Marc Darrow MD,JD

Some golfers like to get that extra bit of exercise of the course by not only walking the course, but carrying their own bags as well. However, carrying a 20-25 pound bag while walking a couple of miles over a course can cause significant chronic pain. In golfers much has been made about the golf swing causing spine problems including into the neck. But not much has been made about what carrying the bag can do if you do not maintain a good posture and a good gait.

A study on caddies shows how the weight of the bag impacts back pain

Golf is an exploding industry in South Africa, a May 2020 study (1) examined how this is impacting the heath of caddies. What they found was caddies were at higher risk  for musculoskeletal pain in the neck foremost, then the back, the arm and then the leg. The expressed concern enough that the suggested work place guidelines be enforced to help protect the necks and backs of caddies.

Caddies for the most part are younger than the golfers. If caddies are vulnerable, certainly older golfers would be as well. You probably did not need a scientific study to tell you you could hurt your neck or back carrying your bag and walking the course but it probably did not hurt to be reminded of the fact.

If you are carrying your bag you probably have been online and bought good shoulder straps or even a harness. If you neck and back began to hurt you probably bought even better straps and harnesses.

Better golf bag straps and a better score

A December 2019 (2) study examined the difference between a single strap and double-strap golf-bag. Here is what the study said:

“A golf bag filled with a set of clubs provides a substantial load. When carried over distance this can increase the demands placed upon the golfer, leading to discomfort, fatigue and injuries. This study aimed to compare the metabolic demands (how much oxygen you need) of 2 methods of golf bag carriage.”

A total of 16 healthy male recreational golfers participated in the study. Equipment consisted of a double-strap golf bag with a standard set of clubs weighing 12.5kg (About 28 pounds). The metabolic demands of cardio-output and oxygen intake were measured.

 Results showed that the double-strap bag required significantly less oxygen consumption, reduced respiratory minute volume (less heavy breathing), and lower heart rates than the single-strap bag.

Conclusions: The decreased metabolic cost of carrying a double-strap golf bag may facilitate a reduction in fatigue and reduced mechanical stress. Golf bag transportation must therefore be recognized as a factor in reducing the risk of injury and improving playing performance.”

Back pain, carrying a bag, oxygen consumption. How much did you shrink during a game of golf?

Now we are going to explore the problems of a golfer, who still wants to carry his/her own bag, but now has back pain. Does the back pain and carrying the bag make you need more oxygen and thereby increasing fatigue and make your back nine a lot was than your front nine?

Look at this 1993 study and the impact it has on research now in 2021. This study was published in the Journal of Sports Sciences. (3)

“Changes in stature during physical activity reflect alterations in spinal column length that occur as a result of loading the spine. (Your spine is shrinking because of loss of disc height). The shrinkage is associated with loss of intervertebral disc height. This study aimed to measure both the load on the spine during simulations of a round of golf and the physiological responses to carrying golf clubs.”

Shrinkage of the spinal column during the game

“Shrinkage was measured after performance regimens which mimicked (a) the ambulatory activity during golf play, (b) ambulation and skills employed in par performance and (c) ambulation and carriage of clubs.” A simulated gold game.

Our observations indicate significant shrinkage associated with golf skills, mean shrinkage after nine holes being 2.53 mm compared to 1.78 mm in the walking condition. The highest shrinkage was observed when the player carried his clubs, the amount of stature loss being 4.76 mm over nine holes.

In a second experiment to further examine the effects of carrying the golf clubs, five of the subjects walked on a motor-driven treadmill for 5 min. Carrying the clubs caused a 15% increase in oxygen consumption and a 25% rise in (ventilation (heavy breathing) compared to normal walking. Increases were found also in perceived exertion.”

The conclusion is less alarming. “The physical and physiological loadings associated with recreational golf were deemed to be light to moderate and do not denote undue strain in occasional practices.” You should “unshrink.”

Back and neck pain is it just the golf swing or is it the weight of the bag of both?

Most people who have back pain, have a back pain that is caused by many problems. They and their doctors then go about a strategy to eliminate those motions or stressors from the back that is causing pain. Is this an effective strategy? For some yes.

There are countless research articles surrounding low back pain and neck pain and the golfer. Many studies suggest many causes above we have studies indicating the weight of the golf bag is a problem. So it is not just the golf swing.

A study (5) from the Sport Medicine Centre, Faculty of Kinesiology, University of Calgary noted: “Methods to help control or eliminate excessive stress on the lower back would include reducing the amount spent playing or practicing, seeking professional assistance to assess and adjust swing mechanics, improve trunk and hip flexibility, increase the strength and endurance of the trunk musculature, consider different footwear options and avoid carrying the golf bag. Adopting some or all of these recommendations should allow players to continue to enjoy the sport of golf well into their senior years.”

In our practice, Stem Cell Therapy is a treatment for back and neck pain. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. We offer stem cells drawn from patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

PRP treatments

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. PRP puts specific components in the blood to work. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.

Research has shown (4) PRP to be effective in treating degenerative disc disease (DDD) by addressing the problems of spinal ligament instability and by stimulating the regeneration of the discs indirectly (although discs were not directly injected, they showed an increase in disc height).

Although I don’t typically consider DDD to be a major player in neck or back pain, I do treat these areas daily. From my exam, it is typically not the discs that are the issue, but the ligaments at their connection to bone that cause the pain. This is called an enthesopathy. Typically, it is something that will respond well to PRP treatments.


Do you have questions? Ask Dr. Darrow

Marc Darrow, MD. JD., discusses the treatment philosophy of the Darrow Stem Cell Institute. Transcript of video

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.

Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References

1 Garnett J, Made F, Tlotleng N, Wilson K, Naicker N. Work Related Musculoskeletal Pain in Golf Caddies—Johannesburg, South Africa. International Journal of Environmental Research and Public Health. 2020 Jan;17(10):3617.
2 Holland CJ, Godwin MS. The metabolic demand of external load carriage in golfers: a comparison of a single versus double-strap golf bag. The Journal of sports medicine and physical fitness. 2019 Dec 1;59(12):1963-7.
3 Wallace P, Reilly T. Spinal and metabolic loading during simulations of golf play. Journal of sports sciences. 1993 Dec 1;11(6):511-5.
4 Gullung GB, Woodall JW, Tucci MA, James J, Black DA, McGuire RA. Platelet-rich plasma effects on degenerative disc disease: analysis of histology and imaging in an animal model. Evidence-based spine-care journal. 2011 Nov;2(4):13.
5 Lindsay DM, Vandervoort AA. Golf-related low back pain: a review of causative factors and prevention strategies. Asian journal of sports medicine. 2014 Dec;5(4).

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