Houston Methodist. Leading Medicine

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Under-Par Abdominals May Influence Back Pain in Golfers

Not much is known about what causes back injuries in golfers. Yet back injuries are the most common musculoskeletal problem among amateurs and professionals in the sport. Some say golfers' back injuries are caused by a poor swing. Others think injuries come from excessive practice and poor physical shape. Professional golfers have twice as many injuries to the low back area compared to amateur golfers. It's possible that long practice sessions and repeating the same motions over and over may lead to back injuries.

A lot happens in the trunk of the body during a golf swing. The trunk has to twist considerably. The low back and abdominal muscles must work together to steady the spine and accelerate the club head. Perhaps this one-sided movement puts too much stress on the low back, leading to injury and pain. Researchers have shown that the abdominal muscles produce much of the power needed for a strong golf swing. Fatigue of these muscles may be the problem.

Researchers set out to measure abdominal muscle activity and compare it in golfers with and without back pain. They thought that elite male golfers with chronic low back pain would have less abdominal muscle activity during the golf swing. They found out it's not the amount of abdominal activity that matters. They also discovered it's not abdominal muscle fatigue that contributes to back injuries. It is the timing of when one part of the abdominals starts to contract!

Eighteen male professional golfers and seven elite amateurs (less than a five handicap) participated in this study. By placing electrodes on the skin over the abdominal muscles, researchers measured when and how much these muscles contracted during the golf swing.

The abdominal muscles are divided into three parts: rectus abdominis, internal oblique, and external oblique muscles. The rectus abdominis muscle goes straight up and down the middle of the abdomen from the lower ribs to the pelvic bone. The internal oblique muscles wrap around the trunk like a girdle, and the external oblique muscles come from the side of the ribs in a downward diagonal. These three sets of muscles work together to move the trunk or hold the back stable.

There were no differences in how and when the rectus abdominis or internal oblique muscles worked between golfers with back pain and those without. In the golfers with back pain, the external oblique (EO) muscles were delayed in starting to contract during the back-swing motion. This means that for the right-handed golfer, the EO muscles on the left side of the body didn't start to turn the front of the body to the right when they should have (the action needed at the start of a right-handed golf swing).

Would changing the golf swing or doing more abdominal exercises make a difference in back pain? Researchers can't say. Future studies to measure muscle endurance and look for other causes of low back pain among golfers may bring the answers.


J. F. Horton, et al. Abdominal Muscle Activation of Elite Male Golfers With Chronic Low Back Pain. In Medicine & Science in Sports & Exercise. October 2001. Vol. 33. No. 10. Pp. 1647-1654.

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