Biomechanical parameters of the golf swing associated with lower back pain: A systematic review

Figures & data

Figure 1. PRISMA flow diagram detailing the process of study selection.

Table 1. Summary of study characteristics.

Study	Pain quantification method	Method of biomechanical measurement			Primary Biomechanical Outcomes	Swings Analysed Per Golfer
		3D Kinematics	Kinetic Load	EMG
Cole et al. 2008 (a) (Cole & Grimshaw, 2008b)	SF-MPQ			Yes	Timing of muscle activity onset	3
Cole et al. 2008 (b) (Cole & Grimshaw, 2008a)	SF-MPQ			Yes	Magnitude of muscle activity	3
Cole et al. 2014 (Cole & Grimshaw, 2014)	SF-MPQ	Yes			Torso-pelvic separation, trunk rotational velocity	3
Horton et al. 2001 (Horton et al., 2001)	SF-MPQ			Yes	Muscle onset timing and magnitude of activity	2
Lindsay et al. 2007 (Lindsay & Horton, 2007)	Not specified	Yes	Yes		Lumbar flexion and extension, lateral flexion and rotation	3
Sim et al. 2017 (Sim et al., 2017)	Not specified	Yes	Yes		Thoracic-pelvic angle, lumbar torsional load, length of transition phase	5
Tsai et al. 2010 (Tsai et al., 2010)	ODQ	Yes			Trunk rotation, extension and pelvic separation, lumbar rotational velocity and torsion	5
Quinn et al. 2022 (a) (Quinn, Olivier, McKinon, & Dafkin, 2022)	Not recorded			Yes	Magnitude of muscle activity	10
Quinn et al. 2022 (b) (Quinn, Olivier, & McKinon, 2022)	Not recorded	Yes			X-factor and upper thoracic, lumbar, hip, knee and ankle joint angles	10

EMG = electromyography, ODQ = Oswestry disability questionnaire, SF-MPQ = short-form McGill pain questionnaire.

Table 2. Demographic characteristics (mean ± sd) of participants included in each study.

Study	Cohort size			Golfing ability (mean handicap index)			Age (years)		Mass (kg)		Height (m)
	Control/NLBP	LBP	Gender	Control/NLBP	LBP	Dexterity	Control/NLBP	LBP	Control/NLBP	LBP	Control/NLBP	LBP
Cole et al. 2008 (a)* (Cole & Grimshaw, 2008b)	15	12	Male	10.4 $\pm$ 4.1	10.5 $\pm$ 8.4	Right-handed	39.6 $\pm$ 13.9	46.0 $\pm$ 17.9	82.7 $\pm$ 5.8	84.0 $\pm$ 5.3	1.77 $\pm$ 0.06	1.85 $\pm$ 0.09
Cole et al. 2008 (b) (Cole & Grimshaw, 2008a)	18	12	Male	13.5 $\pm$ 5.11	10.5 $\pm$ 5.43	Right-handed	43.8 $\pm$ 12.6	46.0 $\pm$ 13.3	76.6 $\pm$ 12.5	84.0 $\pm$ 5.48	1.73 $\pm$ 0.11	1.85 $\pm$ 0.09
Cole et al. 2014* (Cole & Grimshaw, 2014)	15	12	Male	10.4 $\pm$ 4.1	10.5 $\pm$ 8.4	Right-handed	39.6 $\pm$ 13.9	46.0 $\pm$ 17.9	82.7 $\pm$ 5.8	84.0 $\pm$ 5.3	1.77 $\pm$ 0.06	1.85 $\pm$ 0.09
Horton et al. 2001 (Horton et al., 2001)	8	16	Male	Pros	10 pros, 6 < 5 HC	Not specified	29.4 $\pm$ 2.0	36.1 $\pm$ 2.7	81.7 $\pm$ 2.4	81.8 $\pm$ 2.2	1.80 $\pm$ 0.01	1.80 $\pm$ 0.6
Lindsay et al. 2007 (Lindsay & Horton, 2007)	6	5	Male	Pros	Pros	Not specified	32.7 $\pm$ 4.8	29.2 $\pm$ 6.4	85.8 $\pm$ 10.9	78.2 $\pm$ 12.2	1.75 $\pm$ 0.03	1.79 $\pm$ 0.04
Sim et al. 2017 (Sim et al., 2017)	30	30	Male	Half pros, half 11.1 $\pm$ 8.4	Half pros, half 12.8 $\pm$ 7.7	Right-handed	32.3 $\pm$ 8.2	32.4 $\pm$ 7.8	80.1 $\pm$ 10.8	81.9 $\pm$ 8.8	1.77$\pm$ 0.05	1.80 $\pm$ 0.07
Tsai et al. 2010 (Tsai et al., 2010)	16	6	Male	9.5 $\pm$ 4.8	9.1 $\pm$ 4.6	Right-handed	47.9 $\pm$ 8.3	48.6 $\pm$ 7.4	87.5 $\pm$ 9.6	88.3 $\pm$ 18.2	1.81 $\pm$ 0.08	1.78 $\pm$ 0.05
Quinn et al 2022 (a) (Quinn, Olivier, McKinon, & Dafkin, 2022)	17	16	Male	1.0 $\pm$ 3.0	1.0 $\pm$ 3.0	2 left-handed, 15 right-handed	19.0 $\pm$ 3.0	21.0 $\pm$ 3.75	83.49 $\pm$ 13.27	73.46 $\pm$ 11.35	1.81 $\pm$ 0.08	1.78 $\pm$ 0.05
Quinn et al 2022 (b) (Quinn, Olivier, & McKinon, 2022)	NA	NA	NA	NA	NA	2 left-handed, 15 right-handed	NA	NA	NA	NA	NA	NA

EMG = Electromyography, HC = Handicap, LBP = Lower back pain, NA = Not available.

*denotes that the same cohort was used by multiple studies.

Figure 2. Colour-coded summary of potential risk of bias on a study by study basis.

Figure 3. An evidence gap map summarising findings from the studies to use kinematic techniques. Some outcomes were condensed down to the specific plane of movement to allow for optimal visualisation in the manuscript. For a complete breakdown, please see Supplementary Material 3.

Figure 4. An evidence gap map summarisingthe findings of studies to utilise EMG techniques.

Figure 5. An evidence gap map summarising findings of studies to measure outcomes relating to lumbar torsion.

Table 3. Certainty of evidence supporting outcomes reported as statistically significant.

Outcome	Level of Evidence	Direction of Association
Upper Thoracic Lateral Flexion	Very Limited	Greater
Lumbar Flexion Velocity	Very Limited	Reduced
Lumbar Lateral Flexion Velocity	Very Limited	Greater
Trail Hip Abduction	Very Limited	Greater
Trail Hp Adduction	Very Limited	Greater
Lead Knee Abduction	Very Limited	Greater
Lead Knee Adduction	Very Limited	Reduced
Lead Knee Flexion	Very Limited	Reduced
Trail Knee Flexion	Very Limited	Greater
Lead Ankle Adduction	Very Limited	Greater
Lead Ankle Eversion	Very Limited	Reduced
Lead Ankle Dorsiflexion	Very Limited	Reduced
Trail Ankle Adduction	Very Limited	Greater
Transition Phase Length (Thoracic and Pelvic Angle)	Very Limited	Reduced
Transition Phase Length (X-Factor Stretch)	Very Limited	Reduced
Lumbar Torsional Load	Very Limited	Reduced
Lead Erector Spinae Onset Timing	Very Limited	Earlier
Trail Rectus Abdominis Activity	Very Limited	Greater
Trail Latissimus Dorsi Activity	Very Limited	Greater
Lumbar Lateral Flexion	Conflicting	Greater
Lead Erector Spinae Activity	Conflicting	Reduced/Greater
Trail Erector Spinae Activity	Conflicting	Reduced/Greater
Lead External Oblique Onset Timing	Conflicting	Earlier
Trail External Oblique Activity	Conflicting	Greater

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