Deficits in the Star Excursion Balance Test and Golf Performance in Elite Golfers with Chronic Low Back Pain

摘要

The purpose of this study was to investigate whether low-handicap elite golfers with chronic low back pain (CLBP) exhibit deficits in dynamic postural control and whether CLBP affects golfers in terms of their golf swing parameters. A total of fifteen Division 1 college golfers were recruited as participants. Of these, six of whom experienced CLBP, while the remaining participants were healthy. In this study, CLBP was defined as experiencing chronic pain symptoms for more than six months. The Star Excursion Balance Test (SEBT) was administered to examine dynamic posture control in both groups. The TrackMan Golf Launch Monitor Simulator was used to collect data on the performance parameters of the swing of the participants. The results for both feet in the medial, lateral, posterior, posteromedial, and posterolateral directions indicated that the CLBP group scored lower than the control group. However, the CLBP group scored higher for the right foot in the anterolateral direction. The parameters for the club speed and ball carry of the CLBP group were lower than those of the control group. Further, the CLBP group exhibited a more upright swing plane relative to the control group. Taken together, our findings suggest that SEBT may be feasible and highly accessible to assess golf swing performance of elite players with CLBP.Key points Elite golfers with CLBP exhibit poor performance for both feet in the M, L, P, PM, and PL directions but good performance for the back foot in the AL direction and are thus able to compensate for the influence of CLBP.Regarding swing performance, the CLBP group exhibited unsatisfactory club speed and ball carry. In addition, this group tended to produce a more upright swing plane.Our findings suggest that SEBT may be feasible and highly accessible to assess golf swing performance of elite players with CLBP. Key words: Dynamic postural control, low-handicap golfer, overuse, swing planeIntroductionLow back pain is a common problem in the musculoskeletal system of athletes. According to previous studies, the prevalence of low back pain in athletes across various types of sports is anywhere between 33% and 84% (Farahbakhsh et al., 2018). Golfers are more susceptible to low back injury (prevalence: 34%-42%) as compared to other injuries (Fradkin et al., 2003; McCarroll et al., 1990). Previous studies have also shown that overuse is the cause of 82.6% of low back injury cases (Gosheger et al., 2003). In particular, skilled golfers (low handicap golfers) require constant practice to maintain their skill and perform well in tournaments. The incidence rate of lower back injury among professional and nonprofessional golfers (particularly low handicap golfers) is 55% and 35% (Cole and Grimshaw, 2016), respectively, and thus warrants attention. Furthermore, recent research has demonstrated that non-athlete adults have deficits in dynamic postural control caused by chronic low back pain (CLBP) (Ganesh et al., 2015). However, there have been no studies investigating whether CLBP affects dynamic postural control and swing performance in golfers.Chronic low back pain (CLBP) has been defined as low back pain lasting for more than three months after the occurrence of a low back injury (Bogduk, 2004). Deficits in postural control caused by CLBP have been attributed to the dysfunction of the muscle spindle around the spine (Brumagne et al., 2000). In addition, altered proprioception and reduced postural control may increase muscle tension and delay muscle recruitment (Ershad et al., 2009). Ganesh et al. (2015) adopted the Star Excursion Balance Test (SEBT) as a measurement method and demonstrated that, compared with healthy individuals, male and female patients with CLBP have deficits in dynamic postural control. In addition, Hooper et al. (2016) noted that relative to healthy participants, participants who had recovered from low back pain continued to exhibit significantly unsatisfactory dynamic postural control. This suggests that CLBP non-athlete patients have dynamic postural control deficits that may be permanent. However, other studies on back pain in young athletes have presented different results. Appiah-Dwomoh et al. (2016) studied back pain in young athletes and discovered that they exhibited no back pain-induced reductions in dynamic postural control. They suggested that this absence may be due to the athletes’ use of an alternative methods by which to manage their pain. They surmised that athletes focus on sensory clues provided by the body and produce fine movements based on the effects of back pain on postural control. Thus, they concluded that back pain does not affect the postural control of athletes. However, these authors failed to differentiate between acute or overuse in patients with chronic LBP. Young athletes may have non-chronic back pain or have a shorter CLBP history and less severe overuse CLBP compared to older athletes with a longer training history who have CLBP. In ad