Sore back after a cold round? NHS physio self-referral, trolley habits and a five-minute routine

It is a quarter to eight on a grey October Saturday. You have driven forty minutes with the heater on, hauled the bag and the trolley battery out of the boot, and the starter is waving your four-ball on. The first swing of the day is a driver, cold, stiff and in a waterproof. By the 14th your lower back has started to talk to you, and on Sunday morning it is still talking. Very little of it comes from the swing alone. Most of it comes from what happens around it, and a few minutes placed at the right moments change the day.

A word before the detail: this page offers general guidance for golfers who get stiff or sore, not a diagnosis. If your pain is sharp, runs into a leg or wakes you up, go straight to the warning signs further down.

What a golf swing asks of the lower back

The swing combines a hard turn, a side bend and an extension of the spine, all within about a second. When Timothy Hosea and his colleagues measured golfers hitting a 5-iron in 1990, they found the compressive load on the lumbar spine climbed to roughly eight times body weight during the downswing.

Amateur surveys point the same way. Andrew McHardy and colleagues, studying amateur golfers in Australia, found the lower back was the most frequently injured area, accounting for about a quarter of the injuries recorded over a year.

The joints of the lower back are built mostly to bend forwards and backwards, with little twist at each level. The turning is supposed to happen above, through the upper back, and below, through the hips. Sit at a desk all week, add a long drive to the club, and both of those areas tighten. The swing still needs its rotation, so the lower back gets asked for more than its share. Almost everything below aims to keep the hips and upper back moving so the lumbar spine does not have to cover for them.

Start at the boot, not the first tee

Plenty of sore backs are set up in the car park. Lifting a wet bag and a trolley frame over the lip of a hatchback, with straight legs and the load held away from you, is about as poor a lift as golf offers. Park so you can stand close to the boot, bend your knees, pull the bag towards you and bring it out upright, then stand up with it close to your body. After the drive, walk for two minutes before putting your shoes on. If the electric trolley battery lives in the boot too, lift it separately rather than with the frame.

Five minutes by the first tee, even on a frosty morning

This is the short version, for when the tee sheet is tight. Our winter warm-up routine for British club golfers covers the full twenty minutes. Here you need one club and a patch of grass or path.

• Get warm first. Walk quickly, swing the arms loosely across the chest, roll the shoulders. On a cold morning keep your outer layer on until you have finished; a body that is shivering will not turn.
• Hinge with a club along your spine. Hold the shaft behind you so it touches your head, between the shoulder blades and your tailbone. Push the hips back and tip forward, keeping all three contact points, then stand tall again. Ten slow ones. This is the bending shape to use all day.
• Turn from the chest. With the club across your shoulders, take your address position and rotate back and through, letting the hips go with you a little. Ten each side, slowly. Feel the ribcage turning, not the waist wringing.
• Open the hips. Step into a lunge, lower the back knee towards the ground and ease the hips forwards until the front of the back thigh stretches. Two short holds on each side, then a handful of slow squats with the club held out in front.
• Build up the swing. Waist-high swings first, then three-quarter, then full, around ten in total, letting the speed rise only at the end.

Keep every movement comfortable. Short and active is the idea.

Trolley, carry bag or buggy

Walk into almost any British club on a weekend and you will see far more trolleys, many of them electric, than golfers carrying. For a sensitive back that is good news. Pushing or walking alongside a trolley keeps you moving and warm without a heavy weight hanging off one shoulder. If you are weighing up the cost, our piece on hiring, buying or carrying with an electric trolley sets out the sums.

If you prefer to carry, use a double strap so the bag sits square across both shoulders, and strip out the winter clutter: the spare waterproof trousers you never wear, three sleeves of balls, the flask you could leave in the car until the turn. On a course of around 6,500 yards, the walk from green to next tee adds up to a good few miles, and every pound you remove is carried the whole way.

A buggy has its place, especially on a bad day for the back, but it brings its own problem. Sitting folded between shots cools the back down again. Get out early, walk the last few yards to the ball and make a couple of easy swings before you hit.

The small bends that add up over eighteen holes

Count the times you bend in a round: teeing up, repairing pitch marks on soft autumn greens, lifting and cleaning a muddy ball when preferred lies are in force, fishing the ball out of the hole, picking up a head cover the wind has taken. That can easily outnumber your full swings. Do them with bent knees, or use the golfer’s pick-up: lean on the putter, let one leg rise behind you and tip forwards like a see-saw.

Use the halfway hut or the walk from the 9th green to the 10th tee to repeat the hinge and the chest turns. A drink of water helps too; in cold weather people simply forget to drink. Our guide to eating and drinking on a British golf course covers the fading back nine.

Swing changes that go easy on the spine

• Free the hips. Trying to keep the hips still to build coil sends the twist into the lower back. If you are not very flexible, let the hips turn more and let the lead heel come up slightly if it wants to.
• Turn the toes out a touch. A few degrees of flare in both feet makes the hip turn easier going back and coming through.
• Stand up at the finish. Arching back into a reverse C looks dramatic and costs the spine. A tall, balanced finish over the front foot, chest to the target, is kinder.
• Accept a shorter backswing. A compact three-quarter swing that finds the middle of the face often travels close to as far as a long, loose one.

For anything more ambitious, work with a PGA professional who knows about your back. Our advice on choosing a PGA pro and making lessons count includes how to bring it up.

Floodlit bays and winter mats

Winter pushes a lot of British golfers onto the range after work, under the floodlights, and that is where backs often suffer. There is no walk between shots, a basket arrives in seconds and it is tempting to hit driver after driver to keep warm. Set a limit of around fifty balls, stop for a breather every fifteen or twenty, start with the wedges and finish with some chipping and putting. Mats can also jar the body more than turf on a heavy contact, so if the range has a grass tee open, use it. Our floodlit range hour shows how to get more from fewer balls.

After the last putt, and before the car

Walk for two minutes before getting in. Repeat the lunge stretch, add a slow side bend each way, and at home try a gentle knee-to-chest stretch lying down. You want to leave the course loose, not spend an hour in a car seat straight after asking your back to work hard.

On the days in between, ordinary movement helps most: walking, staying active, and simple strength work for the hips and trunk, such as bridges, side planks and bird dogs. A physio can tell you which suit you.

Signs that mean stop and get checked

Normal stiffness after a round usually eases within a day or two. The NHS notes that back pain often improves on its own within a few weeks. Stop playing and seek advice if:

• pain travels down one or both legs, particularly below the knee, or comes with pins and needles or numbness;
• a leg feels weak or your foot starts to catch;
• the pain wakes you at night or does not settle with rest;
• it began with a fall or a sudden, sharp movement;
• it has not improved after a few weeks of rest and gentle activity.

Numbness around the genitals or back passage, weakness or numbness in both legs, or a new difficulty controlling your bladder or bowels is an emergency. Call 999 or go to A&E.

Where British golfers can get a back looked at

In England you do not always have to wait for a GP appointment to see a physio. According to the NHS website, in many areas you can refer yourself to NHS community musculoskeletal (MSK) services, which include physiotherapy, without a referral from a GP. It is free, but the NHS itself warns there may be a long waiting list, and whether self-referral is offered depends on where you live, so check your local service online.

Your GP surgery is the other route. Some surgeries have a first contact physiotherapist, a specialist in bone and joint problems who can assess you and refer you on if needed. The NHS suggests seeing a GP if back pain has not improved after a few weeks of looking after it at home, or if it stops you doing your normal daily activities. For severe pain that comes on suddenly or gets worse quickly, or if you feel hot, shivery or generally unwell with it, contact NHS 111.

If you go private, check the name first. Physiotherapist is a protected title, and the Health and Care Professions Council keeps a public register you can search. When you book, ask whether the physio sees golfers regularly and whether the first session looks at how your hips and upper back move, not only at where it hurts.

And on the course, talk to your club. Most British clubs are used to members on trolleys, and a quiet nine holes with an electric trolley on a winter afternoon is a far better plan than a month on the sofa waiting for the back to feel perfect.

Your winter back card

• Car park: lift the bag out with bent knees and close to the body; walk for two minutes after the drive.
• First tee: warm up in your layers, hinge with a club, turn from the chest, lunge, then swings that build from waist-high to full.
• On the course: push or ride the trolley, bend at the knees for every tee peg and pitch mark, repeat the hinge and turns at the halfway hut, keep drinking.
• Range nights: about fifty balls, regular breaks, wedges first, grass when it is open.
• Afterwards: walk, stretch the hips, then drive home; if a warning sign appears, stop and get help.

None of these steps takes more than five minutes. Done every round through the damp months, they are often what separates a back nine you enjoy from one you simply endure.