Prevalence Of Lower Back Pain In Professional And Amateur Golfers - Literature review Example

? Literature Review: Prevalence of Lower Back Pain in Professional and Amateur Golfers Introduction According to Reed & Wadsworth , “Back pain is one of the most common reasons cited for patients to see a physician. It also is the most frequently reported injury in golf” (Reed & Wadsworth, 2010, p.57). Even though back pain is a big problem for majority of the sports people, it is severe in in the case of golfers. According to Ehast (2011), “The golfer is exposed to greater risk of low back pain due to repeated flexion and extension of the spine, especially in rotation, so the growing fondness for the sport has also resulted in an increase of this disease” (Ehast, 2011). Many people have the illusion that golf is comparatively an easy sports and that is why older generation interested more in playing it. It is a fact that compared to football or hockey, golf involves minimum physical activity. However, it should be noted that a large number of muscular movements are necessary for the golfers to strike the ball accurately. Apart from hand muscles, shoulder muscles, hip muscles and leg muscles are active while a golfer strikes the ball. According to Hoogendoorn et al, (2012) bending and twisting may cause back pain (Hoogendoorn et al, 1999, p.394). It should be noted that golf is a game which involves lot of bending and twisting of the body. Other “Factors that have been suggested to contribute to LBP in golfers include poor endurance and strength of the trunk muscles” (Evans et al., 2005, p.122). Even though it looks like an easy sports activity, golf is a dangerous sports as far as the striking of the ball is concerned. “The back is an area of the body that undergoes significant movement and muscular activity during the golf swing. It is likely that the significant activity and repetitive nature of the swing are associated with the high rate of injury in golfers”(McHardy & Pollard, 2005, p.135). Low back pain is a common muscular disorder seen among both professional and mature golfers because of the improper swings and striking of the balls. Although, there are many views and opinions about the reasons of back pain among golfers, the exact reasons for the increased rate of low back pains among golfers are still unknown. That is why I decided to research more about this topic. According to a study conducted by Burdorf et al. (1996), on back pain among 196 men taking up golf, the incidence of first-time back pain was 8 percent and the incidence of recurrent back pain was about 45 percent. Men involved in golf and another sport demonstrated a risk of 1.4 for recurrence of back pain, compared with men playing golf only (Burdorf et al., 1996, p.659). These findings clearly indicate that back pain is common not only among golfers but also among other sports men and women. “In Britain, during the decade to 1993, outpatient attendances for back pain rose fivefold, and the number of days of incapacity from back disorders for which social security benefits were paid more than doubled”(Palmer et al. 2000, p.1577). According to the statistics released by North Wales Spine Clinic in 2010, “The incidence of golf-related lower back sports injury ranges from 15% to 34% in the amateur golfer and 22% to 24% in the professionals in Britain. Collectively, the incidence of lower back pain in the male golfer is 25% to 36% and 22% to 27% in the female golfer” (North Wales Spine Clinic, 2010). These statistics clearly indicate that a substantial portion of British golfers are facing severe back pain. “Although little is known about the exact causes of low back pain among golfers, development of such pain in amateur golfers is anecdotally attributed to poor swing mechanics, excessive practice, and poor physical conditioning”(Horton et al, 2001, p.1647). The exact reason for such back pains among golfers is still unknown and hence a research on this subject is definitely help sports people in general and golfers in particular. This paper analyses the literature available to know the exact reasons and possible remedies to back pain commonly seen among professional and amateur golfers. Methodology Systematic literature review is used in this research instead of CASP, MCMASTER or PEDRO. A systematic literature review can help me to focus entirely on the specific research question. It will help me to identify, identify, appraise, select and synthesize recent research findings in a systematic way so that the readers can develop proper awareness about the specific problem being researched. No statistical analysis or meta-analysis techniques are used in this research since I do believe that such techniques are not relevant to this problem being researched. Systematic literature review is preferred instead of Critical Appraisal Skill Program (CASP), MCMASTER and PEDRO in order to give 100% focus to the specific question. It should be noted that while using other methods, it is difficult to concentrate fully on the topic. Secondary research with the help of journal and internet article is used to develop the literature review in a systematic manner. Mainly, EBSCOHost and PubMed databases are used for collecting recent research findings regarding the back pain problems among golfers. Scholarly articles from internet are also used to get proper awareness about the research question. Systematic Literature Review: Back Pain among Golfers According to a study conducted by Lindsay & Horton in 2002 among six male professional golfers with low back pain (age 29.2 +/- 6.4 years; height 1.79 +/- 0.04 m; body mass 78.2 +/- 12.2 kg; mean +/-s) and six without low back pain (age 32.7 +/- 4.8 years; height 1.75 +/- 0.03 m; body mass 85.8 +/- 10.9 kg) using a lightweight triaxial electrogoniometer, the following results were yielded; a) golfers with low back pain tended to flex their spines more when addressing the ball and used significantly greater left side bending on the back swing; b) Golfers with low back pain had less trunk rotation (obtained from a neutral posture), which resulted in a relative 'supramaximal' rotation of their spines when swinging and c) Pain-free golfers demonstrated over twice as much trunk flexion velocity on the downswing, which could relate to increased abdominal muscle activity in this group (Lindsay & Horton,2002, p.599) The above results clearly suggests that height, body mass and age of the golfers have nothing to do with the back pain among golfers. On the other hand it is evident that improper movement of the spine is one among the several villains which is causing back pain among golfers. Golfers who flex their spine more towards the left (Right handed golfers) may cause more injuries to their spine while striking the ball whereas those who bend their spine less towards left may cause less injuries to spine. “The tilting of the player’s body to one side during this swing action contributes to back ache” (Swing Without Fear Of Back Pain, 2012) The second reason of increasing back pain among golfers with low back pain is the less trunk rotation. Those golfers who already have back pain may deliberately reduce trunk rotation because of their concerns about injuries. As in the case of over trunk rotation, minimal trunk rotation is also problematic as far as the reasons for the back pain are concerned. Less trunk rotation causes over rotation of the spine at the time of swinging. Over rotation of spine causes back injuries and pains. Pain free golfers on the other hand try to increase the trunk velocity as much as possible to strike the ball more powerfully. This will result in over muscular activity as various parts of spine, stomach etc. After conducting biomechanical swing analysis, trunk and hip strength and flexibility assessment, spinal proprioception testing, and postural stability testing among sixteen male golfers with a history of low back pain (LBP) and 16 male golfers without a history of LBP, Tsai et al. (2010) concluded that “The group with a history of LBP demonstrated significantly less trunk extension strength at 60 degrees/s and left hip adduction strength, as well as limited trunk rotation angle toward the nonlead side” (Tsai et al., 2010, p.430). These findings indicate that golfer’s ability to overcome spinal loads is detrimental in causing back pain among golfers. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future (Grimshaw & Burden, 2000, p.1667) According to Gluck et al. (2008), “The golf swing imparts significant stress on the lumbar spine. Not surprisingly, low back pain (LBP) is one of the most common musculoskeletal complaints among golfers” (Gluck et al., 2008, p.778). Swing is extremely important for a golfer to put the ball in the right place. However, lumbar spine experiences extremely high forces during the time of swing and the possibility of the development of back pain cannot be ruled out. According to Duwall (2008), “Eight times your body weight is forced through your spine as you make contact with the ball” (Duwall, 2008). The above fact clearly suggests that the impact of swing causes more strain on spine than any other parts of the body. (Smith, n.d) “The golf swing is a delicate balance between successive postures and forces that must be developed in a coordinated sequence over a very short period of time” (Dr Heinrichs, 2012). In other words, improper swing may cause improper movements of muscles at the lumbar spine area and the subsequently inflammation and back pain may develop. Cole & Grimshaw (2008) conducted a study among twelve male golfers who reported back pain and fifteen male golfers who never complained about back pain to examine the timing of the erector spine and external oblique muscle activity among golfers with and without low back pain. Their findings revealed that “Low-back-pain golfers switched on their erector spinae muscle significantly in advance of the start of the backswing. This finding was not evident in the group who did not have low back pain symptoms” (Cole & Grimshaw, 2008, p.2829). In other words, low back pain golfers use erector spinae muscle as the primary muscle instead of deeper muscles such as transversus abdominis and multifidus for striking the ball. These findings suggest that the discrepancies in using erector spinae muscle at the time of striking the ball is one of the major reasons in causing back pain to golfers. “LBP group may be associated with a reduced capacity to protect the spine and its surrounding structures at the top of the backswing and at impact, where the torsional loads are high (Cole& Grimshaw, 2008, p.174). The recent findings of Mefford et al. (2011) substantiate the arguments of Cole& Grimshaw. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation (NSAID) (Mefford et al., 2011, p.467). “Modic changes, a common observation in MR imaging, are signal intensity changes in vertebral body marrow adjacent to the endplates of degenerative discs” (Modic Changes on MRI, n.d). Intensity of the signals changes considerably when any irregularities are there in the areas which are undergoing MRI. The inflammation observed in the right-sided endplate of the subjects definitely establishes the relation between golf playing and back pain. Murray (2008), Murray et al.(2008) and Vad et al. (2004) studied a lot about the role of hip movements in causing back pain among golfers. Murray (2008) pointed out that “Hip rotation deficits have been postulated as one possible risk factor and cause of low back pain in golfers” (Murray, 2008, p.10) whereas Murray et al.(2008) mentioned that “the deficit in lead leg medial hip rotation can cause back pain among golfers” (Murray et al., 2009, p.131). “There is a positive correlation between decreased lead hip rotation and lumbar range of motion with a prior history of low back pain in professional golfers” (Vad et al., 2004, p.494). A golfer transfers his entire body weight to the back leg at the time of striking of the ball. Moreover, his lead leg or front leg plays a vital role in controlling the hip rotation along with the back leg. Transfer of body weight to the legs and the movement of hip help a golfer to strike the ball properly. Abdominal muscle is another muscle which is active at the time of striking of the ball by the golfer. Horton et al., (2001) argued that abdominal muscle activity and muscle fatigue is quite common among golfers. In their opinion, “it was clear that repetitive golf swings were aggravating some part of the musculoskeletal system in golfers, which resulted in increased pain in the low back area (Horton et al., 2001, p.1647). BMI, the side bridge endurance test, and hip flexor length were found to be significantly related to LBP amongst professional golfers. Having optimal values on these variables may potentially prevent LBP arising from the repetitive biomechanical demands of the golf swing. Golfers with a body mass index (BMI) < 25.7 kg/m2 and those with a right side deficit of >12.5 s on the side bridge endurance test reported more frequent episodes of moderate-severe LBP. Golfers with reduced hip flexor length more often reported that LBP affected their golf (Evans et al., 2005, p.122) Hip flexors are an important group of muscles, not only to the golfers, but also to every sports person. “There are a number of muscles that assist in flexing the hip such as pectineus, adductor longus, adductor brevis, sartorius and tensor fascia lata but the main contributories to hip flexion are Psoas Major and Iliacus” (McGettigan, 2011). These muscles are providing enough stability and balance to our hip movements. Lack of movements and excess of movements are equally dangerous as far as the functioning of hip flexors is concerned. For example, people who are spending lot of times in seated position may not get enough movements necessary to keep the hip flexor in good condition. Subsequently such people develop back pain. In the case of golfers, excess movements are received by the hip flexors which are as dangerous as fewer movements. Hip flexor length is another important factor which decides whether a golfer develops back pain or not. According to Fritz (n.d), hip flexor is attached to the lumbar spine and discs and therefore shortage of hip flexor length may develop issues that are vital to back health and comfort, both short and long term (Fritz n.d). In short, golfers with shorter hip flexor may experience more back pain that golfers with longer hip flexor length. Body Mass Index or BMI also play an important role in causing back pain among golfers. Body Mass Index is used to decide whether a person is obese, overweight, underweight or normal. BMI within 23 to 25 is believed to be normal in the case of men and BMI within 20 to 22 is normal in the case of women (Halls MD, 2011). Golfers with a BMI less than 25.7 found to be more vulnerable to back pain compared to other golfers. In golfers with chronic low back pain reduced back endurance was associated with significant inhibition of the knee extensors, indicating that this muscle group cannot be activated to a full extent. These findings suggest a possible association between back extensor fatigability and knee extensor dysfunction in male golfers with chronic low back pain (Suter & Lindsay, 2001, p.361). Knee extensor plays an important role in our body movements. While riding a bicycle, kicking a football or running, knee extensor plays an important role in controlling our movements. At the time of swing, knee extensor helps the golfer also. Knee extensor and back extensor function together at the time of swinging in the case of a golfer. Suter & Lindsay (2011) pointed out that “In golfers with chronic low back pain reduced back endurance was associated with significant inhibition of the knee extensors, indicating that this muscle group cannot be activated to a full extent” (Suter & Lindsay, 2011, p.361). These results clearly conclude a strong association between back extensor fatigability and knee extensor dysfunction among golfers. So far we have analysed the literature available to know the reasons of back pain among professional and amateur golfers. Now, let’s change our attention to the treatment options or management mechanisms available to the golfers who are suffering from back pain. Back pain management mechanisms for golfers Since many injuries arise from poor swing biomechanics, taking instruction with a knowledgeable golf instructor can be an important first step towards injury prevention. However, if a golfing client already has an injury which originated or is aggravated by playing or practicing, then the personalized help of a physician or physiotherapist experienced in golf biomechanics is also warranted (Lindsay et al., 2009, p.129). Coaching is necessary for a golfer to avoid back pain and other injuries. While we watch the swings of the golfer, we may think that it is so simple and easy. However, in practice it is not so. As mentioned earlier, golf swing involves the participation of lot of muscle movements at various parts of our body. Improper swing may cause improper movement of muscles. In other words, improper swing may cause improper pressure at some parts of the body. Since hip, abdominal areas and spine participate actively while swinging a golf ball, there areas are vulnerable to injuries related to improper swings. Proper instructions from the coach will help the golfer to control his body movements in an appropriate manner so that too much pressure may not be applied at any areas of his body. Lindsay & Horton (2006) explained that “Trunk rotation endurance in golfers with LBP might be more important than strength alone in the prevention and treatment of LBP” (Lindsay & Horton, 2006, p.80). Many golfers have the illusion that it is necessary to strike the ball with as much as power to put in a long distance. It should be noted that while playing cricket, a batsman try to provide proper timing to his strokes rather than power in order to get maximum runs. Same way, a golfer should give more focus to the swinging angle to send the ball to maximum distance rather than hitting the ball powerfully. Low flight or high flight may not yield longer distances. The following illustration provides a brief idea about how to swing a golf ball to get maximum distance. A coach can provide enough guidelines to the golfers to rectify the mistakes and illusions of the golfer with respect to the swing. “It is stated that, for treating muscle spasms golfers should relax the spine the night before the game by lying on their back as if they are sitting in a chair” (Quick Remedies For An Ailing Back, 2011, p.60). Spine requires proper rest before it engages in a busy schedule like striking of a golf ball. Many golfers have the habit of practicing too much just before the commencement of the game. Such training or practicing may be helpful in other sports and games; however, in the case of golf, such practices just before the commencement of the play may cause too much strain on spine. Shortening the swing often allows golfer to continue playing before the back pain has completely subsided. Golfers are advised to try toeing out exercises which will help the cause immensely. When both hips are excessively tight, a golfer need to turn both of his feet outward to reduce the stress to the lower back (Temporary help for bad backs, 2005, p.76). It is not necessary that the golfers who are experiencing back pain to completely stay away from matches. In fact, it is better for them to continue their matches with some precautions. Instead of going for lengthy swinging, it is better for them to shorten the swing so that the muscles may not stretch too much. Such shortened swinging will give help the muscles from stiffness until the back pain is cured completely. Exercises are required to strengthen the damaged muscles of the golfers. It should be noted that stiffness at the hip area may cause the lower back to work more. So, hip area should be made flexible all the time with the help of proper exercises to reduce the workload of lower back. Only a trainer can help both professional and amateur golfers to practice how to reduce workloads at lower back and how to keep the hip area flexible all the time. Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. Exercise therapy and conditioning has been shown to be an effective treatment modality for these back pain among golfers. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer (Grimshaw, 2002, p.655) Conclusions Back pain is common health problem seen among professional and amateur golfers. Improper swing and body movements are causing this problem in majority of the cases. Golfers normally have a tendency to flex their spines more when addressing the ball. Moreover, golfers with back pain have a tendency to go for less trunk rotation to reduce the trunk flexion velocity. This habit also has the potential to cause or increase back pain among golfers. Increased spinal loads often cause back pain among golfers. Golfers should make sure that they strike the ball in such a way that the spine suffers less workload. Increased hip turn and decreased shoulder turn during the swing can cause more harm to the spine. Moreover, reduction in the amount of trunk flexion/lateral flexion can also cause more damages to the spine. Improper hip rotation, abdominal muscle activity and muscle fatigue can also cause back pain among golfers. Body mass index is another factor which is suspected to be a contributing factor of back pain among golfers. Those golfers with less than 25.7 BMI index are believed to be more vulnerable to back pain. Significant inhibition of the knee extensors is also believed to be another contributing factor of back pain among golfers. The services of trainer or coach are necessary for the golfers to manage back pain problems properly. A coach can help the golfers to rectify their mistakes in swinging so that no body muscles get more workloads at the time of striking of the ball. It is necessary for the golfers to continue their practices in a restricted manner even while they are suffering from back pain. However, too much practice just before the games is not advisable to golfers. In short, the exact reasons for the prevalence of back pain among golfers are still unknown. More researches are necessary to identify the exact reasons which cause back pain among golfers. References 1. Burdorf, A., Van Der Steenhoven, G. & Tromp-Klaren, E.G.M. 1996. A one-year prospective study on back pain among novice golfers. American Journal of Sports Medicine Sept/Oct 1996: Vol. 24 Issue 5. p. 659-664 2. Cole, M.H. & Grimshaw, P.N. 2008. Trunk muscle onset and cessation in golfers with and without low back pain. Journal of Biomechanics Sep2008, Vol. 41 Issue 13, p2829 3. Cole, M.H.& Grimshaw, P.N.2011. Electromyography of the trunk and abdominal muscles in golfers with and without low back pain. Journal of Science & Medicine in Sport Apr2008, Vol. 11 Issue 2, p174 4. Duwall, R. 2008. Is back pain ruining your golf game? [Online] Available at: hhttp://www.sheknows.com/health-and-wellness/articles/7623/is-back-pain-ruining-your-golf-game [Accessed 18 March, 2012] 5. Dr Heinrichs, K. 2012. Golfers with Spine: On and Off the Golf Course: Part I: The Mechanics of the Spine and the Golf Swing: What the Teaching Professional Needs to Know [Online] Available at: http://www.coachesinfo.com/index.php?option=com_content&view=article&id=152:golf-kirsinn&catid=43:golf-general&Itemid=75 [Accessed 18 March, 2012] 6. Evans, K., Refshauge, K. M., Adams, R., & Aliprandi, L. 2005. Predictors of low back pain in young elite golfers: A preliminary study. Physical Therapy in Sport Aug 2005: Vol. 6 Issue 3. p. 122-130 7. Ehast, A. 2011. Increased incidence of low back pain among golfers[Online] Available at: http://www.cilefestival.com/increased-incidence-of-low-back-pain-among-golfers-697.html [Accessed 18 March, 2012] 8. Fritz, W. N.d. Sitting and Back Pain. [Online] Available at: http://www.myofascialpainrelief.com/articles/sitting-and-back-pain/ [Accessed 18 March, 2012] 9. Gluck, GS., Bendo, J.A. &Spivak, J. M. 2008. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine Journal, Sep2008, Vol. 8 Issue 5, p778-788, 10. Grimshaw, P., Giles, A., Tong, R. & Grimmer, K. 2002. Lower back and elbow injuries in golf. Sports Medicine 2002: Vol. 32 Issue 10. p. 655-666 11. Grimshaw, P.N.& Burden, A.M. 2000. Case report: reduction of low back pain in a professional golfer. Medicine & Science in Sports & Exercise Oct 2000: Vol. 32 Issue 10. p. 1667-1673 12. Halls S. MD, 2011. Welcome, Body Mass Index seeker. [Online] Available at: http://www.halls.md/body-mass-index/bmi.htm [Accessed 18 March 2012] 13. Horton, J.F., Lindsay, D.M. & MacIntosh, B.R. 2001. Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise Oct 2001: Vol. 33 Issue 10. p. 1647-1654 14. Hoogendoorn, W.E., van Poppel, M.N.M., Bongers, P.M.,, Koes, .B.W & Bouter, L.M. 1999. Physical load during work and leisure time as risk factors for back pain Scand J Work Environ Health 1999;25(5):387-403. doi:10.5271/sjweh.451 PubMed. www.ncbi.nlm.nih.gov/pubmed/10569458 15. Lindsay, D. & Horton, J. 2002. Comparison of spine motion in elite golfers with and without low back pain. Journal of Sports Sciences Aug 2002: Vol. 20 Issue 8. p. 599-605 16. Lindsay, D.M & Horton, J.F. 2006. Trunk rotation strength and endurance in healthy normals and elite male golfers with and without low back pain. North American Journal Of Sports Physical Therapy, 2006 May; Vol. 1 (2), pp. 80-9; 17. Lindsay, D.M., Versteegh, T. H. & Vandervoort, A. A. 2009. Injury Prevention: Avoiding One of Golf's More Painful Hazards. International Journal of Sports Science & Coaching Sep2009, Vol. 4 Issue 0, p129 18. McHardy, A. & Pollard, H.2005. Lower back pain in golfers: a review of the literature JOURNAL OF CHIROPRACTIC MEDICINE. Number3 • Volume 4. FALL 2005 19. McGettigan, D. 2011. Hip Flexors – Problems, Strength and Length. [Online] Available at: http://davidmcgettigan.ie/2011/11/hip-flexors-problems-strength-and-length/ [Accessed 18 March 2012] 20. Mefford, J., Sairyo, K., Sakai, T., Hopkins, J., Inoue, M., Amari, R., Bhatia, N.N., Dezawa, A. & Yasui, N. 2011. Modic type I changes of the lumbar spine in golfers. Skeletal Radiology, 2011 Apr; Vol. 40 (4), pp. 467-73 21. Modic Changes on MRI, N.d. Online] Available at: http://www.drvxray.com/modic__changes.htm [Accessed 18 March 2012] 22. Murray, E., Birley, E., Twycross-Lewis, R. & Morrissey, D. 2009. The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Physical Therapy in Sport Nov2009, Vol. 10 Issue 4, p131 23. Murray, E. 2008. Hip Rotation Deficits And Low Back Pain In Golf: A Review Of The Literature. SportEX Medicine Jul2008, Issue 37, p10 24. North Wales Spine Clinic, 2010. Golf in Conwy, Gwynedd & Anglesey – Sports Injury – Low Back Pain. [Online] Available at: http://northwalesspineclinic.co.uk/878 [Accessed 17 March 2012] 25. Palmer K.T., Walsh K., Bendall H., Cooper C. & Coggon D. 2000. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years. BMJ. 2000 June 10; 320(7249): p.1577–1578. http://www.bmj.com/content/320/7249/1577.full 26. Quick Remedies For An Ailing Back. Golf Digest Jun2011, Vol. 62 Issue 6, p60 27. Reed, J.J. & Wadsworth, L.T. 2010. Lower Back Pain in Golf: A Review. Current Sports Medicine Reports (American College of Sports Medicine) Jan/Feb2010, Vol. 9 Issue 1. p57. 28. Suter E, Lindsay D, 2001. Back muscle fatigability is associated with knee extensor inhibition in subjects with low back pain. Spine, 2001 Aug 15; Vol. 26 (16), pp. E361-6; 29. Smith B. N.d. Lumbar Pain in Golfers [Online] Available at: http://www.hughston.com/hha/a_13_3_4.htm [Accessed 18 March 2012]. 30. Swing Without Fear Of Back Pain, 2012. [Online] Available at: hhttp://www.bnhspine.com/detail.php?WP=GUAgq2qyqT5cG3vDpYyg4Uq5GTIgn2qlqTIcqUumpTSgoKpzGQWgBTqCqWOchKwtpTEgnKq0GT5gLJq0qT5co3uw [Accessed 18 March 2012]. 31. Temporary help for bad backs. Golf Digest Dec2005, Vol. 56 Issue 12, p76. 32. Tsai, Y.S., Sell, T.C., Smoliga, J.M., Myers, J.B., Learman, K.E. & Lephart, S. M. 2010. A comparison of physical characteristics and swing mechanics between golfers with and without a history of low back pain. The Journal Of Orthopaedic And Sports Physical Therapy. 2010 Jul; Vol. 40 (7). 33. The physics of golf, N.d. [Online] Available at: http://www.golf-simulators.com/physics.htm [Accessed 18 March 2012] 34. Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D.& Andrews, J.R. 2004. Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits. The American Journal Of Sports Medicine, 2004 Mar; Vol. 32 (2), pp. 494 Relevant portions of the references used for this paper from EBSCOhost. 1. A one-year prospective study on back pain among novice golfers. burdorf, A.; Van Der Steenhoven, G.; Tromp-Klaren, E.G.M., American Journal of Sports Medicine Sept/Oct 1996: Vol. 24 Issue 5. p. 659-664 (English Abstract Available) Abstract: We conducted a 1-year follow-up study on back pain among 196 men taking up golf. A questionnaire on individual characteristics, occupation, sports, and back pain was distributed at the start of the study and was followed by another questionnaire after 12 months. Eleven percent of the original subjects (25 of 211) were lost to follow up, but withdrawal from the survey was not associated with health status. In the baseline survey (N = 221), the self-reported lifetime cumulative incidence of back pain was 63 percent; 28 percent reported back pain during the month before answering the questionnaire, and 13 percent reported current back pain. Athletes had an increased odds ratio of 2.1 (95 percent confidence interval, 1.1 to 4.0) for previous back pain. During the 12 months between the surveys, the incidence of first-time back pain was 8 percent and the incidence of recurrent back pain was about 45 percent. Men involved in golf and another sport demonstrated a risk of 1.4 for recurrence of back pain, compared with men playing golf only. Six subjects attributed the recurrent back pain to playing golf. Given the high proportion of athletes in this study (68 percent), the risk factor of playing golf failed to demonstrate an additional significant effect on the general relationship between sport and back pain. Subjects: BACKACHE; BACK; PAIN; GOLF; ATHLETES; PROSPECTIVE study; MALES; CORRELATION (Statistics); ADULTHOOD; MIDDLE age 2. Trunk muscle onset and cessation in golfers with and without low back pain. Cole, M.H.; Grimshaw, P.N., Journal of Biomechanics Sep2008, Vol. 41 Issue 13, p2829 (English Abstract Available) Abstract: Abstract: The knowledge of the onset and cessation timing of the paraspinal muscles that surround the lumbar spine is an important area of research for the understanding of low back pain. This study examined the timing of the erector spinae and external oblique muscle activity in a group of golfers with and without low back pain. The study compared the results of surface electromyography measurements for two groups of golfers. Twelve male golfers who had reported a mild or greater level of pain in the lower back that was experienced while playing golf were examined. A further fifteen male golfers who had reported no history of lower back pain in the previous 12 months were recruited as controls. The results showed that the low-back-pain golfers switched on their erector spinae muscle significantly in advance of the start of the backswing. This finding was not evident in the group who did not have low back pain symptoms. Low-back-pain golfers, therefore, may use the erector spinae muscle as a primary spinal stabiliser instead of the stronger deeper muscles such as transversus abdominis and multifidus. These results may have important implications for conditioning programmes for golfers with low back pain. Copyright &y& Elsevier Subjects: BACKACHE; GOLFERS; ELECTROMYOGRAPHY; LUMBAR vertebrae; MUSCLES; SPINE; INSTABILITY 3. Electromyography of the trunk and abdominal muscles in golfers with and without low back pain. Cole, M.H.; Grimshaw, P.N., Journal of Science & Medicine in Sport Apr2008, Vol. 11 Issue 2, p174 (English Abstract Available) Abstract: Summary: Twelve male golfers who experienced low back pain (LBP) whilst playing or practicing golf and 18 asymptomatic golfers were recruited and divided into handicap-specific groups; low-handicap golfers, with a handicap between 0 and 12 strokes; and high-handicap golfers, with a handicap of between 13 and 29 strokes. The myoelectric activity of the lumbar erector spinae (ES) and the external obliques (EO) was recorded via surface electromyography (EMG), whilst the golfers performed 20 drives. The root mean square (RMS) was calculated for each subject and the data for the ES and EO were normalised to the EMGs recorded whilst holding a mass equal to 5% of the subjects’ body mass at arms length and whilst performing a double-leg raise, respectively. The results showed that the low-handicap LBP golfers tended to demonstrate reduced ES activity at the top of the backswing and at impact and greater EO activity throughout the swing. The high-handicap LBP golfers demonstrated considerably more ES activity compared with their asymptomatic counterparts, whilst EO activity tended to be similar between the high-handicap groups. The reduced ES activity demonstrated by the low-handicap LBP group may be associated with a reduced capacity to protect the spine and its surrounding structures at the top of the backswing and at impact, where the torsional loads are high. When considering this with the increased EO activity demonstrated by these golfers, it is reasonable to suggest that these golfers may be demonstrating characteristics/mechanisms that are responsible for or are a cause of LBP. Copyright &y& Elsevier Subjects: GOLF; SPORTS for people with disabilities; GOLFERS; BACKACHE 4. Predictors of low back pain in young elite golfers: A preliminary study. Evans, Kerrie; Refshauge, Kathryn M.; Adams, Roger; Aliprandi, Loretta, Physical Therapy in Sport Aug 2005: Vol. 6 Issue 3. p. 122-130 (English Abstract Available) Abstract: Objectives: Low back pain (LBP) is a common and disabling problem amongst golfers. Despite this, the risk factors for LBP in golfers have not been clearly established and therefore, optimal prevention strategies are not developed. This study was designed as a preliminary investigation of predictors for LBP in trainee professional golfers. Design: Longitudinal prospective study. Setting: Golf courses. Participants: Trainee professional golfers (N = 14). Main outcome measures: Potential risk factors included anthropometric variables, flexibility, muscle strength, and muscle endurance. Associations were evaluated between these risk factors and reported episodes of LBP obtained from participants after every trainee match during one competition season. Results: Golfers with a body mass index (BMI) < 25.7 kg/m2 and those with a right side deficit of >12.5 s on the side bridge endurance test reported more frequent episodes of moderate-severe LBP. Golfers with reduced hip flexor length more often reported that LBP affected their golf. Conclusions: BMI, the side bridge endurance test, and hip flexor length were found to be significantly related to LBP amongst trainee professional golfers. Having optimal values on these variables may potentially prevent LBP arising from the repetitive biomechanical demands of the golf swing. (Copyright 2005), by permission of the publisher Churchill Livingstone) [ABSTRACT FROM AUTHOR] Subjects: BACKACHE; ELITE athletes; GOLF; PGA Championship (Golf tournament); PHYSICAL fitness; QUEENSLAND; FORECASTING; LONGITUDINAL method; PROSPECTIVE study; MALES; ADULTHOOD; BODY Mass Index; TESTING 5. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. (eng) By Gluck GS, Bendo JA, Spivak JM, The Spine Journal: Official Journal Of The North American Spine Society [Spine J], ISSN: 1529-9430, 2008 Sep-Oct; Vol. 8 (5), pp. 778-88; PMID: 17938007; Background Context: The golf swing imparts significant stress on the lumbar spine. Not surprisingly, low back pain (LBP) is one of the most common musculoskeletal complaints among golfers. Purpose: This article provides a review of lumbar spine forces during the golf swing and other research available on swing biomechanics and muscle activity during trunk rotation. Study Design: The role of "modern" and "classic" swing styles in golf-associated LBP, as well as LBP causation theories, treatment, and prevention strategies, are reviewed. Methods: A PubMed literature search was performed using various permutations of the following keywords: lumbar, spine, low, back, therapy, pain, prevention, injuries, golf, swing, trunk, rotation, and biomechanics. Articles were screened and selected for relevance to injuries in golf, swing mechanics, and biomechanics of the trunk and lumbar spine. Articles addressing treatment of LBP with discussions on trunk rotation or golf were also selected. Primary references were included from the initial selection of articles where appropriate. General web searches were performed to identify articles for background information on the sport of golf and postsurgical return to play. Results: Prospective, randomized studies have shown that focus on the transversus abdominus (TA) and multifidi (MF) muscles is a necessary part of physical therapy for LBP. Some studies also suggest that the coaching of a "classic" golf swing and increasing trunk flexibility may provide additional benefit. Conclusions: There is a notable lack of studies separating the effects of swing modification from physical rehabilitation, and controlled trials are necessary to identify the true effectiveness of specific swing modifications for reducing LBP in golf. Although the establishment of a commonly used regimen to address all golf-associated LBP would be ideal, it may be more practical to apply basic principles mentioned in this article to the tailoring of a unique regimen for the patient. Guidelines for returning to golf after spine surgery are also discussed. Subjects: Back Injuries etiology; Golf injuries; Golf physiology; Low Back Pain etiology; Lumbar Vertebrae injuries 6. Lower back and elbow injuries in golf. / Les traumatismes du bas du dos et du coude au golf. Grimshaw, P.; Giles, A.; Tong, R.; Grimmer, K., Sports Medicine 2002: Vol. 32 Issue 10. p. 655-666 (English Abstract Available) Abstract: Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf. Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club. In the case of the lower back injury, evaluation was based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathy was an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional 'hitting' programme was used to treat the problem. The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are 'fanatical' and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries. Subjects: WOUNDS & injuries; BACK; ELBOW; GOLF; DIAGNOSIS; REHABILITATION; EXERCISE; THERAPEUTICS; BACKACHE; EVALUATION; MALES; WOMEN; CASE studies 7. Case report: reduction of low back pain in a professional golfer. / Etude d'un cas: traitement d'une lombalgie chez un golfeur professionnel. Grimshaw, P.N.; Burden, A.M., Medicine & Science in Sports & Exercise Oct 2000: Vol. 32 Issue 10. p. 1667-1673 (English Abstract Available) Abstract: Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. Motion of the trunk was measured using three-dimensional video analysis and electormyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the less erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report. Subjects: BACKACHE; BACK; PAIN; GOLF; KINEMATICS; ELECTROMYOGRAPHY; REHABILITATION; WOUNDS & injuries; MALES; YOUNG adults 8. Abdominal muscle activation of elite male golfers with chronic low back pain. / Activation des muscles abdominaux de joueurs de golf d ' elite atteints de lombalgies chroniques. Horton, J.F.; Lindsay, D.M.; MacIntosh, B.R., Medicine & Science in Sports & Exercise Oct 2001: Vol. 33 Issue 10. p. 1647-1654 (English Abstract Available) Abstract: The purpose of this study was twofold: I ) to determine whether elite male golfers with chronic low back pain (CLBP) exhibit different abdominal muscle activity patterns during the golf swing than asymptomatic control (AC) golfers and 2) to determine whether elite male golfers with CLBP experience greater fatigue in the abdominal muscles than AC golfers after a typical practice session. Surface EMG data were collected bilaterally from the rectus abdominis (RA), external oblique (EO), and internal oblique (IO) Muscles. Muscle activity during the golf swing was measured using the root mean square (RMS) of the EMG signal in various phases of the golf swing. Fatigue was assessed using the median frequency (MF) and RMS of the EMG signal during a 10-s submaximal isometric contraction. Low back pain was quantified with the McGill Pain Questionnaire before and after the practice session. Results: No differences in the RMS of abdominal muscle activity were noted during the golf swing between AC and CLBP subjects. However, EO (lead) onset times were significantly delayed with respect to the start of the backswing in CLBP subjects. Low back pain in CLBP golfers increased significantly after the practice session. Abdominal muscle fatigue, as measured with MF or RMS, was not evident after the practice session for either AC or CLBP subjects. Abdominal muscle activity and muscle fatigue characteristics were quite similar between AC and CLBP subjects after repetitive golf swings. Despite this, it was clear that repetitive golf swings were aggravating some part of the musculoskeletal system in CLBP subjects, which resulted in increased pain in the low back area. Subjects: KINESIOLOGY; BACKACHE; PHYSIOLOGY; ELECTROMYOGRAPHY; MUSCLES; FATIGUE; ABDOMEN; GOLF; LUMBOSACRAL region; BACK; PAIN; MALES 9. Physical load during work and leisure time as risk factors for back pain. (eng) By Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM, Scandinavian Journal Of Work, Environment & Health [Scand J Work Environ Health], ISSN: 0355-3140, 1999 Oct; Vol. 25 (5), pp. 387-403; PMID: 10569458; This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity. Subjects: Netherlands; Athletic Injuries epidemiology; Back Pain epidemiology; Life Style; Occupational Diseases epidemiology; Weight-Bearing; Workload; Adult: 19-44 years; Middle Aged: 45-64 years; All Adult: 19+ years; Female; Male 10. Comparison of spine motion in elite golfers with and without low back pain. / Comparaison du mouvement de la colonne vertebrale entre les golfeurs de haut niveau souffrant ou non du bas du dos. Lindsay, D.; Horton, J., Journal of Sports Sciences Aug 2002: Vol. 20 Issue 8. p. 599-605 (English Abstract Available) Abstract: Low back pain is a common musculoskeletal disorder affecting golfers, yet little is known of the specific mechanisms responsible for this injury. The aim of this study was to compare golf swing spinal motion in three movement planes between six male professional golfers with low back pain (age 29.2 +/- 6.4 years; height 1.79 +/- 0.04 m; body mass 78.2 +/- 12.2 kg; mean +/-s) and six without low back pain (age 32.7 +/- 4.8 years; height 1.75 +/- 0.03 m; body mass 85.8 +/- 10.9 kg) using a lightweight triaxial electrogoniometer. We found that golfers with low back pain tended to flex their spines more when addressing the ball and used significantly greater left side bending on the back swing. Golfers with low back pain also had less trunk rotation (obtained from a neutral posture), which resulted in a relative 'supramaximal' rotation of their spines when swinging. Pain-free golfers demonstrated over twice as much trunk flexion velocity on the downswing, which could relate to increased abdominal muscle activity in this group. This study is the first to show distinct differences in the swing mechanics between golfers with and without low back pain and provides valuable guidance for clinicians and teachers to improve technique to facilitate recovery from golf-related low back pain. Subjects: SWING (Golf); BACKACHE; GOLF; BACK; PAIN; POSTURE; WOUNDS & injuries; BACCALAUREATE addresses; SWINGS; COMPARATIVE studies; MALES 11. Trunk rotation strength and endurance in healthy normals and elite male golfers with and without low back pain. (eng) By Lindsay DM, Horton JF, North American Journal Of Sports Physical Therapy: NAJSPT [N Am J Sports Phys Ther], ISSN: 1558-6162, 2006 May; Vol. 1 (2), pp. 80-9; PMID: 21522218; Background: The relative importance and asymmetric loading of the trunk muscles in golf (slow rotation backswing followed by high velocity downswing) may cause side-to-side imbalances in axial rotation strength and endurance characteristics amongst elite players who frequently play and practice. Such imbalances may further be compounded by the presence of low back pain. Objective: To establish and compare trunk rotation strength and endurance of healthy individuals who do not play golf and those that are highly skilled at the sport. Additionally, a smaller group of elite golfers with non-debilitating low back pain (LBP) were also evaluated and compared to their healthy counterparts. Methods: Forty healthy non-golfing control subjects, 32 healthy elite golfers, and 7 golfers with LBP participated in this study. Bilateral trunk rotation strength and endurance was assessed using the Biodex System III Isokinetic Dynamometer with torso rotation attachment. Strength and endurance data was analyzed using 2-way ANOVA. Results: No significant differences in peak torque were found within or between groups. However, golfers with LBP demonstrated significantly less endurance in the non-dominant direction (the follow-through of the golf swing) than either healthy group. No significant difference in endurance was found between the non-golfing controls and the healthy elite golfers. Conclusions: Trunk rotation endurance in golfers with LBP might be more important than strength alone in the prevention and treatment of LBP. The results from this study provide useful information on possible risk factors associated with low back pain in golfers (decreased endurance) and allow for sport-specific clinical intervention strategies to be developed. 12. Injury Prevention: Avoiding One of Golf's More Painful Hazards. Lindsay, David M.; Versteegh, Theo H.; Vandervoort, Anthony A., International Journal of Sports Science & Coaching Sep2009, Vol. 4 Issue 0, p129 (English Abstract Available) Abstract: Although the sport of golf may be mistakenly perceived as a benign physical activity, there are in fact patterns of problems such as strains to the upper limb and low-back pain that have the potential to interfere with the professional golfer's livelihood and recreational golfer's enjoyment. In this article, a summary of the literature has been provided outlining the nature and extent of common musculoskeletal injuries that golfers deal with as well as some of the risk factors that may increase injury susceptibility. A detailed overview of prevention strategies to minimize the risk of suffering a golf injury has also been provided. Since many injuries arise from poor swing biomechanics, taking instruction with a knowledgeable golf instructor can be an important first step towards injury prevention. However, if a golfing client already has an injury which originated or is aggravated by playing or practicing, then the personalized help of a physician or physiotherapist experienced in golf biomechanics is also warranted. Proper attention to prevention will ensure a lifetime of enjoyable golf “par”ticipation. ABSTRACT FROM AUTHOR Subjects: GOLF injuries; PREVENTION; STRAIN; BACKACHE; MUSCULOSKELETAL system; WOUNDS & injuries; SWING (Golf); GOLFERS; PHYSIOLOGY; GOLF coaches 13. Lower back pain in golfers: a review of the literature. (eng) By McHardy A, Pollard H, Journal Of Chiropractic Medicine [J Chiropr Med], ISSN: 1556-3707, 2005 Autumn; Vol. 4 (3), pp. 135-43; PMID: 19674655; Objective: To review the epidemiological literature on low back pain in golfers and to review the golf swing and relate the literature on the mechanics of the swing to the lower back. Methods: A computer search was conducted of Index Medicus (1966 to 2004), MANTIS (1880 to present) and CINAHL (1982 to 2004) for literature on the following key words: low back, golf, injury. A manual search for relevant references in review papers on the subject was also conducted. The results were collated and literature fitting the criteria were collected and evaluated for suitability. Results: The lower back is a common site of golf-related injury and has resulted in much research being conducted on the forces produced by the 'modern' swing in the low back. An analysis of the 'modern' swing when compared to the 'classic' golf swing, demonstrates lower rotational forces on the low back in the 'classic' swing. However, no studies exist to compare the different types of swing. Conclusion: The back is an area of the body that undergoes significant movement and muscular activity during the golf swing. It is likely that the significant activity and repetitive nature of the swing are associated with the high rate of injury in golfers. Modification of the golf swing has been hypothesized to reduce the incidence of low back injury in golf. Further research needs to be conducted on the various golf swings to evaluate if different swings change low back injury rates in golfers. 14. Modic type I changes of the lumbar spine in golfers. By: Mefford, Jason; Sairyo, Koichi; Sakai, Toshinori; Hopkins, Justin; Inoue, Madoka; Amari, Rui; Bhatia, Nitin N.; Dezawa, Akira; Yasui, Natsuo. Skeletal Radiology, Apr2011, Vol. 40 Issue 4, p467-473, 7p, 5 Diagrams, 1 Chart; Abstract Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation and administered intradiscal steroid injections with a non-steroidal anti-inflammatory drug (NSAID). Treatment swiftly alleviated LBP and diminished Modic Type 1 changes on follow-up MRI 3-6 months later in all four patients. We suggest that Modic Type 1 changes play a significant role in the diagnosis and treatment of golf-related LBP. [ABSTRACT FROM AUTHOR]; DOI: 10.1007/s00256-010-1066-2; (AN 58721224) Subjects: MUSCULOSKELETAL system -- Diseases; LUMBAR vertebrae; DISEASES; INFLAMMATION; GOLF injuries; SPORTS injuries 15. The relationship between hip rotation range of movement and low back pain prevalence in amateur golfers: An observational study. Murray, Eoghan; Birley, Emma; Twycross-Lewis, Richard; Morrissey, Dylan, Physical Therapy in Sport Nov2009, Vol. 10 Issue 4, p131 (English Abstract Available) Abstract: Abstract: Objective: To investigate whether amateur golfers with self-reported low back pain have reduced hip rotation compared to asymptomatic controls. Design: Observational case-control study. Setting: Data collection took place at 2 amateur golf clubs in southern England. Participants: On initial contact, all participants completed a screening questionnaire used to allocate participants into LBP (n =28) and control groups (n =36). LBP group were found to be heavier than controls (t =2.242, 95% CI 0.763–13.332) but were matched for age, height, handedness, handicap, rounds played per week and years of play. Main outcome measures: Primary outcome measures were lead and non-lead hip medial and lateral rotation in 0° of flexion as measured by inclinometer. Secondary measures included inter and intra-rater reliability. Results: The LBP group had significantly reduced lead hip passive (LBP 21.14±10.17°; controls 31.06±8.06°, t =?4.228, 95% CI ?14.621–?5.205) and lead hip active medial rotation (LBP 21.46±10.01; controls 28.06±7.49°, t =?2.908, 95% CI ?11.147–?2.036) compared to controls. No between group differences were found in non-lead hips or any passive or active lateral rotation measures. Conclusion: Although there is lack of causality between LBP and hip rotation, the deficit in lead leg medial hip rotation in amateur golfers who suffer LBP may be relevant for screening or treatment selection. Copyright &y& Elsevier Subjects: JOINTS -- Range of motion; HIP joint; BACKACHE; GOLFERS; AMATEURS; OBSERVATION (Scientific method); QUESTIONNAIRES; OUTCOME assessment (Medical care) 16. HIP ROTATION DEFICITS AND LOW BACK PAIN IN GOLF: A REVIEW OF THE LITERATURE. Murray, Eoghan, SportEX Medicine Jul2008, Issue 37, p10 (English Abstract Available) Abstract: Golf injuries have received little attention in the literature. Low back injuries in golf are both common and disabling but the specific mechanicsm responsible for these injuries are unclear (1-3). It has been suggested that the mechanics of the golf swing may predispose to spinal injry when subject have restricted movement in an adjacent part of the kinetic chain. Hip rotation deficts have been postualted as one possible risk factor and cause of low back pain in golfers. The aims of this study were to systematically review the evidence that investigated either the incidence of or correlation between, hip rotation deficit and low back pain (LBP) in golfers and to highligh any mechanisms of such. Studies were identified though a search on Medline, Cinahl, Embase, Web of Knowledge and Sport Discues data bases from the earliest date to December 2007. The key search terms were golf; injury; low back pain and hip rotation. No language restrictions were impose. The preliminary evidence suggests that hip rotational deficits have been found to be significantly correlated with low back pain in both the sporting and non-sporting golfing population, although the studies are few in number (4-8). No studies have been carried out on amateur golfer, where alternative symptom mechanisms may exist to those of professionals. Future studies are neccessary to investigate whether there is a relationship between hip rotation range and back pain in amateur golfers ABSTRACT FROM AUTHOR Subjects: GOLF injuries; SWING (Golf); BACKACHE; HIP joint; GOLF; ABNORMALITIES 17. Quick Remedies For An Ailing Back. Golf Digest Jun2011, Vol. 62 Issue 6, p60 (English Abstract Available) Abstract: The article suggests medication for treating three levels of back pain including, soreness or stiffness, muscle spasms, and agonizing pain, among golfers. It is stated that, for treating stiffness golfers should take the recommended dose of over-the-counter ibuprofen or naproxen sodium before going to bed, and again in the morning. It is stated that, for treating muscle spasms golfers should relax the spine the night before the game by lying on their back as if they are sitting in a chair. Subjects: GOLFERS; BACKACHE; MUSCLE cramps; GOLF; NAPROXEN 18. Back muscle fatigability is associated with knee extensor inhibition in subjects with low back pain. (eng) By Suter E, Lindsay D, Spine [Spine (Phila Pa 1976)], ISSN: 0362-2436, 2001 Aug 15; Vol. 26 (16), pp. E361-6; PMID: 11493865; Study Design: Cross-sectional study of 25 male golfers with chronic low back pain and 16 healthy controls of similar age. Objectives: To assess the association between functional capacity of the back extensors and the quadriceps muscles. Summary Of Background Data: Chronic low back pain has been shown to lead to changes in muscle activation patterns of the abdominals and the gluteus maximus. The effect of chronic low back pain on lower limb function has not been investigated. Methods: Back extensor endurance was assessed by a Biering-Sorensen test; surface EMG was measured bilaterally on the erector spinae at T12 and L4--L5. Muscle inhibition in the quadriceps was assessed by applying an electrical twitch to the maximally contracted muscle. The associations between holding time, decrease in EMG median frequency (i.e., the slope of the regression line on median frequency vs. time), and muscle inhibition were compared for study participants with chronic low back pain and controls. Results: Mean back extensor holding times were 88 +/- 30 seconds for study participants with chronic low back pain and 92 +/- 17 seconds for controls. Both groups showed bilaterally similar decreases in EMG median frequency at L4--L5 and T12; however, the slopes were significantly steeper at L4--L5 than T12. Study participants with chronic low back pain with poor back endurance had significantly higher muscle inhibition compared with study participants with chronic low back pain with good back endurance, whereas such an association was not evident in healthy controls. Conclusions: In golfers with chronic low back pain reduced back endurance was associated with significant inhibition of the knee extensors, indicating that this muscle group cannot be activated to a full extent. These findings suggest a possible association between back extensor fatigability and knee extensor dysfunction in male golfers with chronic low back pain. Subjects: Back physiopathology; Fatigue physiopathology; Knee physiopathology; Low Back Pain physiopathology; Muscle, Skeletal physiopathology; Adult: 19-44 years; All Adult: 19+ years; Male 19. Temporary help for bad backs. Golf Digest Dec2005, Vol. 56 Issue 12, p76 (English Abstract Available) Abstract: The article informs that the lower back problem can be very frightening for golfers. No golfer wants to miss any event even though it is because of the lower back pain. Shortening the swing often allows golfer to continue playing before the back pain has completely subsided. Golfers are advised to try toeing out exercises which will help the cause immensely. When both hips are excessively tight, a golfer need to turn both of his feet outward to reduce the stress to the lower back. These suggestions can be very useful for a golfer who always wants to play. Subjects: BACKACHE; GOLFERS; SWING (Golf); GOLF; EXERCISE; PAIN 20. A Comparison of Physical Characteristics and Swing Mechanics Between Golfers With and Without a History of Low Back Pain. TSAI, YUNG-SHEN; SELL, TIMOTHY C.; SMOLIGA, JAMES M.; MYERS, JOSEPH B.; LEARMAN, KENNETH E.; LEPHART, SCOTT M., Journal of Orthopaedic & Sports Physical Therapy Jul2010, Vol. 40 Issue 7, p430 (English Abstract Available) Abstract: The article presents a study of the kinematics and kinetics of the trunk and the physical qualities of trunk and hip in golfers with and without low back pain (LBP) history. It is stated that in the testing of male golfers with LBP history and those without, the former showed less trunk extension, left hip adduction strength and trunk rotation angle toward the nonlead side. These deficits may reportedly affect a golfer's overcoming of spinal loads during the swing, although exercises to improve these deficits can be done. Subjects: GOLFERS; SWING (Golf); BACKACHE; TORSO; PELVIS; KINEMATICS; DYNAMICS 21. Low back pain in professional golfers: the role of associated hip and low back range-of- Read More