Is "Reverse Spine Angle" Harming Your Low Back?

According to Titleist Performance Institute (TPI), reverse spine angle is the leading cause of low back pain among golfers. An analysis of 387 players found that nearly 40% demonstrated this reverse spine angle during their swing. That’s a lot of potential for injury.

What it is?

With reverse spine angle, from a face-on view of the golfer, the upper part of the trunk is leaning toward the target at the top of the backswing. The upper body tends to dominate the swing and the player can lose power (and distance) as a result.  

How does it happen?

Without getting into the complicated spinal mechanics of a golf swing, the basic answer is through excessive spinal extension. Under normal circumstances, the trunk is slightly flexed (bent forward) at address, but it extends during the swing and ends up relatively extended at impact compared to address. What happens in the case of reverse spine angle, the player's spine extends too far, placing much more mechanical stress on the spinal joints.

What are the main causes?

According to TPI, there are three main causes for reverse spine angle: 

1. Upper & lower body separation: the upper trunk and shoulders should rotate around a relatively stable lumbar spine. Shoulder & thoracic spine mobility are important for this separation, especially thoracic rotation. 

2. Core stabilization (abdominal & gluteal strength): If these muscles are weak or not engaging appropriately during the swing, the player might lose position, especially at the top of the backswing and/or while transitioning to the downswing.

3. Hip internal rotation mobility: Full range of motion is 45 degrees. Many people, not just golfers, tend to lose this motion, especially with age. If the body attempts to rotate beyond the hip’s limits, the body might compensate with motion at the nearest available motion segment - the low back.

How do you correct it?

Consider working with a TPI trained physical therapist if you are experiencing low back pain with your golf game. Depending on your specific limitations, they might work on improving your thoracic & hip mobility so that the lumbar spine doesn’t move excessively to compensate. They might address what’s happening at the pelvis and work on finding the optimal position and maintaining it throughout the swing. It may also help to work with a swing coach for more swing-specific advice, such as shortening the backswing or flaring the trail leg outward at setup if hip rotational mobility is lacking.

-Matt Kooy, DPT

Golf & Shoulder Pain

Shoulder injuries are common among golfers. The shoulder is an incredibly mobile joint that lacks a lot of inherent stability and is exposed to significant forces during the golf swing. When a shoulder is moving properly and has sufficient strength, there generally is not a problem during the golf swing. Conversely, if there is a deficit in shoulder mobility or strength in a golfer, there is a good chance of eventually experiencing some shoulder pain while golfing. Here are some ways to check your own shoulder for rotational mobility:

INTERNAL ROTATION

Reach your arm behind your back: how high can you reach your thumb? Is it between your shoulder blades? Those with good mobility will reach to the level of T9 (the 9th thoracic vertebra) or higher, which roughly equates to bra strap level, or near the bottom corner of the shoulder blade. If your motion only makes it to the region of your low back or hip, that is a sign of reduced internal rotation mobility, with the most likely culprit being a stiff posterior capsule.

The shoulder capsule is a set of ligaments that blend together to form sort of a protective shell surrounding the “ball and socket” part of the joint. Anatomically, the socket isn’t particularly deep, allowing for more mobility, but at the cost of less stability. This is why the capsule is important, as it provides some joint stability while still allowing it to move through a large range of motion. When part of the capsule becomes stiff, it can adversely affect the mechanics of the joint, potentially leading to pain. This could manifest at the site of restriction itself or in other areas.

To stretch the posterior capsule of your shoulder, try the “sleeper stretch”. To stretch your right shoulder, lie on your right side with your elbow raised to shoulder level. Then take your left hand, grasp your right wrist, and guide the right arm to rotate downward toward your feet. Hold for 30 seconds. Click on the link below for a photo and further instruction of the sleeper stretch:

Sleeper Stretch

If the sleeper stretch is painful to perform, an alternative exercise to similarly improve shoulder mobility is the cross-body shoulder adduction stretch. The key to this stretch is that it should be felt behind the shoulder, without any pinching or sharp pain experienced in the front of the shoulder. 

Cross-Body Shoulder Adduction Stretch

EXTERNAL ROTATION

To check external rotation of your shoulder, raise your hand up to a “high five” position. Can you do this without pain? When you look at your forearm in this position, ideally it would be vertical, indicating roughly 90 degrees of shoulder external rotation. Some can rotate beyond 90 degrees, which is okay for most people. But remember, excessive mobility can come at the cost of stability. In other words, those with more mobility may need to compensate with additional strength surrounding the joint in order to ensure pain-free shoulder function. External rotation stiffness may be capsular or muscular, and there are some simple ways to stretch both.

Shoulder External Rotation Stretches

It can be helpful to remember that ideal shoulder function involves balancing both mobility and stability. If either of those are compromised, it could affect not only your ability to golf without pain, but also result in pain with day-to-day activities.

-Matt Kooy, DPT

Golf & Low Back Pain

Does your low back hurt at the end of your round? Does it hurt with every swing? Do you have low back issues that prevent you from playing at all? Over 80% of adults experience an episode of low back pain in their lifetime, with low back pain being a major cause of disability across the globe. The low back is the leading site of injury in golfers and could have any number of causes: irritated disks, facet joints, muscles, ligaments, etc. While there are many potential causes for low back pain, it is often helpful to look at the low back’s neighbors (the hips and thoracic spine) for mobility restrictions that might relate to the painful tissues in the low back.  

HIPS

The hips are highly mobile joints and hip mobility is critically important for the golfer during both the backswing and follow through. For a right handed player, the right hip internally rotates on the backswing and externally rotates on the follow through. Conversely, the left hip externally rotates on the backswing and internally rotates on the follow through. For left handed players, it’s the reverse. For many individuals (especially those with aging hips), there is usually more of a limitation with internal rotation compared to external rotation. While there are some stance modifications that may help while playing golf, such as increasing the amount of “toe out” at address, a better approach may be to identify where you are stiff and improve your baseline mobility in order to improve not only your golf game, but potentially day-to-day activities as well. 

THORACIC SPINE 

The spine is divided into three sections: the cervical spine (neck), thoracic spine (mid-back), and lumbar spine (low back). There are some distinct anatomical differences in each section and the shape of the bones and their connections can affect how far they are able to move in a particular direction. The neck moves well in all directions. The thoracic spine is mobile with rotation, but not as mobile with side bending or backward bending. The lumbar spine is mobile with forward & backward bending, but less mobile with rotation. It’s more important that the lumbar spine provide a stable foundation around which to swing, than to provide the rotational motion itself.

Since rotation is such a critical component of the golf swing, it is important to maximize the available rotation from the hips and thoracic spine so that we don’t place too much rotational demand onto the lumbar spine. If the hips and thoracic spine won’t fully rotate, the body might make up for it at the lumbar spine, an area without much rotation to give. See the exercises below to work on improving your hip and thoracic mobility and hopefully your golf game at the same time.

Hip & Thoracic Spine Mobility Routine For Golfers

-Matt Kooy, DPT