We watch it all the time on sports channels. How do they execute it? That golf swing is really a work of art. Entailing such a complex array of finely coordinated movements, it's no wonder a golfer's body is considered a ticking time bomb for acute injury or chronic pain.

Recent stats: 53 percent of male and 45 percent of female golfers endure low back pain; 30 percent of professional golfers play injured; 33 percent of golfers are over the age of 50; and playing golf and another sport increases chance of injury by 40 percent.¹

Researchers agree that a majority of injuries affecting male golfers manifest in the low back and are related to improper swing mechanics and/or the repetitive nature of the game.^2,3 The amateur or weekend golfer generally experiences injuries due to improper swing mechanics, whereas the sports professional is more likely to fall victim to overuse injuries from obsessive repetitive movement patterns. When a high velocity rotary force couples with trunk sidebending (the crunch factor), the golfer's spine and deep paravertebral tissues take a thumping. No wonder low back pain (LBP) is the most widespread golfer complaint!

To hit the ball a great distance, the body must have the ability to rotate into and maintain a wide arc all the way through the swing. Manual therapy techniques that increase range of hip turn allow a decrease in the amount of shoulder turn, thus reducing the amount of trunk flexion and sidebending during the downswing (the most damaging moment of the swing). If golfers lack full range of hip mobility due to an adhesive capsule, powerful torsional forces will pass up the kinetic chain through lumbopelvic ligaments, joint capsules and intervertebral discs. Motion-restricted facets and damaged ligamentous tissue can neurologically inhibit deep spinal groove muscles such as rotatores, multifidus and intertransversarii leading to substitution patterns and low back instability.

Reported in the Journal of Science and Medicine in Sport (2008), University of South Australia researchers learned that golfers with LBP were overly dependent on erector spinae muscles for spinal stabilization rather than allowing load transfer to be distributed among more efficient lumbopelvic stabilizers such as quadratus lumborum, transverse abdominus, multifidus, hip extensors, and thoracolumbar fascia.⁴ They theorized that the brain, sensing weakness, is forced to recruit global muscles (lumbar erectors and obliques) to compensate for the weakened deep spinal stabilizers. The question is, "What mechanism causes the deep lumbopelvic stabilizers to weaken?"

Reconnecting the Disconnect

The body's myofascial system is built from a continuous arrangement of tissues intended to function in organized patterns, not as isolated muscle groups. When operating properly, energy is competently transmitted via force-coupling through a reaction chain rooted in the ground. Motor unit recruitment only becomes isolated to a precise muscle group when the brain senses a system disconnect and calls in "the subs." Such as, during a golf swing, if a fibrosed hip capsule were blocking energy transfer up the kinetic chain, normal force-coupling would suffer due to lack of mobility of the femoral head in the acetabulum. (Fig 3) The manual therapist must first mobilize the fixated joint in all three cardinal planes, and then move up the kinetic chain to assess and correct any sacroiliac or lumbar compensation that may be driving the golfer's back pain.

Successful treatment of golf-related injuries not only needs golf swing modifications and functional rehab, but, in most cases, restoration of proper lumbar lordosis. Too much or too little curve results in excessive torsional and compressive loads through the thoracolumbar and lumbosacral junctions. The myoskeletal approach begins by correcting lower crossed muscle imbalance patterns followed by restoration of "joint-play" to fixated low back, sacroiliac and thoracic articulations.