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The Role of Decreased Hip IR as a Cause of Low Back Pain in a Golfer: a Case Report

  • Case Report
  • Published:
HSS Journal ®

Abstract

Background

Among golf injuries, low back pain (LBP) is the most common compliant for both professional and amateur golfers. Hip rotational range of motion (ROM) might be related to LBP in those who repeatedly place specific activity rotational demands on the hip in one direction. Coordination of timing of movement (neural control) between the hip and lumbopelvic region during trunk movements is critical for normal mechanics. Altered timing can contribute to areas of high tissue loading and can lead to LBP symptoms seen during active lower limb movement tests. Patient was a 42-year-old male recreational golfer who presented with low back pain and decreased hip internal rotation ROM.

Methods

With the use of manual physical therapy to increase hip ROM and lumbar stabilization therapeutic exercises, the patient was able to return to pain-free golf and to better his handicap by three strokes.

Results

Significant improvement was seen in his Oswestry outcome score, and a (−) prone instability test was noted.

Conclusion

It is recommended to address hip ROM limitations in those experiencing low back pain while golfing. Rapid spinal rotation may produce large spinal loads, but this is likely not the major contributor to low back pain in golfers. Mechanical factors may play a larger role.

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References

  1. Barrentine SW, Fleisig GS, Johnson H. Woolley TW. Ground reaction forces and torques of professional and amateur golfers. Science and Golf II: Proceedings of the World Scientific Congress of Golf. London E & FN Spon. 1994; 33–9.

  2. Bendelba M, Torgerson WS, Ling DM. A validated, practical classification procedure for many persistent low back pain patients. Pain. 2000;87:88-97.

    Google Scholar 

  3. Callaghan JP, Gunning JL, McGill SM. Relationship between lumbar spine loads and muscle activity during extensor exercises. Phys Ther. 1998;78:8-18.

    PubMed  CAS  Google Scholar 

  4. Cibulka MT, Sinacore D, Cromer GS, et al. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint pain. Spine. 1998;23:1009-1015.

    Article  PubMed  CAS  Google Scholar 

  5. Delitto A, Erhard RE, Bowling RW. A treatment based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1995;75:470-89.

    PubMed  CAS  Google Scholar 

  6. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: Evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37:290-302.

    Article  PubMed  Google Scholar 

  7. Frymoyer JW, Selby D. Segmental Instability. Rationale for treatment. Spine. 1985;10:280-6.

    Article  PubMed  CAS  Google Scholar 

  8. Gulgin H, Armstrong A, Gribble P. Passive hip rotation range of motion in LPGA golfers. Clinical Kinesiology. 2008;62:9-15.

    Google Scholar 

  9. Gulgin H, Armstrong C, Gribble P. Weight-bearing hip rotation range of motion in female golfers. NAJSPT. 2010;5:55-62.

    PubMed  Google Scholar 

  10. Harris-Hayes M, Sahrmann SA, Van Dillen LR. Relationships between the hip and low back pain in athletes who participate in rotation-related sports. J Sports Rehabil. 2009;18:60-75.

    Google Scholar 

  11. Hicks G, Fritz J, Delitto A, McGill S. Preliminary development of a clinical prediction rule for determining when patients with low back pain will respond to stabilization exercise program. Arch Phys Med Rehabil. 2005;86:1753-1761.

    Article  PubMed  Google Scholar 

  12. Hicks G, Fritz J, Delitto A, Mishock J. Inter-rater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84:1858-64.

    Article  PubMed  Google Scholar 

  13. Hosea TM, Gatt CJ, Gertner E. Biomechanical analysis of the golfer's back. In: Stover CN, McCarroll JR, Mallon WJ, eds. Feeling up to Par: medicine from tee to green. Philadelphia, PA: F.A. Davis Company; 1994:97-108.

    Google Scholar 

  14. Juker D, McGill SM, Knopf P, Steiffen T. Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc. 1998;30:301-10.

    PubMed  CAS  Google Scholar 

  15. Knutsson F. The instability associated with disk degeneration in the lumbar spine. Acta Radiol. 1944;25:593-609.

    Article  Google Scholar 

  16. Lindsay D, Horton J. Comparison of spine motion in elite golfers with and without low back pain. J Sports Sci. 2002;20:599-605.

    Article  PubMed  CAS  Google Scholar 

  17. Marras WS, Lavender SA, Leurgans SE, et al. Biomechanical risk-factors for occupationally related low-back disorders. Ergonomics. 1995;38:377-410.

    Article  PubMed  CAS  Google Scholar 

  18. Marras WS, Lavender SA, Leurgans SE, et al. The role of dynamic three-dimensional trunk motion in occupationally-related low back disorders. The effects of workplace factors, trunk position, and trunk motion characteristics on risk of injury. Spine. 1993;18:617-28.

    Article  PubMed  CAS  Google Scholar 

  19. Martin RL, Irrang JJ, Scheyar JK. The diagnostic accuracy of a clinical examination in determining intraarticular hip pain for potential hip arthroscopy candidates. Arthroscopy. 2008;21:1013-18.

    Google Scholar 

  20. Martin RL, Kelly BT, Philippon MJ. Evidence of validity for the hip outcome score. Arthroscopy. 2006;22:1304-11.

    Article  PubMed  Google Scholar 

  21. McCarroll JR. The frequency of golf injuries. Clin Sports Med. 1996;15:1-7.

    PubMed  CAS  Google Scholar 

  22. Mellin G. Correlation of hip mobility with degree of back pain and lumbar spinal mobility in chronic low back pain patients. Spine. 1988;13:668-670.

    PubMed  CAS  Google Scholar 

  23. Nadler SF, Malanga GA, Bartoli LA, Feinberg JH, Prybicien M, DePrince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc. 2002;34:9-16.

    PubMed  Google Scholar 

  24. Nadler SF, Malanga GA, DePrince M, Stitik TP, Fienberg JH. The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes. Clin J Sports Med. 2000;10:89-97.

    Article  CAS  Google Scholar 

  25. Posner I, White AA 3rd, Edwards WT, Hayes WC. A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine. Spine. 1982;7:374-89.

    Article  PubMed  CAS  Google Scholar 

  26. Sahrmann S. Diagnosis and treatment of movement impairment syndromes. St. Louis, MO: Mosby; 2002.

    Google Scholar 

  27. Scholtes SA, Gombatto SP, Van Dillen LR. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clinical Biomechanics. 2009;24:7-12.

    Article  PubMed  Google Scholar 

  28. Tsai YS, Sell TC, Smolgia JM, Myers JB, Learman KE, et al. A comparison of physical characteristics and swing mechanics between golfers with and without history of low back pain. J Orthop Sports Phys Ther. 2010;40:430-8.

    Article  PubMed  Google Scholar 

  29. Vad VB, Bhat AL, Basrai D, Begeh A, Gebeh A, et al. Low back pain in professional golfers. The role of associated hip and low back range-of-motion deficits. Am J Sports Med. 2004;32:494-7.

    Article  PubMed  Google Scholar 

  30. Van Dillen LR, Bloom NJ, Gombatto SP, Susco TM. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport. 2008;9:72-81.

    Article  PubMed  Google Scholar 

  31. Van Dillen LR, Sahrmann SA, Norton BJ, et al. Effect of active limb movements on the symptoms in patients with low back pain. J Orthop Sports Phys Ther. 2001;31:402-13.

    Article  PubMed  Google Scholar 

  32. Van Dillen LR, Sahrmann SA, Norton BJ, Caldwell CA, McDonnell MK, Bloom NJ. The effect of modifying patient—preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys med Rehabil. 2003;84:313-22.

    Article  PubMed  Google Scholar 

  33. White AA, Panabi MM. Clinical Biomechanics of the spine. 2nd ed. Philadelphia: JB Lippincott; 1990:23-45.

    Google Scholar 

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Disclosures

Conflict of Interest:

Gregory Reinhardt, PT, MSPT, has declared that he has no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was waived from all patients for being included in the study.

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Authors and Affiliations

  1. Sports Rehabilitation and Performance Center, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Gregory Reinhardt PT, MSPT

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  1. Gregory Reinhardt PT, MSPT
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Correspondence to Gregory Reinhardt PT, MSPT.

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Reinhardt, G. The Role of Decreased Hip IR as a Cause of Low Back Pain in a Golfer: a Case Report. HSS Jrnl 9, 278–283 (2013). https://doi.org/10.1007/s11420-013-9353-9

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