Golf: How to reduce your handicap and your backache

The physiological demands of golf and analyses on the correct technique for an effective golf swing

Article at a glance

  • Golf is not a sport that we readily associate with great athleticism, yet the accomplished player can produce tremendous twisting force (torque).
  • Scott Smith looks at the physiological demands of golf and analyses the correct technique for an effective golf swing
  • This article also examines the main areas of injury including lower back, shoulders and knees.

The amateur golfer is only as good as the limits of their physique. Scott Smith focuses on the core problem

Golf is a complex technical sport with millions of enthusiasts and a seemingly infinite supply of instruction books to feed their demand for self-improvement. And this is where many injury problems begin. The keen weekend golfer will read a golfing tip in an instruction book or the local paper, and off they go to the driving range to try it out – without knowing whether they are doing it right, or more importantly whether they are physically capable of getting it right.

It is probably fair to say that the average amateur golfer spends a lot of time practising with poor technique and with a physique that falls a long way short of the strength, control and range of movement of the professional golfer.

These days golf pros, in keeping with all elite athletes, spend more and more time in the gym and on the therapist’s treatment table, in order to improve their game without injury. Amateurs, by contrast, think nothing of spending their working week leaning over a desk, getting weaker and weaker, and then expect to be able to swing like Tiger Woods on a Saturday morning. They will usually play for a while bearing some degree of pain before ever seeking help.

So it was with Bob, a 40-year-old software programmer routinely working 50-hour weeks, whose central lower back gave him pain when he put his trousers on in the morning, or when he sat for longer than 30 minutes.

“Golf is not a sport that we readily associate with great athleticism, yet the accomplished player can produce tremendous twisting force”

Bob’s main concern, however, was to be able to play his regular two games and one hour of practice of golf each week. He was a devoted amateur player. He would regularly take anti-inflammatory medication and have a hot-pack on his back in the car on the way to the golf course. He had not consulted any therapist about his back pain for fear that they would simply tell him to stop playing the game he so loved.

It would indeed be very easy to advise Bob to stop playing, because it was clear from my assessment of his problem that the golf was the aggravating factor in his back pain (which would ease off during the week when he was not playing). But patients don’t come to therapists just to be told to stop doing the things they love.

Bob sits all day at his workplace with his shoulders slumped forward, placing his shoulder stability muscles in a position of permanent stretch and weakening them. When he twists, he pulls his shoulder blades forwards instead of rotating through his mid spine, a movement error that is pretty common among office workers.

The all-important swing

Golf is not a sport that we readily associate with great athleticism, yet the accomplished player can produce tremendous twisting force (torque). The golf swing makes heavy demands on two specific parts of the body:

  • The mid (thoracic) spine;
  • the hip joint.

If either area is deficient in its range of movement or muscular control, the resultant force of the swing will be directed through the low back, shoulder or knee – the most common sites of golfing injury among amateurs.

There are many theories as to how to achieve a perfect swing, but golf professionals will normally teach players to try to coil their upper body over a relatively stable lower body. This produces a lot of torque to transmit to the golf shot. Some coaches require the mid spine to rotate 90 degrees against a 45-degree turn of the hips (the pelvic girdle), as in figure 1 below.

Golf professionals emphasise the importance of the back swing because this is where the player can set the coordination of spine and hip to produce the powerful spinal coil. Most of the common errors in the back swing arise from a combination of poor technique and poor musculoskeletal control.

Figure 1: Rotation against stable base

The low back has little twisting ability, but it does side bend, flex and extend very easily, movements that can be disastrous if combined at speed with mid spine and hip rotation – the classic bad technique golf swing.

One of the most common technique errors is for the player to finish in a ‘reverse C’ position, as in figure 2a below. By contrast, figure 2b shows a golfer finishing with the weight on the front leg and less strain on the low back.

Figure 2a: Reverse C finish and Figure 2b: Corrected finish

The reverse C places a left side-bending strain and an extension force on the low back. In the 1970s and 1980s many professionals, such as Greg Norman, used this technique. It gave them a lot of power but also put the spine under great strain. At that time club technology was less advanced, so the players were forced to use this technique.

The modern golf swing involves a lot more rotational movement, so the lower body’s role is much more about stability and control of the swing. This requires good lower body muscular control coupled with good range of movement. The upper body needs very good range of movement in the mid spine coupled with good muscular control of spine and shoulders.

Bob’s technique analysed

I sent Bob off to have his technique checked out by a golf professional in Brisbane and together we analysed his main problems. Bob was committing the classic error of sliding his legs into the ball rather than turning through the ball. The golf professional identified Bob’s main movement errors thus:

  • lack of turn in the mid spine and right hip joint in the back-swing;
  • too much weight-shifting to the left side rather than the right during the back swing;
  • too much weight shift back to the right on the down-swing, causing the left hip to slide into the ball.

For Bob to be able to swing with an improved technique that placed a lot less strain on his low back, he would need better mobility and control.

I believe one reason why amateur players become frustrated with golf instruction is that they are set drills to improve their swing which they are never going to be able to master because of their inadequate physical conditioning. This is where the sports therapist can help, by setting sport-specific exercises, coupled with manipulation where appropriate.

“One reason why amateur players become frustrated with golf instruction is that they are set drills to improve their swing which they are never going to be able to master because of their inadequate physical conditioning”

The key movement control issues for the back-swing are:

  1. Good postural set-up over the ball. The golfer must bend at the hip joint in order to use the bum muscles (gluteals) rather than the low back. The bottom should sit backwards while the golfer maintains neutral spine and good upper body height (not bringing the chest down low), see figure 3.

Figure 3: Postural set-up

  1. The gluteal muscles need adequate length and good strength. A lot of problems occur at the hip joint because of lack of strength in the bum muscles, especially gluteus medius (the upper outer-edge muscle). Older golfers may also find it harder to turn their hip inwards.
    The single-leg rotation exercise in figure 4 is a great example of a sport-specific strengthening drill. Holding a club in front with both hands, the player adopts the stance of ‘addressing the ball’. Next they transfer all their weight on to the right leg, knee slghtly bent. They rotate the thoracic spine over a stable right leg, working on bum muscle control and taking care to turn the chest, rather than simply allowing the shoulders to move back and forth.
    Squats are another great exercise for regaining control and strength of the buttock muscles.

Figure 4: Single-leg rotation

  1. Good rotation through the mid spine is essential to wind up in the back swing and rotate through the shot. Try these three exercises to increase spinal range of movement:
    1. sit with a golf club placed horizontally behind the back, tucked into the elbows, and twist round. Aim to turn through 60 to 80 degrees. The positioning of the club restricts movement at the shoulder blades, forcing you to use the spine to turn.
    2. Mid-spine twists with the club in front of the chest (see figure 5a) rather than behind the back; this is a better drill than the more traditional golfing warm-up drill (see figure 5b). Try this exercise and feel the vast difference, particularly in the way the side stomach muscles (obliques) are stretched. In 5a you can really feel these abdominal twisting muscles tensioning and developing torque ready to release in the downswing.

Figure 5: Thoracic rotation drills

    1. Hold a club across the chest and gently suck in lower abs. Keeping the pelvis still and without turning the head, turn through the waist as far as possible to the right. Hold at the end point for a count of two, then rotate back through as far as possible to the left. Hold this position for two, and repeat. Perform 10 repetitions (see figure 6).

Figure 6: Rotation with coordination

  1. To practise your overall coordination, stand in the ‘address’ position, squeezing a ball between the legs and another between the forearms for stability. Then turn through your mid-spine against the resistance of a stretchy band. This develops tremendous wind-up of the obliques, ready to be uncoiled in the downswing (see figure 7).

Figure 7: Developing wind-up power

Impatience impedes rehab

Bob was a very enthusiastic client and worked hard on his home programme. He was, however, also a typical patient in not allowing himself enough time to build up his strength and coordination. Over the next two weekends he went out to play two rounds of golf followed by practice sessions, because he was feeling so good after our sessions. Unfortunately the pain kicked in again because he did not have the muscular control or range of movement he needed.

Of course there is a happy ending to Bob’s story. After regular appointments over the next six weeks, Bob had played weekly and had reduced his handicap by two shots. He was still getting intermittent soreness but did not need medication or post-match heat packs. He will continue with my exercise regime until he can perform the drills comfortably, at which point he will be able to cope with the drills set by the golf pro.

Scott Smith is an Australian physiotherapist. He works at Albany Creek Sports Injury Clinic in Brisbane, specialising in running and golf injuries. He is currently working with Australian Rules football teams in Brisbane

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