Golf is a sport that is enjoyed by 30 million people in the United States currently, according to the National Golf Foundation. A third of these players are older than 50 years of age. Golf places some huge demands on the spine from compression, shear and rotational forces used to swing a golf club. Although amateur golfers have a higher incidence of low back pain than professional golfers, professional golfers have the highest incidence of back injury of all professional athletes. When decreased flexibility and degenerative changes of aging are mixed with these spinal forces, it doesn’t seem unusual for golfers to have some back pain.
How Your Swing Affects Your SpineAlthough probably not readily apparent, compression loads can reach up to eight times body weight during the swing. These forces are approaching those of a college football lineman hitting a sled. The facet joints of the lumbar spine normally bear 20% of the weight bearing forces (compression) that cross the lumbar spine while the other 80% are transmitted across the inter vertebral discs. These forces are increased with the rotation of the golf swing and tend to accelerate the degeneration of the facet joints. Degenerative changes of the facet joints are characterized by loss of the cartilage surfaces, thickening of the joint capsules, and osteophyte or spur formation. These degenerative changes of the facet joints can result in loss of motion and pain, sometimes called facet syndrome.
Interestingly enough, the swing you use may influence the amount of force the facet joints get exposed to. The “classic” swing has less trunk rotation and extension than the “modern” swing that finishes with a more arched back. If you have back pain that is related to the facets, perhaps using the “classic” swing might help reduce your back pain by reducing trunk rotation and increasing muscular control at the extremes of the swing.
The evaluation of low back pain in the golfer needs to be comprehensive in the search for muscle imbalances and defects in the complicated range of motion required to swing a golf club correctly. Ankle and foot range of motion can even affect a golf swing!
People who have back pain that originates from the lumbar facet joints and cannot be relieved by conservative measures or a change in one’s golf swing may have seen a pain management physician. It is likely that some facet blocks were done to confirm the source of pain and possibly injected with cortisone to diminish any inflammation. If the pain returned, it is possible that you had treatment with RF (radio frequency) to heat and inactivate the pain nerves. The main problem with RF is that it is usually temporary, usually lasting only 6-9 months.
Surgery and Permanent ReliefLaser back surgery or endoscopic spine surgery can offer permanent pain relief from facet syndrome pain by using one of two techniques. One technique uses the laser to vaporize and inactivate the pain nerves as they enter the facet joints. This surgery is performed under direct vision as an outpatient using the endoscope and holmium laser. I coauthored a paper (LINK) that was published in 2010 that showed the effectiveness (pain relief) and long term results that lasted years (probably permanent), as opposed to RF (radio frequency) treatment that is almost always short term (lasts 6-9 months). The other technique is one that uses endoscopic spine surgery to visualize the nerves before they get to the facet joints and then use mechanical, radio frequency, and/or the laser to remove the nerves that supply the sensation of pain in the facet joints. Both of these techniques preserve the facet joints, even though they are usually arthritic. You would not know or care about the arthritis in the facet joints if you did not have pain.
Consider these two outpatient endoscopic spine surgery procedures for facet syndrome that preserves the facets and spine motion to the “old school” approach of fusing the spine!
Laser back surgery can offer a permanent cure for persistent back pain from facet syndrome. This is a really good alternative that can be performed as an outpatient with minimal disruption to your life.
References 1. Roh EY, Gerachi MC, Smuck M. Preseason Training in Golfers with Low Back Pain. Spineline January-February 2012:17-21
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