Golf can be enjoyed by all at almost any age. The game affords a way of getting outside and spending quality time with friends or family, or for some, time alone. The handicap system acts to level the field for competition as well. Unfortunately, golf is often viewed more as a leisure activity than a sport. This can be well observed as to how often a golfer will take the appropriate time to warmup or even practice. This lack of preparation can lead to potential musculoskeletal injuries, especially issues with the lower back. 85% of people will experience back pain at some point in their lives. How many people have an actual workout routine that involves flexibility, core strengthening, and cardiovascular exercises 3 to 5 times a week?
How the Spine Ages
To truly appreciate the forces generated on the human spine by the golf swing, a basic understanding of the spine’s structure and aging process is needed. By the age of 10 years, the spine will start to exhibit signs of aging. The human disc is essentially 90% water content at birth and that percentage decreases with age. It is essentially slowly drying up. The mechanics of the disc will change with age as a direct result.
The disc is made up of 2 distinct components: the annulus (outer coating) and nucleus polposus (soft inner component). The annulus is composed of multiple layers of fiber that have a basket weave configuration. Pulling it taut or directly compressing into it does not significantly distort it. However, twisting it could lead it to fail by tearing. These tears occur in the annulus with age or trauma. This is similar to dried out rubber which can crack. Tears in the annulus can be a source of back pain. If the tear is large or deep enough, the inner component of the disc, the nucleus polposus, can emerge through that opening and compress a nerve leading to back and or leg pain – a disc herniation.
Muscles Have Needs
Our spine, which allows us to stand erect and walk while keeping our arms free to use for other purposes, relies on the support of our muscles. The bones, ligaments, discs, and joints of the spine, if loaded with more than five pounds, would collapse without the presence of the muscles, which act like guy wires stabilizing a free-standing pole. Muscles respond to exercise, which can maintain their flexibility, strength, and endurance if exercised throughout our lives. Muscles will become tight, inelastic, and waste away or atrophy if not used.
Modifications to Lighten the Load
The mechanics of a golf swing place a significant torsional or rotational load on the lower back, especially the discs. As the degree of body rotation and speed increase, so do the loads across these structures. We are in a slightly forward bent position, which increases the load across the discs and twists or places a torque load on the lower spine as well. Plus, swinging a golf club is a repetitive activity for the duration of the game. This is where a golf professional can use a variety of mechanisms to lessen that load.
The modern golf swing allows for tremendous torque and therefore sends the ball a greater distance, while the more traditional golf swing lessens the loads across the spine, but can still achieve acceptable results without placing the spine at as much risk for injury. Equipment modifications can allow for shot distances to be increased with the more traditional swing. The length, type, and flexibility of the golf club shaft and the materials utilized in the club face and shaft all can play a role as well.
The golf professional can help make the appropriate adjustments. Unfortunately, medical insurance may not cover these as medically indicated expenses.
Play Smart and Enjoy the Game
By playing smart—being conscientious about a workout routine and modifying our game—we can enjoy golf on a regular basis. Obviously, there are spine issues that occasionally need to be addressed either non-operatively or with surgery before one can enjoy this sport. Tiger Woods is the most prominent example of this!
THOMAS DOWLING, MD.
Dr. Thomas Dowling is the founding partner of Long Island Spine Specialists, P.C. A nationally-recognized, Board-certified orthopedic surgeon, Dr. Dowling has been committed to helping his patients relieve their symptoms and restore pain-free lives for more than 30 years.