Golf, Back Pain and Mobility: Why Your Whole Body Matters
Before I started playing golf, I had always assumed that hitting a golf ball was mainly about using your arms to swing the club.
Once I started learning to play myself, I quickly realised how wrong that assumption was.
A golf swing is a surprisingly complex whole-body movement. It involves rotation through the body, weight transfer from one side to the other, and coordinated movement from the ground up. Your hips and pelvis move and rotate, your trunk helps control and transfer the movement, and your upper back, shoulders and arms all work together to move the club.
It also made me understand something else: why the lower back can be placed under so much demand during a golf swing.
Watching an experienced golfer, a good swing can look almost effortless. But when you actually try it yourself, you begin to appreciate just how much mobility, strength, control and coordination are involved.
More than just the arms
Research into golf biomechanics supports the idea that the swing is very much a whole-body movement.
The downswing involves a sequence of movement beginning with the pelvis, followed by the torso and then the arms and club. Research has also shown that the work performed by the legs contributes significantly to clubhead speed.
Muscles throughout the trunk, hips and shoulders are involved. The abdominal and spinal muscles contribute to trunk movement and stability, while the gluteal muscles contribute to movement and control around the hips and pelvis.
So the arms really are only one part of the story.
This is also why the “core” is about much more than simply having strong abdominal muscles. The trunk, pelvis and lower body all have to work together as the body rotates and transfers movement through the swing.
This does not mean that having a weak core or weak glutes automatically causes pain. Strength, mobility, movement patterns and coordination may all be relevant, and the evidence linking individual physical or swing characteristics with back pain is not straightforward.
Why can the lower back become painful?
This was something that made much more sense to me once I started playing myself.
The golf swing is a repetitive and asymmetrical movement involving considerable rotation. During the swing, the lumbar spine is exposed to a combination of compressive, rotational and shearing forces, particularly as the body moves rapidly through the downswing and follow-through.
And you do not perform the movement just once. During a round of golf or a session at the driving range, similar movements are repeated many times.
The lower back is therefore an important area in golf. The most recent systematic review describes low back pain as the most common injury among golfers across different levels of ability.
However, golf-related back pain is not as simple as blaming a weak core, tight hips or a “bad swing”.
A 2024 systematic review identified several possible differences in movement and muscle activation between golfers with and without lower back pain. However, the evidence was very limited and conflicting, and the authors concluded that there is currently no conclusive evidence to support the commonly held belief that lower back pain is associated with “poor” golf-swing technique.
An earlier systematic review and meta-analysis reached a similar conclusion: although several potential risk factors have been proposed, evidence linking swing characteristics with the development of golf-related low back pain remains unclear.
This is why it is important to look at the individual rather than assuming there is one particular cause.
What about pain around the shoulder blade?
This has become particularly interesting to me since starting golf.
Occasionally, I notice discomfort around the inside of my shoulder blade after playing.
Rather than simply assuming that the sore muscle itself is the problem, it makes me think about the movement as a whole.
Why might that area be working so hard?
How is the shoulder blade moving around the rib cage? How well is the thorax rotating? What is happening at the shoulder? And how is the rest of the body contributing to the movement?
Pain does not necessarily mean that something elsewhere is weak or restricted. But looking at mobility, strength and control throughout the whole movement can give us a broader picture of how an individual golfer is managing the demands of their swing.
Looking at the whole golfer
This is where an osteopathic assessment can be useful.
If a golfer comes to me with lower back, shoulder or neck pain, I am interested in the painful area - but I also want to understand how the rest of their body is moving.
Depending on the individual, I may look at areas such as spinal and thoracic mobility, hip and pelvic movement, shoulder and shoulder-blade movement, muscle strength and control, and previous injuries.
This holistic approach is particularly relevant in golf because the swing involves coordinated movement between multiple regions of the body rather than one joint or muscle working in isolation. Research into golf-related low back pain has also considered factors including trunk muscle activation, hip strength and mobility, and pelvis and trunk rotation.
Treatment may include soft-tissue techniques, joint mobilisation or manipulation where appropriate, together with individual exercise and movement advice.
Having recently taken up golf myself, I now appreciate this much more than I did before. What I once thought was largely an arm movement is actually an impressive combination of rotation, weight transfer, mobility, strength and coordination throughout the whole body.
And having experienced the movement myself, I now have a much better appreciation of why the lower back - or sometimes somewhere seemingly unrelated, such as the area around the shoulder blade - can end up feeling the demands of the game.
References
Edwards N, Dickin C, Wang H. Low back pain and golf: A review of biomechanical risk factors. Sports Medicine and Health Science. 2020;2:10–18. DOI: 10.1016/j.smhs.2020.03.002.
Smith JA, Hawkins A, Grant-Beuttler M, Beuttler R, Lee S-P. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Sports Health. 2018;10(6):538–546. DOI: 10.1177/1941738118795425.
Watson M, Coughlan D, Clement ND, Murray IR, Murray AD, Miller SC. Biomechanical parameters of the golf swing associated with lower back pain: A systematic review. Journal of Sports Sciences. 2023;41(24):2236–2250. Published online 2024. DOI: 10.1080/02640414.2024.2319443.
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