The Lower Back Trap: What I've Learned Treating Golfers in Clinic
In This Article
Many golfers on the Costa del Sol live with nagging lower back pain. They rest, feel better for a few weeks, then one round of golf brings the pain straight back. If this sounds familiar, there is a strong chance your lower back is not the real problem.
In clinic I see a clear pattern. The scans, the pain, the stiffness all seem to point to the lumbar spine. Yet once we assess the whole body, the true cause is usually somewhere else entirely.
Why the lower back always gets blamed
When your lower back hurts, it is natural to think that the problem must be in the same place. After all, that is where you feel it. The difficulty is that the lumbar spine often ends up as the victim rather than the culprit.
The lower back sits in a vulnerable position. Below it, the hips are designed to rotate. Above it, the thoracic spine in the mid back is also designed to rotate. The lumbar spine in the middle prefers stability rather than large amounts of rotation.
When the hips or thoracic spine become stiff, the body still has to find the rotation needed for a golf swing. The only place left to take up the slack is the lower back. Over time it is asked to absorb forces it was never built for. Pain is the result.
Hands-on treatment or a short break from golf can settle the symptoms for a while. However, if the underlying restriction in the hips or thoracic spine is not addressed, the same pattern returns the next time you play.
The maths of the golf swing
Classical anatomical research, including Kapandji’s work on joint physiology, suggests that the lumbar spine has about 13 degrees of true rotation in total. Some studies give slightly higher figures, but the overall message is consistent. The lower back is not a highly rotational area.
By contrast, a competent golf swing requires roughly 35 to 45 degrees of trunk rotation during the backswing, often more for powerful hitters. If the lumbar spine can safely contribute only a fraction of that, the rest has to come from somewhere else.
In a healthy and well prepared golfer, the additional rotation is shared between the hips and the thoracic spine. When one or both of those areas are restricted, the body has limited options. The lower back begins to twist and bend more than it should every time you swing.
This helps explain why two golfers with the same handicap and the same coaching can have very different experiences. One plays regularly without pain. The other struggles to get out of the car the next morning. The visible swing may be similar, but the way their joints share the load is very different.
Quick Tip: If you feel more restriction turning to one side during your swing, pay attention to how your hips and ribcage move, not just your lower back. That asymmetry is often where the real problem lies.
The three real culprits in golf-related back pain
In golfers with persistent lower back pain, I repeatedly find the same three issues. None of them are located in the lower back itself.
1. Restricted hip internal rotation
For a right-handed golfer, the lead hip on the left side needs to internally rotate as the pelvis turns towards the target in the downswing. If that rotation is restricted, the pelvis cannot turn freely, so the lower back starts to twist more than it should to keep the club moving.
Limited hip internal rotation is one of the most consistent findings in golfers who present with recurring back pain. Years of sitting, limited movement variety, and a lack of specific hip mobility work are common contributors.
Many patients are surprised to learn that their lower back will not settle properly until their hip mobility improves. Their hips often do not feel painful, which makes it tempting to ignore them. Yet they quietly dictate how much stress reaches the lumbar spine.
2. Limited thoracic rotation
The thoracic spine in the mid back should provide a large share of the rotation needed for an efficient backswing. When it becomes stiff, the body compensates. Once again, the lumbar spine is pushed into movement it does not comfortably own.
Thoracic stiffness is especially common in golfers who spend long hours at a desk or driving. The upper back gradually loses its ability to extend and rotate, the shoulders round forwards, and the swing relies more on the lower back and shoulders to generate power.
This area often flies under the radar. People are usually aware when their hips feel tight, but they rarely notice reduced thoracic mobility until it is measured. Even without pain in the upper back, a stiff thoracic spine can place extra load on the joints below.
3. Inadequate core stability under rotational load
Mobility is only half of the picture. The other half is control.
Some golfers have good hip and thoracic mobility when tested on the treatment table, yet still struggle with lower back symptoms on the course. The missing link is often the ability to stabilise the spine while the surrounding joints move dynamically.
The trunk muscles, including the deep abdominals, diaphragm, pelvic floor and obliques, all work together to support the spine as you swing. If this system cannot cope with the speed and load of a golf swing, the lower back absorbs forces that should be managed by muscular control.
Why stretching alone rarely fixes golf back pain
Once golfers realise their hips or upper back are tight, many understandably turn to stretching. They might feel a little looser for a few days, yet the pain returns as soon as they increase their golf again.
Static stretching can temporarily increase tissue length. However, it does not automatically build the strength to control that new range or update the movement patterns used during the swing. Within hours, sometimes minutes, the body often settles back towards its familiar resting length.
Meaningful change comes from regular work that combines mobility with strength and coordination. Mobility drills help you access the range. Strength and control help you use it safely during real-world movements like the golf swing.
Quick Tip: After each mobility exercise, add a light strength or control drill in a similar position. For example, follow a hip rotation stretch with a slow, supported lunge or split squat to help your body use the new range.
What actually helps golfers with lower back pain
Once serious problems that need urgent medical input have been ruled out, the approach I recommend to most golfers has three key components.
1. Daily mobility for hips and thoracic spine
Ten to fifteen minutes a day of targeted mobility work for the hips and mid back is far more effective than a long session once a week. Gentle, frequent input helps the body gradually adapt and keeps improvements present when you play.
2. Rotational strength training
Two or three sessions per week of strength work aimed at the trunk, hips and shoulders can make a significant difference. This does not need to be heavy or complex. The aim is to build control and endurance in the positions your body adopts during the swing.
3. A golf-specific warm up
Arriving at the first tee straight from the car is one of the quickest ways to provoke a sensitive lower back. A short warm up that includes hip mobility, thoracic rotation and gentle trunk activation can reduce stiffness and improve how your body tolerates the round.
Structured programmes designed specifically for golfers can be very useful here. They remove the guesswork from choosing exercises and provide the consistency most people struggle to achieve alone. Short, regular sessions are far more valuable than waiting for the perfect long workout that rarely happens.
The most important factor is not intensity, but consistency. Golfers often ask which single exercise will fix their back. There is no magic movement. The real change comes from doing the right kind of work, repeatedly, over time.
When self-management is not enough
Many golfers notice clear improvement within a few months of consistent mobility and strength work. However, there are situations where you should seek a clinical assessment instead of trying to manage things on your own.
Arrange an assessment promptly if any of the following apply:
- You have leg pain, numbness, tingling or weakness as well as back pain.
- The pain wakes you at night and changing position does not ease it.
- There is no obvious pattern to when the pain starts or settles.
- You have had a clear injury, such as a fall or a sudden twist.
- The pain has persisted for more than three months despite genuine attempts at self-care.
In these cases, you need more than a quick treatment of the painful area. A thorough assessment should look at the whole movement chain, including the hips, thoracic spine, neuromuscular control and swing mechanics.
At Costa Performance Therapy in Mijas and Marbella, this is the kind of work we carry out with golfers. We combine a detailed clinical screen with hands-on treatment and tailored exercise plans so that we can address the true source of the problem rather than repeatedly chasing symptoms.
Rethinking lower back pain in golfers
For most golfers, lower back pain is better viewed as a feedback signal than as a simple back injury. It is the area that protests when other parts of the chain are not doing their share of the work.
When you start to see it this way, your approach changes. Instead of relying on short term relief in the lumbar spine, you begin to restore mobility and strength in the hips and thoracic spine, and improve how your trunk stabilises through the swing.
This approach can take longer than a quick fix, but in many cases the improvements last far longer. The lower back settles once it is no longer asked to perform the jobs of both the hips and the mid back.
With the right assessment and a clear plan, golfers of all levels can usually return to playing with more comfort and confidence, and far less reliance on short term pain relief.
Sarah Monaghan is a chiropractor and the founder of Costa Performance Therapy, a clinical golf performance and rehabilitation service on the Costa del Sol. She works with golfers of all levels and runs TPI-style movement assessments alongside hands-on rehabilitation in her clinics in Mijas and Marbella.
Frequently Asked Questions
Is it safe to keep playing golf with lower back pain?
Mild, familiar stiffness that settles quickly after a round is often manageable, especially if you are following a structured mobility and strength plan. However, if the pain is sharp, worsening, travels into the leg, or significantly affects your swing or daily activities, you should reduce or pause play and seek a clinical assessment. Continuing to play through more severe symptoms can delay recovery and, in some cases, aggravate an underlying problem.
Do I always need an MRI or X-ray for golf-related back pain?
Not usually. Many golfers’ scans show age-related changes such as mild disc bulges or wear and tear that are common and not always linked to pain. In most cases, a careful clinical assessment is more useful than imaging for planning treatment. MRI or X-ray may be appropriate if you have red flag symptoms such as significant leg weakness, changes in bladder or bowel control, unexplained weight loss, a history of cancer, or trauma. Your clinician can advise whether imaging is necessary based on your individual presentation.
How long does it take for golf-related lower back pain to improve?
Timeframes vary from person to person. Some golfers notice clear improvement within 4 to 6 weeks of consistent mobility and strength work, especially if the pain has been present for a relatively short time. Longer standing problems, or those linked to significant stiffness in the hips or thoracic spine, may take several months to settle. The key factors are an accurate diagnosis, a tailored plan, and steady adherence rather than intensity. Regular review with your clinician helps keep you progressing in the right direction.
Can hands-on treatment alone fix my golf back pain?
Hands-on approaches such as chiropractic care, physiotherapy techniques or sports massage can be very helpful for easing pain, improving short term mobility and calming irritated tissues. However, on their own they rarely resolve recurring golf-related back pain for the long term. To change how your body copes with the golf swing, you usually need a combination of hands-on care, targeted exercises and better warm up and training habits. The exercise and movement component is what helps the improvements last.
What should a good warm up for golf include?
A useful warm up should gently raise your heart rate, loosen the hips and thoracic spine and activate the trunk muscles. This might include a short walk, dynamic hip movements, controlled thoracic rotations and a few practice swings that gradually build in range. The whole routine can take as little as 5 to 10 minutes. The aim is to prepare your body for the demands of the swing, not to tire you out before the round starts.
