Nerve pain in golfers: Low back, hip, and leg pain
The most common complaint we see with Nashville golfers. Low back pain. How often is radiating or local nerve pain included? About 40% of the time. Nerve pain adds an additional level of complexity that needs an exceptionally close look to truly understand. These are the cases that can be improved rapidly and almost miraculously when the correct interventions are placed in front of the patient or become a battle of chasing downy symptoms and trial and error.
At Integrated Rehab, we take advantage of our comprehensive evaluation and meticulous data gathering to improve our outcomes with these complex cases above our more standard or protocol driven peers. In this article, I want to break down what is happening when nerve pain is included with low back pain and what our framework does to improve our odds of a solution.
Check out similar articles here:
-Do you think there is hope, part 1: Hip pain
-Do you think there is hope, part 2: Low back pain
Key points
First, a list of key points to understand about this type of pain.
1. Nerve pain can be present at the location of the injury or not. We have had examples of pain in the foot, mis-diagnosed previously as plantar fasciitis, that was actually pain radiating from a disc injury in the low back. There was absolutely no symptom’s between the foot and the low back! Low back injury, foot pain and discomfort. This is why understanding nerve injury and pain is critical in the diagnosis and exam process. We must look at everything!
2. Nerve pain can come from compression or tension. Sometimes, the solution to nerve pain is mechanical (opening up joints and taking away compression) while other times the solution requires creating slack. These solutions will look different from each other but assure you stretching is the answer to neither.
3. Injections are not a solution. Steroid injections for pain relief can be effective at relieving pain while other times they do not help at all. Either way, injections are a short term answer (sometimes necessary!) that are not limitless. Injections have a cost, bone health being one of them, with a diminishing return. Finding actual movement-based solutions is critical for the long term.
4. Nerve pain often requires mechanical intervention AND nerve specific treatment. This means we often need to work on dysfunction or restriction at many of the effected joints (including the joints of the vertebrae) as well as the injured (and often hypoxic) nerve itself. Be careful of single modality treatment planes that works to address only a single element like decompression, shockwave, or core stability protocols alone.
Low back pain with nerve symptoms
There can be a few different reasons why local low back pain can include radiating nerve symptoms into the glute, hip and groin, and down the leg.
1. Disc bulge
Pressure from the intervertebral disc on the mixed spinal nerve as it leaves the spinal cord will create an array of symptoms down that nerve track. These symptom’s do not always trace along the path of the nerve but can be present distal or far from the actual site of compression (key point 1).
2. Deep gluteal pain syndrome
Known as piriformis syndrome or sciatica, these diagnoses are referring to a nerve compression happening away from the spinal canal. In this case typically muscle is responsible for creating compression around a nerve, sometimes the piriformis muscle around the sciatic nerve, sometimes not. It is critical to identify when deep gluteal pain syndrome is present or of the symptom’s are actually a product of spine dysfunction.
3. Facet arthritis, disc space narrowing
We all have a little of this, but sometimes it creates a problem. The arthritic change and extra bone formation can compress the mixed spinal nerve as it leaves the canal, similar to a disc bulge. The key difference here is the facets are responsible for the dysfunction, changing how we attack the mechanical joint problem.
4. Nerve glide restrictions
Similar to deep gluteal pain syndrome, when we have tissue tightness around a nerves track, we may lose the ability to glide a nerve without creating excessive tension and eventually nerve injury. The difference here is that the injury can be present anywhere on the nerve track beyond the deep glute and hip, yet create symptoms elsewhere.
How does an evaluation reveal your nerve pain problem?
To keep it simple, we need to better understand the nerve physiology involved (and present injury to it) along with the mechanical dysfunctions present. This means we need to know if the joints are moving appropriately through the vertebrae the low back, the thoracic spine, the hip, the knee, or the foot and ankle. We need to know if you are accessing speed and power from the ground in your golf swing or torquing through the spine instead. If you have access to hip internal rotation or achieving your backswing from excessive shoulder and spine turn. It is these changes and problems that create the incidence of arthritic change at the spine that compresses the nerve, the disc bulge that pushes on mixed spinal nerves, and the muscle hypertonicity that eventually presses and squeezes a nerve.
Comprehensive approach to low back and nerve pain
A detailed exam helps outline the treatment. If we find severe hip and thoracic spine mobility loss, weakness in the glute and missing motor control over pelvic orientation, and an excessive sway in the golf swing, we are going to address these dysfunctions in our treatment plan. It is the combination of these goals with the specific nerve injury treatment that allows us to make the changes in highly complex and chronic cases that traditional practices, surgeries, and pain killers have failed. This comprehensive approach was designed for complex nerve pain in golfers.
Conclusion
Nerve pain is one of the most frustrating conditions golfers experience because the source of the problem is often very different from where the pain is actually felt. Treating only the painful area, relying on injections, or following a generic exercise program rarely addresses the underlying cause. Lasting improvement comes from identifying exactly where the nerve is being irritated, understanding why it is happening, and correcting the movement and mechanical faults that created the problem in the first place.
At Integrated Rehab and Performance Center, our comprehensive golf evaluation allows us to connect the dots between your symptoms, your body, and your golf swing. Whether the issue is a disc injury, joint restriction, deep gluteal nerve compression, or poor movement patterns that overload the spine, our goal is to restore normal mechanics, improve nerve health, and get you back to playing golf without pain. If low back, hip, or leg pain has been limiting your game, the right diagnosis—not simply more treatment—is often the key to getting back on the course with confidence.
