Movement, the musculoskeletal system and lower back pain in young elite male golfers
Young elite male golfers experience golf related lower back pain with a worrying prevalence. Little is known about the musculoskeletal association with lower back pain development in elite golfers. The major purpose of this thesis was to identify the musculoskeletal factors related to lower back pain in young elite male golfers. This was achieved through four studies on elite male golfers recruited from an elite golf academy in South Africa. The first investigation focused on the lower quadrant swing kinematics associated with lower back pain. The second study explored whether spinal muscle recruitment was associated with developing lower back pain. The third aimed to establish if commonly used functional movement screening tools were able to identify golfers at risk of developing injury. The final study tested whether the measurements made in the above studies as well as conventional monitoring tools would identify parameters associated with improved performance amongst elite golfers. Golfers who developed lower back pain displayed distinct differences in terms of their kinematics. Golfers at risk of developing lower back pain had: reduced non-dominant leg squat at set up and at the top of the backswing, increased dominant knee flexion during impact and decreased dominant hip abduction during the backswing and during follow through. The incidence of lower back pain was 41%. This considerable injury incidence in a young golfing population is concerning. Furthermore, elite golfers who developed lower back pain had increased dominant latissimus dorsi and dominant rectus abdominis activation during the swing. This may have resulted in increased dominant side spinal compression. The increased muscle recruitment of dominant latissimus dorsi and dominant rectus abdominis appears to be a centralised movement strategy and was not as a result of pain at the time of measurement. Out of 30 screening tests only three tests were associated with developing lower back pain (all three had weak effect sizes). Functional movement screening was not effective in identifying elite golfers at risk of injury in this study. Swing characteristics did not affect overall performance, but golf drive distance did. This suggests that swing characteristic modifications, such as those identified in study one and two, can be made in an attempt to reduce lower back pain incidence without impacting negatively on performance, provided the golf drive distance is not negatively affected. The findings of this PhD address the second step in the TRIPP (Translating Research into the Injury Prevention Practice) model of injury prevention, namely, identifying lower back pain associations. Now that musculoskeletal associations have been identified, future randomised controlled intervention studies should be conducted to determine if modifying these associations reduces the incidence of golf related lower back pain in young elite male golfers.
A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, 2022