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Fix your golf back pain, Step 1: The importance of assessment

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This article is co-written with Marnus Marais. Since 2011, Marnus has worked with some of the world’s best players on both the PGA Tour and European Tour, helping them to maintain optimal health and peak physical performance. His current stable of players includes Dustin Johnson, Patrick Cantlay, and Louis Oosthuizen, amongst others. 

This article is No. 1 in a 4 part series:

Step 1: The Importance of Assessment

Step 2: Early Stage Rehab

Step 3: Functional Strength and Golf Movement Patterns

Step 4: Building global strength for prevention of future injury

Introduction

If your back pain has been bugging you for a while and is starting to annoy and worry you, then your enjoyment of the game and your performance is likely beginning to be affected too. It’s frustrating, and you are ready to take action……..with your new foam roller and exercise bands in hand, you’re ready to knock the back pain on the head finally and forever. 

Please wait a moment before you start!

Back pain and especially back pain in golfers, is a complicated thing. More often than not, it’s the result of many contributing factors, and is vitally important that you identify what those factors are before you start your mission to fix your back pain. We really can’t stress this point enough! We have seen many people start a program to ‘help’ or ‘strengthen’ their backs, but only succeed in making them worse and getting even more frustrated.

As the famous saying goes: “If you’re not assessing, you’re guessing!”

To help successfully address your back pain, we must first identify what the main causes are. In our experience, it’s usually a combination of factors from these three categories:

1 – Physical issues (muscle imbalances, alignment issues, muscle weakness, lack of strength endurance, etc.)

2 – Golf swing mechanics (swing faults such over-swinging and excessive side bend)

3 – Lifestyle factors (sleep, diet, hydration, stress, posture, activity level outside of golf, etc.)

To help identify contributing physical issues, specific physical tests and screening tests are extremely valuable. There is a range of these we like to use, and in this article, we will share 5 of the main ones with you. These are tests we often use with our professional golfers on the road and remotely when we can’t see them in person. They are also go-to tests and screens we use with our online clients who can do them in the comfort of their own homes.

These tests will help give you an indication if an underlying alignment or muscle imbalance issue could be a contributing factor to your stubborn back pain. Please read the instructions carefully! Even though they seem like ‘simple’ tests, they are subtle, and the more careful you are with the execution, the better the results will be.

With all these tests, it can be helpful to take a picture or video with your phone. It is also useful to have them documented for comparison with future test results.

Test 1 – Leg Length Test

  • Start by lying on your back relaxed.
  • Rest your arms at your sides on the floor. Take a normal breath in through your nose. Exhale fully through your mouth to bring the ribcage downward and to feel your lower back make contact on the floor.
  • Ask a friend or family member to have a look at the bones on the insides of your ankles (medial malleolus).
  • Are they the same level, or is one higher/lower compared to the other one?

Test 2 – Seated Ankle Mobility Test

  • In bare feet, sit with both heels on the floor and your back resting comfortably against the back of the chair.
  • Hips and knees should be bent approximately 90 degrees each.
  • Keeping your heels on the ground, feet flat, and toes pointing straight ahead.
  • Slide your foot straight back until your heel starts lifting up off the floor. Stop as soon as the heel starts lifting up.
  • Note the distance. Keep that foot there.
  • Now repeat on the other side.
  • Note if there is any difference in range of motion between the two sides.

Test 3 – Seated Rotation Test

  • In bare feet, sit on the front half of a chair with both heels on the floor.
  • You should feel your “sit bones” in contact with the chair.
  • Find the center of both heels and maintain the position throughout the test.
  • Place a foam roller, small ball or equivalent object of about 4-6” in diameter between your knees.
  • Place a broomstick, golf club or the equivalent across the front of the shoulders with your arms crossed.
  • Keeping your heels centered at all times and holding the stick stable across the front of your shoulders, turn the shoulders as far as you can to the right.
  • Note how far and how easily you can turn to your right side.
  • Return to the starting position.
  • Again, keeping your heels centered at all times and holding the stick stable across the front of your shoulders, turn the shoulders as far as you can to the left.
  • Note how far and how easily you can turn to your left side.
  • Repeat the test a few times to ensure an accurate measurement.
  • Take note of any difference in range of motion between the two sides, and areas of restriction and discomfort.

Test 4 – Supine Hip Internal Rotation Range Test

  • Start by lying on your back relaxed.
  • Rest your arms at your sides on the floor. Take a normal breath in through your nose. Exhale fully through your mouth to bring the ribcage downward and to feel your lower back make contact with the floor (as discussed above).
  • Lightly squeeze either your fists, foam roller, or a small ball between your knees.
  • Rotate your feet outwards while maintaining 90 degrees at your hips and knees.
  • This will measure your hip internal rotation range of movement.
  • Go as far as comfortably possible. Don’t force it.
  • Take note of the range of motion and any difference between the two sides.


Test 5 – Seated Hip External Range Test

  • Sit with both heels on the floor and your back resting comfortably against the back of the chair.
  • Bring the outside of your ankle and place it on the top of the opposite knee.
  • Go as far as comfortably possible. Don’t force it.
  • Relax in this position.
  • This will measure your hip external rotation range of movement in the seated position.
  • Repeat on the other side.
  • Take note of any difference in range of motion between the two sides, and areas of restriction and discomfort.

If there is an imbalance or difference between the left and the right sides in any of the above tests, it could be an indication that you might have an alignment or muscle imbalance issue that needs to be addressed first before you start any strengthening program. You wouldn’t want to throw a bigger, more powerful engine in a car with poor alignment and bad suspension!

In the next article; Step 2: Early Stage Rehab, we will provide you with exercises that can help improve mobility / flexibility, muscle imbalances and posture issues.

If you would like to see how Marnus can help with your golfing back pain, then check out the resources below:

Marnus Marais – marnusmarais.com

If you would like to access training programs designed for elite and recreational players, then check out the following resources and services from Nick at Golf Fit Pro:

Articles
Golf Fit Pro App (iOS)
Online Training
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Nick Randall is a Strength and Conditioning Coach, Presenter and Rehab Expert contracted by PGA Tour Players, Division 1 colleges and national teams to deliver golf fitness services. Via his Golf Fit Pro website, app, articles and online training services, Nick offers the opportunity to the golfing world to access his unique knowledge and service offerings. www.golffitpro.net

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