Patient Case: Combining Physical Therapy with Golf Instruction For Low Back Pain in Golf

     Today I would like to present a patient success story in which a combination of physical therapy and expert golf instruction helped a patient return to playing golf free from low back pain.

     My patient Jennifer is a 62 year old female who came to physical therapy for general low back pain which was worst first thing in the morning and was exacerbated by playing golf.  At the time she was just learning to play golf as a social activity with her friends.  She was taking lessons at the time and playing golf 1-2 times per week but she noticed her back pain was progressively getting worse the more she played golf.

    Based on x-rays and my evaluation it was determined that Jennifer had mild to moderate facet joint arthritis in her lumbar spine, which was being aggravated by golf leading to generalized low back pain.

    During my PT evaluation, golf swing analysis, and TPI Physical Assessment Screen for golf I found a few key factors that were contributing to aggravation of the lower back and ultimately pain.

    From a golf perspective Jennifer displayed excessive S-posture at address, and both sway and slide in her backswing and downswing respectively.  Both of these swing faults can lead to increased compression of the facet joints in the lumbar spine and cause pain.  See pictures below:

physical therapy for golf neutral stance

physical therapy golf swing

From a physical perspective I found the following deficits in my evaluation and TPI Physical Assessment Screen:

1) Limited hip internal rotation – This likely leads to excessive rotation of the lumbar spine due to lack of available hip rotation.

2) Limited thoracic spine rotation – This likely lead to excessive rotation of the lumbar spine due to lack of available thoracic spine rotation.

3) Gluteal muscle weakness – Jennifer did not have the strength to stabilize her hips to prevent either sway or slide.

4) Abdominal muscle weakness – Jennifer’s abdominals were not strong enough to maintain neutral posture throughout her swing.

     This combination of physical impairments is very common and was a recipe for low back pain for Jennifer.

     In physical therapy, as the name suggests were able to address all of the physical causes contributing to her low back pain.  With manual therapy and exercise were able to regain the range of motion, strength and stability needed to execute an efficient golf swing without pain.  But my tools as a physical therapist were limited as far as implementing her newfound physical capabilities in her golf swing.  This was the territory of a good golf instructor.

    Luckily Jennifer had already been working with a great golf coach.  We were able to have an open dialogue about her current physical abilities and what swing characteristics were most important to address to prevent low back pain in her swing.  We agreed that we needed to address her starting posture, while preventing sway and slide during her swing.  With Jennifer’s improved strength and flexibility, her coach was able to implement these characteristics in her swing and she was able to return to golf without pain or limitation.  She was actually playing better golf at the end of this process too!

    In conclusion I would like to highlight the importance of a team approach in helping our patients reach their goals.  Even though I feel I have a wonderful set of tools that I can use to help my patients as a physical therapist, it is important to know my scope of practice and refer to the appropriate professional when needed. In this case the golf coach was the final piece of the puzzle in helping Jennifer reach her ultimate goal.

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