Returning to golf after LBP: Restoring your

client's drive without reinjury

By Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS
Background
Golf is a popular activity, particularly in the older population which provides an opportunity
to play a game that enables someone to socialize while truly enjoying the outdoors. Golf has
become popular internationally providing an activity with a low level of physical exertion
over an extended period without the physical contact required in many other sports. It
challenges the golfer to tackle variable obstacles in the golfers path such as bunkers, narrow
fairways, winds and the most important goal, to drive the tiny white ball into the cup.
Injuries
Low back injuries are becoming more prevalent in workplace, however as well as in golfers.
Can low back pain be prevented? A prospective survey over 1 year by McHardy et al
examined golf injuries among 588 golfers at 8 Australian golf clubs. Information collected
included golfers injuries sustained during the year, location of injury, onset, mechanism of
injury, and whether injury occurred during the golf swing or at another time. Results: The
overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to
a range of 0.36 to 0.60 injuries/1000 hours/person. Conclusion: Injuries in golf are most
likely sustained in the lower back region as a result of the golf swing.2 This reinforces the
importance of strengthening the lower back and keeping the driving muscles(hip flexors &
back extensors)flexible.
Movement Analysis: Human Movement Training for Golf1
When we look at golf in terms of the swing mechanics, it is important to understand
functional anatomy and biomechanics to produce the necessary force to hit the ball.

Preparatory movement & setting

Figure 1
Source: Carr

Figure 2. Backswing

Figure 3. Follow-through

The golf swing consists of three major phases: 1)the preparation phase 2)the execution
phase(backswing and downswing) and 3)follow through phase.

Preparatory phase and setting1

Movement analysis:
The posture and alignment of the golfer influences the golfers ability to rotate properly,
transfer weight and maintain good balance during the swing. The body must be aligned so
that feet, hips and shoulders are parallel to the target line. The golfers left arm is straight
while the right is partially flexed keeping the head positioned over the ball.
Muscles contracted: Rectus abdominis, deltoids and forearm flexors.
Backswing phase1
Movement analysis:
The purpose of the backswing is to establish a perfectly balanced powerful position at the
top of the swing. Here, the hands and the shoulders must start in one motion. The weight of
the feet in the stance is shifted laterally from the front to the rearfoot. This shifting increase
the range of hip rotation. At the top of the backswing, the shoulders are coiled, the hands
are swung high and the arms are extended.
Muscles contracted: Latissimus dorsi, teres major, teres minor and quadriceps. The
forearm flexors and extensors stabilize the golf club.
Downswing-follow-through phase1
Movement analysis:
The downswing is initiated by the rotation of the hips. At this point the golfer must lengthen
the lever arm, which results in an increased acceleration of the club head. Simultaneously
while the hip turns, a transfer of weight occurs. The weight is shifted from the back foot to
the front foot. This shifting of weight enables the golfer to increase the impact area and
improve accuracy. When the downswing is initiated by the hips, and the turning of the hips
unwind the upper part of the torso, the shoulders and arms flow easily into the swing. At the
point of impact, the wrists straighten while the trunk produces the force with other muscles
producing a maximum striking effort.
Restoring your clients drive: Strengthening their weak link
Many muscles support the lumo pelvic junction and contribute to its control and stability. In
fact there are several muscles required for function. There is considerable biomechanical and
motor control evidence, however, that argues that different muscles and different control
strategies may be involved in the control of different elements of stability. 3
With any back(lumbar) injury, one of the most important things is that return to sport
follows a progressionary path from physical therapy to return to the course slowly. The
nervous system and the musculoskeletal system need time to retrain and through motor
learning this is possible. Per the research, anatomically and biomechanically, the focus of
core strengthening should focus on strengthening the weaker erector spinae/multifidi,
external obliques, TVA and quadraturs lumborum.
Training to Improve Spinal Stability and Prevent Low Back Injuries
Trunk extensors, flexors, rotators and lateral bend agonists are active through all portions of
the golf swing. Due to the muscular demands of the golf swing, training the trunk
musculature improves performance and decrease injury risk. Adequate spinal stability is the
amount of trunk muscle co-contraction necessary to reinforce the spine to prevent
segmental buckling. 4

Retraining inured areas for optimal performance

In order to retrain injured lumbar musculature, three things must be taught, motor control,
core strengthening and systematic strength training as described by Hibbs et al
Motor control stability is low-threshold stability where the CNS modulates the efficient
integration and low-threshold recruitment of local and global muscle systems. Core strength
training: high-threshold and overload training of the global stabilizer muscle system and
leads to hypertrophy as an adaptation to overload training. Systematic strength training:
traditional high threshold or overload strength training of the global mobilizer muscle
system. It is proposed that initial core strengthening programs should enable people to
become aware of motor patterns and allow them to learn to recruit muscles in isolation
programs can then progress to functional positions and activities. 5
In the next section, simple sport specific exercises that you can teach the golfer client are
listed below targeting the weak links.

Figure 4. Four point plank

(strengthening erector spinae)

Figure 6. Back extension on ball

Figure 8. Medicine ball twist throw

Figure 5. Side plank targeting the external oblique and QL

Figure 7. Diagonal D1 Flexion to Extension with cable

Progression of golfing training: safe return to the golf course

Progressing a client to return to the golf course requires a perdiodized hitting program and
and resistance training program complimenting the core strengthening previously
mentioned. Progressive hitting program: Time between session 1 and 2 is at least 24 hrs.
Week Session 1
Session 2
1
5 of 5 each
5-10
chip/putt 5 rest
5 rest 5 12 swing 5 rest 5
12 hits
2

Hit >1/2 bucket 15-20 min of putting short

of balls w/50%
puts 20 or less
intensity w/irons

Hit bucket of balls 70%

intensity w/irons

Start chipping in
sand w/sand
wedge 10-20
swings 50-75%
intensity
Start practice with
drivers 50%
intensity
Play 9 holes

Play 18 holes

Play 18 holes

Full hit controlled(quality

vs quantity) bucket of
balls

Periodized progressive strengthening

The aim of resistance exercise is to improve the strength of the golfer and their ability to
generate power during the golf swing to increase club head speed. Listed below is a 6 week
mesocycle golf program for the golf client.
Weeks 1 to 2: Relearning how to properly contact the transversus abdominis is vital.
This can be carried out in a supine and four-point kneeling position.
Weeks 2 to 4: Static lumbar strengthening exercises beginning with planks and side planks
are essential to rebuild the weak foundation of the lumbo-pelvic girdle. Once the static
exercises become easy, progression can be made to higher repetitions and/or altering the
base of support(ie. four point plank with alternating leg lift) PREs: Since the Lats are one
of the primary movers in all phases of the swing, Lat pulldown exercises, one arm rows are
excellent to target this area. In addition, seated/standing mid row exercise targeting the
rhomboids is vital for upper trunk stability as well as diagonal trunk chop simulating the golf
swing.
Stretching: The hip flexors and lumbar extensors need to be routinely conducted. These
exercises need to repeated (20 to 30-second count maximum) 1-5 reps.
Weeks 4 to 6: Inclusion of oblique and dynamic core stability strengthening is pivotal and
should be included at this stage. Examples are standing medicine ball toss in golfers stance,
standing medicine ball toss throw(figure 8), seated on floor rapid trunk rotation using
medicine ball in hands(twisted side to side) with knees bent.
Summary

Golf is a popular activity for the young and old providing an opportunity to play a game that
enables someone to socialize while truly enjoying the outdoors. Golf is a sport that requires
practice, skill, finesse and most of all patience. However, it is important to understand a
clients full medical history and their injury before designing & incorporating a regular
strength training program. Which should consist of core strengthening, flexibility training
and practice enabling your client to play at their optimal level without injury.
Biography:
Chris Gellert, PT, MMusc & Sportsphysio, MPT, CSCS, AMS is the President of Pinnacle
Training & Consulting Systems. Gellert offers educational workshops on human movement,
home study courses on human movement, and consulting services. As a clinician, author,
presenter, with extensive experience having treated and worked with individuals of all ages
with various spinal injuries, post surgical conditions, traumatic and sport specific injuries in
industrial rehabilitation, outpatient and private practice settings. For more information,
contact www.pinnacle-tcs.com or email him at ptcg99@verizon.net.

REFERENCES
1

Carr, Gerry. 1997 Mechanics of Sport: A Practitioners Guide. Human Kinetics, pp. 136-137.

McHardy, A, MChiro, Henry Pollard, & Luo, K, 2007, One-Year Follow-up Study on Golf
Injuries in Australian Amateur Golfers, Vol. 35, No. 8, pp. 1354.1359.
3

Hodges, P, 2003, Core stability exercise in chronic low back pain. Orthopedic Clinical North
American. Vol. 34, pp. 245254.
4

Lehman, G, 2006, Resistance training for performance and injury prevention in golf,
Journal of Canadian Chiropractic Association. Vol. 50, No. 1, pp. 27-42.
5

Hibbs, A et al, 2008, Optimizing Performance by Improving Core Stability and Core
Strength, Journal of Sports Medicine, Vol. 38, No. 12, pp.995-1008.