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What We Still Do Not Know About Golf and Low Back Pain

Written by Ifije Ohiorhenuan, MD, PhD — Board-Certified Spine Surgeon. Last updated 2026-06-20.

The evidence is useful, but not complete

Golfers want clear answers: Which swing causes back pain? Which exercise prevents it? How many rounds are too many? What stretch fixes it? Unfortunately, the research is not always that simple.

The source synthesis includes many useful studies on golf-related low back pain, but it also highlights controversies and gaps. That uncertainty is important. It prevents overconfident advice and encourages individualized care.

Swing mechanics are not a simple villain

Some studies identify movement differences in golfers with low back pain or in golfers who later develop pain. Other reviews find that evidence is not strong enough to conclude that specific swing characteristics directly cause low back pain.[1, 2, 3]

This is not necessarily a contradiction. Golfers vary by age, skill, body type, mobility, training volume, pain history, and competition level. A swing feature that is harmless for one golfer may be irritating for another.

The practical conclusion is that swing mechanics matter, but they should be interpreted in context.

Muscle activation findings are complex

Research on trunk muscle activation is also mixed. Some studies find early erector spinae activation, some find altered abdominal timing, and some describe different patterns based on handicap or skill level.[4, 5, 6, 7, 8, 9]

This makes sense because low back pain is not one disease. Golfers with pain may have disc irritation, facet pain, muscle fatigue, hip stiffness, poor endurance, fear-related guarding, or post-surgical changes. These different problems may produce different muscle strategies.

For patients, the message is not to chase one “correct” muscle activation pattern. The goal is coordinated, pain-free, repeatable movement.

Screening tests may not predict everything

Movement screening is popular in golf fitness. It can identify limitations and guide training, but the source synthesis notes uncertainty about whether screening batteries reliably identify golfers who will develop low back pain.[10]

This does not mean screening is useless. It means screening should be used as one tool, not as a crystal ball. A golfer’s history, symptoms, workload, exam, swing, and goals all matter.

We need better research on workload

Golfers frequently ask how much practice is safe. The honest answer is that golf-specific workload research is still limited. We know that overuse and repetitive motion matter, but precise thresholds are not well defined.[11]

Future research could help answer practical questions:

  • How many full swings per week increase risk?

  • How quickly can practice volume safely increase?

  • Are range sessions more provocative than course play?

  • How should older golfers progress after time off?

  • What workload metrics best predict flares?

Until then, golfers should use gradual progression and symptom monitoring.

Women and adolescent golfers are under-studied

The source synthesis notes gaps in research involving female golfers and adolescent golfers.[12, 13, 14, 15] This matters because injury patterns, mobility, strength, training schedules, and developmental factors may differ across groups.

Advice based mostly on adult male golfers may not fully apply to women, juniors, or older recreational players. More inclusive research would improve prevention and treatment recommendations.

What should golfers do with uncertainty?

Uncertainty does not mean inaction. It means golfers should focus on principles that are broadly supported and clinically reasonable:

  • Warm up before play.

  • Build trunk and hip strength.

  • Maintain hip and thoracic mobility.

  • Avoid sudden workload spikes.

  • Modify painful swing patterns.

  • Coordinate physical therapy and coaching when symptoms persist.

  • Seek medical evaluation for persistent, radiating, severe, or unusual pain.

These principles do not require perfect evidence to be useful.

Bottom line

The research on golf and low back pain is promising but incomplete. There is no single swing flaw, stretch, or exercise that explains every golfer’s pain.

The best current approach is individualized: understand the golfer’s body, symptoms, swing, workload, and goals. Then build a plan that reduces unnecessary lumbar stress while preserving the ability to play.

References

This guide draws on the following studies and reviews. Much of this literature is observational or abstract-level, so findings are described here as associations rather than proof. The numbered markers in the text show which sources support each point.

  1. Watson M, Coughlan D, Clement ND, et al. Biomechanical parameters of the golf swing associated with lower back pain: A systematic review. J Sports Sci. 2023;41(24):2236-2250.
  2. Smith JA, Hawkins A, Grant-Beuttler M, et al. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Sports Health. 2018;10(6):538-546.
  3. Cole MH, Grimshaw PN. The crunch factor’s role in golf-related low back pain. Spine J. 2014;14(5):799-807.
  4. Quinn SL, Olivier B, McKinon W, et al. Increased trunk muscle recruitment during the golf swing is linked to developing lower back pain: A prospective longitudinal cohort study. J Electromyogr Kinesiol. 2022;64:102663.
  5. Quinn SL, Olivier B, McKinon W. Lower Quadrant Swing Biomechanics Identifies Golfers With Increased Risk of Low Back Pain: A Prospective Longitudinal Cohort Study. J Sport Rehabil. 2022;31(8):1041-1051.
  6. Lindsay D, Horton J. Comparison of spine motion in elite golfers with and without low back pain. J Sports Sci. 2002;20(8):599-605.
  7. Cole MH, Grimshaw PN. Electromyography of the trunk and abdominal muscles in golfers with and without low back pain. J Sci Med Sport. 2008;11(2):174-81.
  8. Cole MH, Grimshaw PN. Trunk muscle onset and cessation in golfers with and without low back pain. J Biomech. 2008;41(13):2829-33.
  9. Horton JF, Lindsay DM, Macintosh BR. Abdominal muscle activation of elite male golfers with chronic low back pain. Med Sci Sports Exerc. 2001;33(10):1647-54.
  10. Quinn SL, Olivier B, McKinon W. The efficacy of injury screening for lower back pain in elite golfers. S Afr J Physiother. 2023;79(1):1843.
  11. Zemková E, Kováčiková Z, Zapletalová L. Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes? Front Physiol. 2020;11:894.
  12. Lee S, Lastella M, Vitiello A, et al. Golf-Related Injuries in Adolescent Golfers: A Scoping Review. Health Sci Rep. 2026;9(3):e71818.
  13. Hamada Y, Akasaka K, Okubo Y, et al. Warm-Up Program for Adolescent Golfers Reduces Low Back Pain: A Double-Blind, Randomized Controlled Trial. Transl Sports Med. 2025;2025:6993582.
  14. Hamada Y, Akasaka K, Okubo Y, et al. Effects of a golfers’ low back pain exercise prevention program on physical function and golf performance in adolescent golfers: a double-blind, randomized, sham-controlled trial. BMC Sports Sci Med Rehabil. 2025;17(1):348.
  15. Mountjoy M, Schamasch P, Murray A, et al. Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships. Clin J Sport Med. 2024;34(2):127-134.

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This article is educational and does not replace individualized medical advice. If your back pain is severe, persistent, radiates into the leg, or comes with numbness, weakness, or bowel or bladder changes, seek evaluation from a qualified clinician.