Par for the Course

It would seem that the sport of golf was invented by someone who wanted to play havoc with the human spine. As we have studied spinal structures, we have learned that flexion and rotation are potentially injurious to discs. In addition, rotation can injure the facet joints. This is unfortunate since golf involves flexion and rotation with each and every stroke! Furthermore, the sport of golf is just about as non-aerobic as something can be and still be called a sport. Although tremendous effort goes into each stroke, there is an inordinate amount of time between strokes.

Listening to the conversations, anecdotes, and home remedies exchanged in a golf club’s locker room, it is clear that a great percent of participants suffer chronic backache associated with their participation in this sport. Fortunately, most of these back conditions are fairly mild and self-limited. Nevertheless, there are on-the-course as well as off-the-course measures that can be taken to reduce the frequency and intensity of one’s back pain. Proper attention to spine mechanics should free the patient from the handicap of back pain, to focus on the true suffering…caused by slices, hooks, topped balls, and divots. The experience of this suffering, accumulated in a mere few hours on a golf course by the average novice golfer, can then be shared with friends and colleagues for days and weeks to come over a casual drink or at meal time.

The Intervertebral Disc

Intervertebral discs are “shock absorbing” structures consisting of multiple layers of collagenous fibrous material interwoven, referred to as annulus fibrosis. Within the center of the disc is a dense gelatinous substance, known as nucleus pulposus.

It has been proven that trunk rotation is associated with:

1. An increase in intradiscal pressure;
2. A displacement of the nucleus toward the posterior wall of the annulus, where the supporting ligaments are thin and less protective; and
3. Twisting and sheer force on the fibers within the annulus.

Repetitive rotation and flexion with the additional force of the golf swing itself contribute to excessive forces, as described, which may ultimately result in tearing or fissuring of annular fibers. The nucleus, posteriorly located, is then predisposed to bulge or herniated. This may result in development of central back pain initially, and buttock or “sciatic” pain if ignored.

The Facet Joint

The facet joints are pain sensitive articulations located on either side of the back, posteriorly, at each level in the long chain of vertebrae. Facet joints control and guide motion of the spine; their planar orientation allows, primarily, flexion and extension in the lumbar spine. Hence, rotation and abrupt extension (arching) cause frictional and compressive forces. These forces may impinge or tear the facet joint capsule, with resultant inflammation. This results in pain in the lower back, less often radiating down the leg. Because these joints have a rich nerve supply, however, and because of the propensity of “nerve” pain to be referred to other structures of common nerve supply, even people with facet pain may feel symptoms into the buttock or leg. Rarely, however, will symptoms be felt beyond the knee. In addition, unlike patients with disc symptoms, rarely should there be any sensory or motor complaint, or change in deep tendon reflexes.