Low back pain in golfers: risks may not be what you think

2018 England’s Jordan Smith during the final round Action Images via Reuters/Andrew Boyers

Golf is a popular worldwide sport, with nearly one-quarter of the population in many parts of the world participating at all levels(1). Unfortunately, golfers regularly complain about low back pain. In fact, up to you half of the professional golfers evaluated report low back injuries(2). Many assume that low back pain is due to the repetitive motion and forces endured during a golf swing. A golf swing consists of the backswing, downswing, ball impact, and follow through (see figure 1).

In the backswing, the golfer experiences a rotational separation between the upper body and the pelvis. The angle of this separation is known as the X-factor. Increasing the X-factor means increased rotation in the spine and thus greater club speed during the downswing. Increased club velocity as it contacts the ball translates into further distance traveled by the ball. Therefore, golfers often strain and stretch to achieve a further backswing in order to maximize the stretch-shorten cycle on the downswing. During follow through, the golfer hyperextends and rotates the spine in a reverse-C, further contributing to the torque, compression, and shear forces experienced during the golf swing.

Researchers from California conducted a literature review and meta-analysis to identify risk factors for back pain in golfers(2). After an extensive literature search, they identified 19 studies to be included in their analysis. They found that professional golfers experienced nearly double the incidence of back pain compared to recreational golfers(2). Other risk factors included age, a history of previous back pain, and greater mass or weight. Factors usually implicated, such as golf swing technique, biomechanical forces during the swing, hip and trunk range of motion, and strength did not appear to increase the incidence of back pain.

Sports scientists at Stanford tested the rotational velocities of professional golfers and compared them to amateurs(3). They found that professional golfers maintained high rotational velocities throughout the downswing and follow through. Amateurs, however, showed lower overall rotational velocities and dramatic decreases in rotational velocity after impact with the ball. The researchers speculate that maintaining rotation velocities during follow through accounts for the increased power generation in the professional golfers’ swing.

If professional golfers report a higher incidence of back pain than amateurs, and they maintain high rotational velocities in the follow through component of their swing, then perhaps the hyperextension and compressive forces of the reverse-C position contributes more than the torque forces in the backswing.

While we wait for science to pinpoint the cause of back pain in golfers, minimizing risk factors may help golfers remain pain-free. Since increased size increases the chance for back pain, golfers at all levels should maintain physical fitness and a healthy weight. Aging and professional golfers especially should strive for good spinal health with special attention to trunk strength. Andrew Hamilton recommends several excellent core-strengthening exercises to incorporate into an overall fitness plan and combat back pain. Golfers with a history of back pain as well as a current complaint may not have adequately rehabilitated their previous injury. When treating back pain, be sure to investigate prior injuries and deficiencies related to those past complaints.

Figure 1: Golf swing

The first portion of the golf swing (A) is known as the backswing. The rotation between the shoulder girdle and the pelvis is known as the X-factor. In the follow through (B), the golfer assumes a rotated and hyperextended position. Professional golfers maintain their high rate of rotational velocity throughout the swing including the follow through. 


  1. Journal of Quantitative Analysis in Sports 5(1):9-9
  2. Sports Health.2018 Nov/Dec;10(6):538-546
  3. Ann Rehabil Med 2018;42(5):713-721


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