Golf, Low Back Pain, and Special Considerations for the Female Athlete

In the United States, lower back pain (LBP) is the most common musculoskeletal injury, sustained by as much as 80% of the general population (1).  The same is true for golf, as lower back pain is the most common injury in the sport and affects up to 34.5% of the golf athletes (2)(3).  According to the National Golf Foundation, women make up 19% of the golfing population (4).  And although male and female golfers are predisposed to the same conditions leading to LBP, there are anatomical differences that should be considered by the multidisciplinary team, including physicians, physical therapists, and PGA professionals, when working with female golfers.  

Low back pain in golfers is most often linked to the relationship between the anatomical structures of the lumbar spine, pelvis, and hip.  When joints are tight, muscles are weak, and/or when motor coordination is inefficient, pain is a probable outcome.

Anatomical Differences in the Female Athlete 

Bone

-The female pelvis is broader and has a rounder pelvic inlet (to enable childbirth).  

female vs male pelvis

-The female hip has greater femoral anteversion (inward twisting of the thigh bone). 

femoral anteversion

-During pregnancy, women often experience an increase in lumbar lordosis (lumbar spine arch becomes more curved and compressed). 

lumbar lordosis due to pregnancy

-A stress fracture is a break in a bone that occurs due to repetitive, rather than sudden or traumatic, mechanical load.  When a bone’s reparative capacity cannot keep up with the repetitive load it is sustaining, a breakdown can occur.  Stress fractures occur at a higher incidence in female athletes.  Osteoporosis (brittle bone) and reduced bone mineral density have been correlated with the risk of stress fractures in the female athlete as well.  Other factors such as hormonal, nutritional, and genetic components are thought to contribute to the higher risk for women as well (1).  

Muscle

-Muscles located in the lumbar/pelvic/hip region required to provide stability and strength for golfers include: the diaphragm, rectus abdominis, internal and external obliques, transverse abodominis, quadratus lumborum, iliopsoas, multifidi, gluteus maximus/medius/minimus, deep rotators of the hip, and the pelvic floor.

muscles

-For any female golfer that has experienced pregnancy and childbirth, most of these muscles are stretched and strained; this can lead to muscular weakness, poor coordination, and therefore…lower back pain.  A specific example of this is called diastasis recti, a condition where the rectus abdominis (the “six-pack abs” muscle) becomes so elongated and stretched that it splits and separates during pregnancy.  

Ligament

-Ligaments are the tough, fibrous bands of tissue that connect one bone to another.  Women have increased levels of specific hormones, such as relaxin and estrogen, which cause greater ligament laxity (hyperflexibility).  This laxity can be one factor contributing to low back pain, as joints in the lumbar spine, pelvis, and hip sustain compromised stability.  

Currently, there is no available research comparing the prevalence of lower back pain in male vs. female golfers, and further studies are indicated.  But considering anatomical differences as part of a thorough evaluation of the female golfer experiencing back pain should lead to getting her out of pain and back on the course faster.

Blair Watson
Physical Therapist

 

  1. Walter R. Frontera, MD, PhD; et al. Clinical Sports Medicine: Medical Management and Rehabilitation.  Chapter 8.  Special Considerations in the Female Athlete.  2007.
  2. Christopher Finn, MSPT, CSCS. Rehabilitation of Low Back Pain in Golfers.  Sports Health. 2013 Jul; 5(4): 313–319.
  3. Greg Rose, MD.  The Golfer’s Guide to Low Back Pain-Part 1. TPI. http://www.mytpi.com/articles/health/the_golfer%27s_guide_to_lower_back_pain_part_1
  4. Bridget Brennan. PGA Looks to Women to Grow Golf.  Forbes.  Feb 7, 2013.

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