Low back pain is the most common complaint in golf, and the reason is not mysterious. A golf swing asks the body to rotate hard and then decelerate, and that rotation has to come from somewhere.
Where the rotation is supposed to come from
Two places do most of the work: the hips and the thoracic spine, which is the upper and middle part of your back where the ribs attach.
The lumbar spine, the low back, is not built to rotate much. It is built to be stable. Its job in a swing is to transmit force between your hips and your ribcage while staying relatively still.
What happens when the rotation is not available
If your lead hip cannot internally rotate far enough, or your thoracic spine has stiffened up the way most desk-bound bodies eventually do, the movement still has to happen. Your body does not simply refuse to swing. It finds the range somewhere else, and the nearest available joint is the lumbar spine.
So a segment designed for stability starts absorbing rotation, several hundred times a week during the season, at speed, under load.
That is what most golf-related low back pain actually is. Not a back injury in the sense of something that happened, but a back that has been doing another joint’s job for years.
Why this is not a technique problem
The frustrating part for a lot of players is that they have been told about it. Stop sliding, stop losing your posture, stop coming out of it. What often has not been checked is whether the body in question is physically capable of the alternative.
You cannot coach someone into hip rotation they do not have. The compensation will keep reappearing under pressure, at speed, and on the back nine when they are tired, because it is not a habit. It is the only option available.
This is the reason the same swing fault survives years of lessons for one player and disappears in a few weeks for another. One of them had the range and the other did not.
What to actually check
A physical screen tells you quickly which of these is true for you:
Lead hip internal rotation. Lie on your back, bend a knee to 90 degrees, and let the lower leg rotate outward, which turns the hip inward. Compare sides. A large difference between them is worth investigating.
Thoracic rotation. Sit on a chair, cross your arms over your chest, and turn. Then compare against how far you can turn when someone stabilises your pelvis. If most of your “rotation” disappears once the pelvis is held still, it was coming from your low back.
Ankle mobility, which people always skip. If your lead ankle cannot dorsiflex, the chain above it changes how it loads.
None of this is a diagnosis. It tells you where to look.
What treatment involves
If the finding is a mobility restriction, treatment is about restoring the range first: manual therapy, dry needling where a muscle is genuinely holding something shut, and then loading the new range so your body starts using it rather than reverting.
That last part is where most home programs fail. Range that is not loaded does not get adopted. You have to teach the pattern with the new range available, or the body goes back to what it knows.
When to see someone quickly
Low back pain that stays in the back and improves with movement is usually a mechanical problem worth assessing at your convenience.
Pain that travels down a leg, numbness, pins and needles, or weakness in the leg or foot is different, and so is any change in bladder or bowel function. Those need looking at promptly, not after the season.
Brian Bolin is a Doctor of Physical Therapy certified by the Titleist Performance Institute at Level 1 and Medical Level 2, treating golfers across Naples and Marco Island in their homes, at their clubs and on the course.