By Marc Darrow, MD, JD
During my August 1, 2026 radio program, a low-handicap golfer described how back pain once limited him to one or two rounds per week. His story raises an important question: why is the lower back such a frequent problem in golf?
Golf may look gentle compared with collision sports, but the swing combines rotation, side bending, compression, and rapid acceleration. These forces are repeated during practice swings, range sessions, and full rounds. Fatigue, restricted hip motion, reduced trunk endurance, and swing mechanics can transfer additional stress to the lumbar spine and pelvis.
Low back pain is the most common injury reported by golfers
A 2024 systematic review evaluated biomechanical golf-swing variables associated with low back pain. The authors confirmed that low back pain is the most common injury among golfers, but also found that the evidence connecting individual swing variables to pain remains limited and inconsistent. (1)
This is useful clinically. It means we should not blame one movement—such as rotation—or prescribe the same swing correction to every golfer. The painful structure and the golfer’s individual movement pattern must be evaluated.
An MRI abnormality may not be the pain generator
Many golfers arrive with MRI reports describing disc degeneration, bulging discs, arthritis, or spinal stenosis. These findings can be important, especially when they correspond with neurologic symptoms. They are also common in adults who have no pain.
A systematic review of asymptomatic people found that degenerative spinal findings become increasingly prevalent with age. (2) Therefore, an MRI should be interpreted alongside the golfer’s history, physical examination, neurologic findings, and pain behavior.
Structures that may cause golf-related back pain
Possible pain generators include:
- Intervertebral discs
- Lumbar facet joints
- Sacroiliac joints
- Iliolumbar and sacroiliac ligaments
- Paraspinal and abdominal muscles
- Tendon and fascial attachment sites
- Hip disease referring pain toward the back
- Lumbar nerve irritation
Pain arising where a tendon or ligament attaches to bone is sometimes described as enthesopathy. Repetitive rotation and forceful deceleration may irritate these collagen-rich attachment sites. This is different from nerve-root compression and should not automatically be treated as a disc problem.
Clues that require neurologic or surgical evaluation
Pain radiating below the knee, progressive weakness, loss of reflexes, significant numbness, or foot drop may indicate nerve involvement. Loss of bowel or bladder control, saddle numbness, fever, major trauma, unexplained weight loss, or suspected cancer requires urgent evaluation.
Surgery can be appropriate for progressive neurologic loss, severe instability, fracture, tumor, infection, or carefully selected structural compression. The point is not to avoid necessary surgery. It is to identify the correct diagnosis before operating.
Rehabilitation and returning to golf
Exercise remains a foundation of care for most uncomplicated low back pain. A 2024 systematic review found that several forms of specific exercise can improve pain and function in nonspecific low back pain, although no single program is best for everyone. (3)
A golfer’s program may address:
- Hip rotation and thoracic mobility
- Trunk and gluteal endurance
- Gradual exposure to rotational loading
- Swing volume and practice frequency
- Warm-up quality
- Recovery between rounds
Returning immediately to full-speed swings can overload healing tissue. A staged progression may begin with putting and chipping, advance to partial swings and a limited range session, and then progress to nine and eighteen holes if symptoms remain controlled.
Where PRP or bone marrow concentrate may fit
Platelet-rich plasma (PRP) is prepared from the patient’s blood and contains concentrated platelets and signaling proteins. Bone marrow aspirate concentrate (BMAC) is a same-day autologous marrow preparation containing platelets, cytokines, and a small population of progenitor and stromal cells. It is not the same as a culture-expanded MSC product.
Orthobiologic evidence in the lumbar spine is still developing and depends on the target. Intradiscal treatment, facet-joint injection, and treatment of a painful ligament or tendon attachment are different procedures. Research concerning one target should not be used to guarantee success at another.
PRP or BMAC may be discussed when a specific pain generator has been identified and reasonable rehabilitation has not restored function. These procedures should support a progressive return-to-golf plan rather than replace it.
Summary
Golf-related back pain is not one diagnosis. The MRI may show abnormalities without identifying the structure that hurts. A useful assessment considers discs, facets, nerves, hips, muscles, tendons, and ligaments, as well as the golfer’s swing volume and movement pattern. The goal is not merely to suppress pain, but to restore enough strength, mobility, and load tolerance for a safe return to play.
References
- 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).
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.
- Salehi S, Sobhani V, Mir SM, et al. Efficacy of specific exercises in the general population with nonspecific low back pain: A systematic review and meta-analysis of randomized controlled trials. J Bodyw Mov Ther. 2024;39:673-705.
Medical disclaimer: This article is for education only and does not provide a diagnosis or individualized treatment recommendation.