = .04); and torso rotation and peak pelvis rotation speed (r = .741, P = .01). Single-leg balance, overhead deep squat, and pelvic tilt were the GSFMS tests which participants had most difficulty in performing. The most common swing faults identified included loss of posture, slide, chicken winging, and early hip extension.

CONCLUSIONS

The GSFMS may be used to identify movement limitations that relate to golfing performance. These findings may potentially allow intervention to correct movement patterns and potentially improve golf performance.

Low back pain and golf: A review of biomechanical risk factors

Golf is an international sport played by a variety of age groups and fitness levels, and although golf has a low to moderate aerobic intensity level, injuries are common among professional and amateur golfers. High amounts of force experienced during the golf swing can lead to injury when golfers lack appropriate strength or technique with the lower back most commonly injured. Research has indicated that trunk muscle activation, hip strength and mobility, and pelvis and trunk rotation are associated with low back pain (LBP). Based on anecdotal evidence, golf practitioners specifically address issues in weight shift, lumbar positioning, and pelvis sequencing for golfers with LBP. This review aims to elucidate the effects of proper and improper golf swing technique on LBP and to help golf practitioners understand how to approach the alleviation of LBP in their clientele.

The onset of deep abdominal muscles activity during tasks with different trunk rotational torques in subjects with non-specific chronic low back pain

BACKGROUND

Although delayed onset of the deep abdominal muscles activity in subjects with non-specific chronic low back pain (CLBP) has been suggested to be related to trunk rotational torque, no study has examined the onsets associated with non-specific CLBP during a variety of tasks with different trunk rotational torque. The aim of this study is to compare the onsets of deep abdominal muscles activity among tasks with different trunk rotational torques in subjects with and without non-specific CLBP.

METHODS

Twelve subjects with non-specific CLBP and 13 control subjects were included. They performed 8 types of upper limb movements. The onsets of muscular activity of bilateral internal oblique-transversus abdominis (IO-TrA) and trunk rotational torque due to the upper limb movements were measured using a surface electromyography and a three-dimensional motion analysis system.

RESULTS

In non-specific CLBP group, right IO-TrA activities were significantly delayed during tasks with left trunk rotational torque compared with the control (P < 0.05), while onsets of the left IO-TrA activities were significantly later than those of the control during tasks with right rotational torque of the trunk (P < 0.05). There were no significant differences in onsets of both sides IO-TrA during tasks without trunk rotational torque between non-specific CLBP and control groups (P > 0.05).

CONCLUSIONS

The onsets of IO-TrA activities in subjects with non-specific CLBP were delayed during tasks with rotational torque of the trunk in the opposite direction, suggesting a possibility that delayed onset of the deep abdominal muscles during rotational torque of the trunk might be etiology of chronic low back pain.

A Systematic Review of Golf Warm-ups: Behaviors, Injury, and Performance

Ehlert, A and Wilson, PB. A systematic review of golf warm-ups: behaviors, injury, and performance. J Strength Cond Res 33(12): 3444-3462, 2019-Previous literature has demonstrated that warm-ups have the potential to increase physical performance and reduce risk of injury. Warm-ups before golf may have a similar result, but a systematic evaluation of their effects in golf is currently lacking. Three electronic databases (PubMed, SPORTDiscus, and Web of Science) were systematically searched to address 3 primary research questions: (a) What are the current warm-up behaviors of golfers?; (b) Is there an association between warm-up behaviors and golf-related injury?; and (c) What are the effects of various warm-up protocols on measures of golf performance? Twenty-three studies (9 observational and 14 experimental) were identified that included data on warm-ups before golf participation. Overall, the current data suggest that many golfers either do not warm-up regularly or perform a warm-up that is short in duration. Studies on the association between warm-up behaviors and golf-related injury were mixed and inconclusive. Experimental studies suggest that a variety of warm-up methods may be beneficial for golf performance. Specifically, dynamic warm-ups and those with resistance exercise tended to enhance measures of performance, whereas static stretching was inferior to other methods and potentially detrimental to performance. Overall, the results of this systematic review suggest that various warm-up protocols (with the exception of static stretching) may enhance golf performance, but observational data suggest many golfers do not regularly perform them. More data are needed on the warm-up behaviors of competitive golfers, the impact of warm-up behaviors on golf-related injury, and to further identify effective warm-up methods for enhancing golf performance.

FUNDAMENTAL MOVEMENT AND DYNAMIC BALANCE DISPARITIES AMONG VARYING SKILL LEVELS IN GOLFERS

BACKGROUND

Sports medicine professionals have instituted easy to use on field screening tests to determine physical readiness and identify athletes who may have increased injury risk. Currently there is little research on fundamental movement and dynamic balance abilities in golfers.

PURPOSE

To examine differences in fundamental movement patterns and dynamic balance in varying competition levels in golfers.

STUDY DESIGN

Cross-sectional Cohort.

METHODS

The Functional Movement Screen^TM (FMS), and Y-Balance Test Upper Quarter and Lower Quarter (YBT-LQ/UQ) were performed on middle school (MS), high school (HS), college (COL), and professional (PRO) golfers. The FMS^TM was assessed for individual tests and composite score. The YBT-LQ/UQ reaches were averaged normalized to limb length. Statistical analysis was completed with a series of Kruskall-Wallis tests with Dunn's post hoc for the FMS™ and YBT-LQ/UQ asymmetries, and a series of ANOVAs, with Tukey's post hoc for the YBT-LQ/UQ reaches (p<0.05). Effect Size Indices (ESI) were also calculated to determine clinical relevance.

RESULTS

A total of 53 MS, 129 HS, 207 COL, and 29 PRO golfers were included in this study. Significant differences were observed between COL and HS in two FMS™ tests (push up; p=0.001), active straight leg raise; p=0.0019). PRO golfers YBT-LQ posteromedial reaches were greater than MS (p=0.0127, ESI = 4.3552). PRO YBT-UQ medial reaches were greater than COL (p<0.0001, ESI = 0.8915), HS (p<0.0001, ESI = 1.2640) and MS (p<0.001, ESI = 1.4218). PRO inferolateral (IL) and superoloateral (SL) reaches were greater [IL: COL (p=0.0427, ESI = 0.4413), HS (p=0.0002, ESI = 0.5851)], [SL: COL (p=0.0005, ESI = 0.5990), HS (p=0.0004, ESI = 0.6068)]. YBT-UQ composite scores were greater for PRO compared to COL (p<0.0001, ESI = 0.7657), HS (p<0.0001, ESI = 0.8161) and MS (p<0.0001, ESI = 1.085).

CONCLUSIONS

Differences were observed in golfer's fundamental movement patterns in relationship to competition level. These data can be utilized to design personalized training programs that focus to improve movement quality.

LEVEL OF EVIDENCE

2b.

The evaluation of foot pressure and postural structure of national golfers

Objective

The aim of this study was to perform the static and dynamic biomechanical assessment of postural structure and analyze variations of foot pressure in elite golfers.

Methods

A total of 8 golfers (3 female, mean age 15.33 ± 0.57 years; mean height 167 ± 3.61 cm and mean weight 59.3 ± 11.71 kg; 5 male, mean age 17 ± 0.83 years; mean height 177.2 ± 8.61 cm; mean weight 72.8 ± 15.61 kg) from Turkish National Team were participated to this study. Digital Biometry Images Scanning (DBIS) system was used for BioPostural analyses. All participants were applied Modular Electronic Baropodometric test for foot pressure evaluation and Stabilometry for body balance evaluation. Results were analyzed by SPSS 16.0 (SPSS Inc., Chicago, IL, USA) program, using Wilcoxon test.

Results

In static evaluation, there were significant differences in forefoot and rearfoot surface (cm²) (p < 0.05); forefoot and rearfoot load (%) (p < 0.05); forefoot and rearfoot weight ratio (%) (p < 0.05) and foot angle (p < 0.05). In dynamic evaluation, there were significant differences in right and left foot surface and load values (p < 0.05). The golfers dominant foot values were higher than non-dominant foot and also the balance parameters were found to be high (p < 0.05). The BPI Static mean value of the golfers were 7 points. The BPI Dynamic mean value of the golfers were 29 points. Also the golfers’ Stabilometric (Balance) Evaluation results were 20 points, whereas the norm values ranged from 0 to 10.

Conclusion

Our results suggest that static and dynamic postural structure parameters are very important for performances and injuries of the golfers. It is believed that these differences were due to the weight transfer applied especially in the swing motion at the moment of impact.

Level of Evidence

Level IV, Diagnostic Study.

Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis

Context:

Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing.

Objective:

The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers.

Data Sources:

A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017.

Study Selection:

Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain.

Study Design:

Systematic review and meta-analysis.

Level of Evidence:

Level 3.

Data Extraction:

Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain.

Results:

The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain.

Conclusion:

Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers.

Mechanical lower back pain and sacroiliac joint dysfunction in golfers at two golf clubs in Durban, South Africa

Background

Mechanical lower back pain (MLBP) and sacroiliac joint dysfunction (SIJD) are common problems among golfers. There are currently few studies on golfers regarding the relationship between MLBP and SIJD.

Objective

The objective of this study was to determine the prevalence of MLBP and SIJD and their association in golfers at two golf clubs in Durban, South Africa.

Method

A correlation design included convenience sampling. The Standardised Nordic Questionnaire for the analysis of musculoskeletal symptoms determined the prevalence of MLBP. Sacroiliac joint pain provocative tests determined the prevalence of SIJD. Institutional ethical clearance was granted and consent from participants was obtained. Data were collected over 3 weeks and SPSS was used to calculate descriptive and inferential statistics.

Results

There were 271 participants dominated by males (86.7%) aged between 39 and 47 years (33.2%). A total of 123 (45%) of the participants presented with MLBP and 62 (23%) with SIJD. The MLBP prevalence was moderately associated with age (χ² = 71.22, p = 0.004) and years of experience (χ² = 69.93, p = 0.001). The SIJD prevalence was moderately associated with age (χ² = 55.49, p = 0.003) and poorly associated with years of experience (χ² = 44.93, p = 0.005). Twenty-two per cent (60) had both MLBP and SIJD and 54% (146) had neither. A strong association (χ² = 88.234, p = 0.000) between MLBP and SIJD was observed.

Conclusion

There was a high prevalence of MLBP and SIJD and a strong association between them. A comprehensive management approach is recommended for golfers with MLBP and SIJD.

Clinical Implications

This study will provide valuable knowledge that will assist clinicians, especially physiotherapists, in their clinical management of golfers with MLBP and SIJD. Intervention studies are needed to address lower back and sacroiliac joint problems reported in this study.

INVESTIGATION OF WEIGHT-BEARING SYMMETRY IN A GROUP OF ATHLETES WITH LOW BACK PAIN AND HEALTHY PEOPLE DURING GAIT

The asymmetrical loading applied to legs was proposed as a risk factor for low back pain development. However, this proposed mechanical risk factor was not investigated in the athletes with LBP engaged in rotational demand activities. The aim of the present study was to examine symmetry of weight-bearing in patients with rotational demand activities compared to that in healthy people during gait. In total, 35 subjects, 15 males with LBP and 20 males without LBP, participated in the study. The participants were asked to walk 12 trials in gait lab. Forces applied to legs were recorded by a force plate. Then, the peaks of anteroposterior, mediolateral, and vertical forces were measured. Next, the asymmetrical loads applied to the legs were calculated. The results of our study demonstrated that people with LBP exhibit more asymmetry of vertical peak forces in heel strike and mid-stance. They also exhibited more asymmetry of loading in the anterior direction. But the mean values of ASI of mediolateral and posterior forces in these participants were not significantly different compared to those in the control group. It can be concluded that, in comparison to the healthy subjects, patients with LBP walk with a greater magnitude of asymmetrical weight-bearing at a comfortable speed.

Electromyographic analyses of the erector spinae muscles during golf swings using four different clubs

The purpose of this study was to compare the electromyography (EMG) patterns of the thoracic and lumbar regions of the erector spinae (ES) muscle during the golf swing whilst using four different golf clubs. Fifteen right-handed male golfers performed a total of twenty swings in random order using the driver, 4-iron, 7-iron and pitching-wedge. Surface EMG was recorded from the lead and trail sides of the thoracic and lumbar regions of the ES muscle (T8, L1 and L5 lateral to the spinous-process). Three-dimensional high-speed video analysis was used to identify the backswing, forward swing, acceleration, early and late follow-through phases of the golf swing. No significant differences in muscle-activation levels from the lead and trail sides of the thoracic and lumbar regions of the ES muscle were displayed between the driver, 4-iron, 7-iron and pitching-wedge (P > 0.05). The highest mean thoracic and lumbar ES muscle-activation levels were displayed in the forward swing (67-99% MVC) and acceleration (83-106% MVC) phases of the swing for all clubs tested. The findings from this study show that there were no significant statistical differences between the driver, 4-iron, 7-iron and pitching-wedge when examining muscle activity from the thoracic and lumbar regions of the ES muscle.

Comparison of Thoracic and Lumbar Erector Spinae Muscle Activation Before and After a Golf Practice Session

Lower back pain is commonly associated with golfers. The study aimed: to determine whether thoracic- and lumbar-erector-spinae muscle display signs of muscular fatigue after completing a golf practice session, and to examine the effect of the completed practice session on club head speed, ball speed and absolute carry distance performance variables. Fourteen right-handed male golfers participated in the laboratory-based-study. Surface electromyography (EMG) data was collected from the lead and trail sides of the thoracic- and lumbar-erector-spinae muscle. Normalized root mean squared (RMS) EMG activation levels and performance variables for the golf swings were compared before and after the session. Fatigue was assessed using median frequency (MDF) and RMS during the maximum voluntary contraction (MVC) performed before and after the session. No significant differences were observed in RMS thoracic- and lumbar-erector-spinae muscle activation levels during the five phases of the golf swing and performance variables before and after the session (p > .05). Significant changes were displayed in MDF and RMS when comparing the MVC performed before and after the session (p < .05). Fatigue was evident in the trail side of the erector-spinae muscle after the session.

The Biomechanics of the Modern Golf Swing: Implications for Lower Back Injuries

The modern golf swing is a complex and asymmetrical movement that places an emphasis on restricting pelvic turn while increasing thorax rotation during the backswing to generate higher clubhead speeds at impact. Increasing thorax rotation relative to pelvic rotation preloads the trunk muscles by accentuating their length and allowing them to use the energy stored in their elastic elements to produce more power. As the thorax and pelvis turn back towards the ball during the downswing, more skilled golfers are known to laterally slide their pelvis toward the target, which further contributes to final clubhead speed. However, despite the apparent performance benefits associated with these sequences, it has been argued that the lumbar spine is incapable of safely accommodating the forces they produce. This notion supports a link between the repeated performance of the golf swing and the development of golf-related low back injuries. Of the complaints reported by golfers, low back injuries continue to be the most prevalent, but the mechanism of these injuries is still poorly understood. This review highlights that there is a paucity of research directly evaluating the apparent link between the modern golf swing and golf-related low back pain. Furthermore, there has been a general lack of consensus within the literature with respect to the methods used to objectively assess the golf swing and the methods used to derived common outcome measures. Future research would benefit from a clear set of guidelines to help reduce the variability between studies.

Immediate Effects of Sports Taping Applied on the Lead Knee of Low- and High-Handicapped Golfers During Golf Swing

Kim, T-G, Kim, E-K, and Park, J-C. Immediate effects of sports taping applied on the lead knee of low- and high-handicapped golfers during golf swing. J Strength Cond Res 31(4): 981-989, 2017-Elite golf athletes suffer from various musculoskeletal injuries due to repeated golf swings. Repetitive varus moment during golf swing has been suggested as a possible cause of injuries to the lead knee. The aim of this study was to objectively and quantitatively evaluate the immediate effects of sports taping on the lead knee of elite golfers to restrict varus moment. Thirty-one elite golfers were assigned to the low- (LHG, n = 15) or high-handicapped group (HHG, n = 16). Using 3-dimensional motion analysis, the lead knee position on the frontal plane with and without rigid taping (RT), elastic taping (ET), and placebo taping was identified in 4 separate phases by the 5 events of golf swing as follows: the peak of the backswing (E1), parallel to the ground during downswing (E2), ball impact (E3), parallel to the ground during follow-through (E4), and finish (E5). The LHG when using a driver club had decreased movement toward knee varus with RT and ET than that without it from E1 to E2 (p = 0.001). The LHG when using a 5-iron club decreased movement toward knee varus with RT than that without it from E1 to E2 (p = 0.006) and from E2 to E3 (p = 0.019). The HHG when using a driver club had decreased movement toward knee varus with RT from E1 to E2 (p = 0.014). Sports taping may be helpful for elite golfers in terms of reducing varus moment of the lead knee during the downswing and be useful for the development of preventive strategies for golf-related knee injuries.

Leg lateral reach test: The reliability and correlation with thoraco-lumbo-pelvic rotation range

OBJECTIVES

The aim of the present study was to examine the intra- and inter-rater reliabilities of the leg lateral reach test as a screening tool for thoraco-lumbo-pelvic rotation and to assess the relationship between leg lateral reach distance and thoraco-lumbo-pelvic rotation range in a supine position.

DESIGN

Controlled laboratory study.

METHODS

Thirty-six physically active participants were recruited. The leg lateral reach test was performed over 2 days. In the first session, two testers measured the distance of the leg lateral reach to determine the within-day inter-rater reliability, and one tester repeated the measurement on day 2 to determine the intra-rater reliability between days. The leg lateral reach test was performed three times per leg, and the mean value was used for data analysis. Reliability was determined using the intraclass correlation coefficient, standard error of measurement, and minimal detectable change. The correlation between leg lateral reach distance and thoraco-lumbo-pelvic rotation range was determined using Pearson correlation.

RESULTS

Almost perfect intra- and inter-rater reliabilities were shown for the test [intraclass correlation coefficient_2,3=0.97 (95% confidence interval=0.914-0.984) and 0.99 (0.974-0.996), respectively]. The within-day inter-rater standard error of measurement was 1.40cm, and the minimal detectable change was 3.87cm. The between-day intra-rater standard error of measurement was 2.66cm, and the minimal detectable change was 7.37cm. The Pearson correlation showed a moderate to good correlation between the leg lateral reach distance and the thoraco-lumbo-pelvic rotation range (r=0.73).

CONCLUSIONS

The leg lateral reach screening test is reliable for measuring thoraco-lumbo-pelvic rotation range and allows for practical measurement of the thoraco-lumbo-pelvic rotation range in a supine position.

Spine biomechanics associated with the shortened, modern one-plane golf swing

The purpose of this study was to compare kinetic, kinematic, and performance variables associated with full and shortened modern backswings in a skilled group of modern swing (one-plane) golfers. Shortening the modern golf backswing is proposed to reduce vertebral spine stress, but supporting evidence is lacking and performance implications are unknown. Thirteen male golfers performed ten swings of each swing type using their own 7-iron club. Biomechanical-dependent variables included the X-Factor kinematic data and spine kinetics. Performance-related dependent variables included club head velocity (CHV), shot distance, and accuracy (distance from the target line). Data were analysed with repeated measures ANOVA with an a priori alpha of 0.05 (SPSS 22.0, IBM, Armonk, NY, USA). We found significant reductions for the X-Factor (p < 0.05) between the full and shortened swings. The shortened swing condition ameliorated vertebral compression force from 7.6 ± 1.4 to 7.0 ± 1.7 N (normalised to body weight, p = 0.01) and significantly reduced CHV (p < 0.05) by ~2 m/s with concomitant shot distance diminution by ~10 m (p < 0.05). Further research is necessary to examine the applicability of a shortened swing for golfers with low back pain.

Golf-related low back pain: a review of causative factors and prevention strategies

Golf is a popular sport with both perceived and real health benefits. However, certain injury risks are also prevalent, particularly to the lower back. Epidemiological studies have shown that lower back pain (LBP) from golf account for between 18% and 54% of all documented ailments, leading many researchers to regard the condition as the most common golf injury.

The purpose of this review was to examine the scientific literature to ascertain the risk factors associated with the development of LBP from playing golf and suggest methods to modify or limit these factors. Results of the review indicate that the high frequency of LBP appears multi-factorial although the asymmetrical and forceful nature of the swing along with excessive play and practice, particularly amongst elite players, appear to be common factors. Other factors include swing flaws leading to excessive side-bend and over-rotation of the spine, abnormal muscle recruitment, poor trunk endurance, restricted lead hip internal rotation and the use of unnecessarily stressful club transportation methods. Methods to help control or eliminate excessive stress on the lower back would include reducing the amount spent playing or practicing, seeking professional assistance to assess and adjust swing mechanics, improve trunk and hip flexibility, increase the strength and endurance of the trunk musculature, consider different footwear options and avoid carrying the golf bag. Adopting some or all of these recommendations should allow players to continue to enjoy the sport of golf well into their senior years.