How To Conquer Rotation-based Low Back Pain

With the US Open wrapping up this weekend, it couldn’t be more timely to post the third part of this series on rotation-based low back pain. While the first two parts of this series focused specifically on golf, the key points of this series can also 100% apply to tennis, and baseball as well. You can find part 1 here, and part 2 here.

All three of these sports–golf, baseball, and tennis–rely heavily on rotation-based movement for sports performance. Driving a tee shot of 200+ yards, hitting a homerun, or serving up an ace are all important parts of their respective sports, and we’re only scratching the surface on how important rotation is.

The injury mechanisms that we discussed at length in our last blog apply to all three sports. Optimal rotational movement is driven by the hips and upper back, while power is transferred from the lower body to the upper body through a solid and stiff torso.

When the hips or the upper back are tight however, an adjacent joint must pick up the slack. In this instance, the onus now falls on the lower back, which isn’t meant to rotate in the first place. Your ab muscles and your torso can stretch and contract to produce rotation, but they must have the proper strength to minimize these movements in the spine–especially the low back.

The silver lining though is that these injuries are preventable. Adequate rest and recovery, proper movement (especially in rotation), and strength can all mitigate injury risk. This all sounds obvious, but these three things make an enormous difference when it comes to staying healthy for golf, tennis, and baseball.

Get Strong in Anti-rotation

As a single unit, the core and its muscles are responsible for stabilizing the spine during static and dynamic posture. I go into detail on this in an old blog from last year. Perhaps the most direct way to strengthen the core and help buffer against low back pain is to teach the core how to resist rotation, and how to produce that rotation elsewhere in the body.

Why is anti-rotation and core strength important? Just like you must learn how to walk before you run, you should get your core strong before you use it to rotate. In rotational mechanics, the abs will stretch and contract to produce rotation, but you want to be able to do this while minimizing stress on the lumbar spine. That’s why you must get the core strong in its primary function first.

Some of the most direct ways to strengthen the core are shown below:

Today’s #QuickTip: Join the resistance to train your abs. — Resist the urge to do another crunch or sit-up, and train your abs to resist movement instead. The core is responsible for stabilizing your spine during posture and movement. A strong, solid core links the upper and lower halves of your body so that you can walk, run, and move efficiently. Thus, you should be training your core to be stable in the face of movement. Train your abs to resist flexion, extension, rotation, and lateral flexion, and keep your spine healthy and pain-free. In these chops, lifts, holds, and pulls, notice how the abs don’t move, but movement is produced elsewhere; that’s the goal. The key to moving better might just be a solid core, so try out this QuickTip and join the resistance today! — #fitness #fitspo #fitfam #nyc #gym #gymtime #personaltrainer #privategym #halevylife #health #abs #coretraining @jeff.halevy

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These anti-rotation pulls, chops, and lifts, shown in order above, all teach the core how to resist movement, especially movements of the spine that mimic specific aspects of tennis swings. In these instances, the anti-rotation pulls are akin to forehands/backhands, the cable chops to serves, and the cable lifts to forehands/backhands as well.

Just add rotation of the t-spine, hips, and feet, and we have movement that begins to resemble the swings more closely. But it’s important to get the core strong first, and isolating it like we do here is exactly how to do so.

These are far from the only” core stability” or “anti-rotation” exercises you can do. After spending some time with the variations above, you can play with different stances, and add a little rotation as well.

The rotation must come from the proper places, however. The goal is always to keep the torso solid and rotate around it. There will be slight stretch/contract of the torso here, but the goal should be to always keep the ribs down throughout this cable lift. I find this simple cue is enough for someone to keep the core stable and braced throughout these basic rotational movements.

Here’s another way to train rotary stability, that also falls into the category of getting the core strong first before focusing on rotation:

Practice Rotation

Once you’ve gotten the core strong enough, you can begin to focus on rotation itself. And perhaps the best way to boost power in the weightroom specific to the rotational demands of tennis, baseball, and golf are medicine balls.

In order to make the most out of rotation, it is important to maximize something called the“X-factor,” or hip-shoulder separation. Better separation means better distance when it comes to the golf swing, faster serves/forehands/backhands in tennis, and faster throws and more powerful swings in baseball. In simple terms, hip-shoulder separation is when the shoulders are rotated as far away from the target as possible, while the hips remain stationary and square to the target. Then, the hips rotate forward towards the target in the “wind-up” of each motion, before the shoulders follow suit and rotate forward. This creates a stretch in the trunk muscles (the abs) that preloads them for a bigger contraction and better speed of the club head, racquet, bat, or the hand, which in turn drives balls harder and farther.

Think of the trunk as a rubber band. The more you stretch one, the harder it snaps back.  Likewise, better hip-shoulder separation stretches the trunk more.

Going back to our golf example, it has been found that experienced golfers do this better than beginners, but separation does put more stress on the spine and increases injury risk. Furthermore, golfers with low back pain had delayed firing of the obliques during backswing/wind-ups and they activate their trunk musculature differently than healthy golfers. Over time, this can lead to reduced trunk strength and endurance. Finally, LBP golfers had weak isometric endurance of tranverse abdominus and erector spinae, both important stabilizing muscles of the torso. Not surprisingly, we can deduce that LBP golfers had lower rotational strength and endurance of the core (Lindsay & Vandevoort, 2014).

Powerful rotation requires velocity of the extremities but substantial strength and power of the trunk. Reduced muscular support equals increased stress on passive restraints like ligaments, bones, and discs which can cause low back pain.

This is why medicine ball throws and tosses are so great. They are heavy enough to train strength of the core, but slow enough that the velocity of the rotational movement isn’t as dangerous as the sports skills themselves.

Here are a few ways to use medicine balls for this purpose:

The last two are from my time training baseball players as part of Cressey Sports Performance in Jupiter, Florida. These medicine ball drills apply to all three of the sports we are talking about here. In these drills, the medicine balls shouldn’t be too heavy, as you still want to be able to throw them hard into the wall with velocity and force. For these drills, anywhere from 4-12 pounds is fair game, with more emphasis placed on the lower range here.

Even in these exercises, rotation still comes in large part from proper movement of the hips, shoulders, and arms. That’s the way it should be!

Get Strong (Axially)

Last but not least, we cannot minimize the importance of proper strength training when it comes to health in any sport. Rotational movements have a large magnitude of hips, shoulder and torso movement, which creates a lot of shear and compressive force in the spine.

The best buffer against these forces is to get stronger, everywhere and overall. Let’s not forget that strength-training over the long haul improves bone density, especially in the spine. Bigger, beefier vertabra mean better tolerance to stress. The spine can handle axial loading very well, which is why squats and deadlifts are the cornerstone of any strength-training program.

I won’t bore you with the details here, just keep in mind that the cornerstone of athletic performance is strength, and any athlete should squat, hinge, push, pull, lunge, and carry for success in their chosen sport, and life afterwards!

Wrapping Up

Proper training in the gym can be the game-changer that helps you conquer rotation-based low back pain in tennis, golf, and baseball. It is important to get strong, resist rotation, and eventually rotate well; hopefully this blog has shown you the proper way to do so!

References:

Lindsay, D. M., & Vandervoort, A. A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine5(4), e24289. http://doi.org/10.5812/asjsm.24289

by Jeremy Lau

Jeremy Lau is a Senior Staff Coach and Metabolic Lab Manager at Halevy Life.

Jeremy graduated cum laude from Rensselaer Polytechnic Institute with a BSc. in Biomedical Engineering and received his Master’s in Exercise Physiology at Columbia University. In addition to his academic accolades, Jeremy is a Certified Strength & Conditioning Specialist (CSCS).

Prior to joining the team at Halevy Life, Jeremy completed a coaching internship at Cressey Sports Performance, where he coached both amateur and professional athletes, among whom were many professional MLB baseball players.

As an athlete, Jeremy has played baseball competitively for most of his life.