Want to lower your golf handicap? Get rid of your low back pain.

Pietro A. Memmo, MD

by Pietro A. Memmo MD

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When I was playing a round of golf with my son last week, I must confess that I felt envious of him. It was not because he was consistently winning every hole. Rather, I simply could not help but admire his fluid and effort-less golf swing. It was a natural swing, never exposed to the lessons of a golf pro. He was able to maintain a consistent, fluid motion from his back swing all the way to follow through. The ball went straight and far.

It started with how he addressed the ball and how he was able to assume the correct spine posture. His spine was straight, knees slightly bent, and he was flexed at the hips about 35-45 degrees. He maintained this angle throughout his swing. Golf pros refer to this as the proper “spine angle and position.”

A proper spine angle is essential in order to master a successful golf swing. The golfer maintains a neutral spine position as the ball is addressed, with-out hunching forward with the upper back (thoracic spine) or excessively arching the low back (lumbar spine). Maintaining this angle will allow the golfer to turn and rotate his spine efficiently, swing powerfully and consis-tently, while remaining centered and balanced throughout the swing. More importantly, this angle protects the spine.

So the question is this: Why is this spine angle so easily and naturally main-tained by young adults, and so difficult to achieve by seasoned golfers in their 40’s, 50’s or 60’s?

Simple: As we age, we become less flexible in our lower extremity muscles (hamstrings, quadriceps and hip flexors), weaker in our core muscle groups (abdominal muscles, paraspinal muscles) and quite often, we have low back pain. Sedentary jobs and long car rides shorten our hamstrings and our hip flexor muscles; demanding work schedules limit our ability to exercise and strengthen our core muscle groups; and lastly, as we age, the discs and joints in our spine become more degenerative through natural aging and wear and tear (Osteoarthritis).

In my practice, the majority of my patients are treated for painful spine re-lated conditions like Sciatica, Spinal Stenosis, Degenerative Disc Disease. However, a growing number of my patients are middle-aged individuals who enjoy sporting activities such as golf. Many of them complain of low back pain with bending and twisting, and how it is impacting their golf game and activity level.

When I see these patients in my office, I will conduct a full initial assess-ment, which would include an extensive history and physical examination, as well as imaging studies such as Xrays of the spine. The initial treatment will include a round of customized and sport specific Physical Therapy to address deficiencies in flexibility and strength as well as a trial of non-steroidal anti-inflammatory medications. Most patients respond favorably to this initial intervention.

For those patients who do not respond to therapy, additional imaging studies such as an MRI will be ordered to assess spinal anatomy. The most relevant anatomy to assess includes the supporting structures of the spine: Vertebral Bodies (the bony building blocks of the spine), Intervertebral Discs (the car-tilaginous spongy material between the vertebrae) and Facet Joints (two olive size stabilizing joints located between and behind adjacent vertebrae). The discs and facet joints are support structures that act as a tripod between each vertebrae. Conversely, they are critical in permitting and limiting spi-nal movement. As we age and the cartilage between our vertebrae (the discs) and these facet joints narrow and deteriorate due to osteoarthritis, spi-nal movement can become limited and painful.

In the case of a golfer, these "facet joints" are typically the true source of low back pain. Although they help stabilize the spine, they also are acti-vated with bending and twisting, activities needed to maintain that perfect spine angle and position seen in golf. Fortunately, we have a solution to ad-dress this facet mediated spine pain.

Radiofrequency Ablation is a minimally invasive, low risk, outpatient pro-cedure used to treat facet joint pain. Through the use of radiofrequency en-ergy, a heat lesion is created on the medial branch nerves that supply and are specific to the facet joints. These nerves do not control any muscle or sensa-tion in the legs. Once heat is applied to these selected sensory nerves, the pain signal from these joints to the brain is eliminated. This in turn elimi-nates the pain.

So do not lose hope if your golf handicap is suffering due to low back pain. There is hope in regaining that perfect golf angle and swing, and hitting the ball like a 20 year old.

Dr. Memmo is an Interventional Physiatrist. He is Board Certified in Pain Management and Physical Medicine and Rehabilitation. The focus of his practice is to diagnose and treat painful spinal conditions in a conservative, non-operative fashion, with minimal utilization of narcotics. Dr. Memmo performs the most advanced, fluoroscopically guided, minimally invasive spinal procedures at the Orthopedic Associates Surgery Center.