Back pain is a movement problem; just ask Jason Day, who scored 68 in his first round at the Barclays Tournament in Plainfield, NJ. Do you golf? Many of our patients do and experience back pain after they finish their rounds. Professional golfers do as well, and many of them unlike the rest of us have personal trainers and other people to help them avoid back pain when they compete. Some have managed their problem better than others over the years, while other well known players such as Tiger Woods, have been badly afflicted while playing high profile tournaments. The most recent literature suggests that the form of movement leads to better or more poor levels of function and is why we experience back pain. While the science behind why you hurt is improving, many healthcare practitioners continue to work in the older model of back pain being condition and protocol driven which has a poor record for long term success in preventing future episodes. Repeating poor movement patterns over and over has been shown to result in acute lower back pain, tweaks, and other types of painful back experiences as well. Gray Cook, in his book Movement, describes his ideas on movement and teaches many types of therapists his movement screens and exercises, which attempt to identify or attack the poor movement patterns that make us hurt. While there is no one method that can diagnose and solve the problems, his methods have been widely adopted by many types of therapists. In our office, I have developed our own protocols of treat - test - treat which helps us scientifically figure out the painful patterns quickly and accurately. Around the time Gray Cook developed his ideas, our methods of active evaluation of movement and function were developing as well, as there were no established guidelines for performing this type of exam in the 1990's. Currently, active evaluation and treat - test - treat is the most cost effective way of evaluating and resolving back problems today conservatively. Cooks methods, as well as ours are very effective, but the most important thing your doctor needs is a good thought process and methods that can work effectively when the mechanism behind the pain is recognized and then effectively treated. Efficiency is also very important because of time of visit constraints and patient expectations place constant pressure to get fast relief and a cost effective resolution of a back pain problem and episode. With the advent of higher deductibles, and restrictive fee schedules, methods such as our active evaluation procedures screen and diagnose movement problems very quickly, when compared to movement screens alone which may take at least 10 minutes to perform and execute depending on the complexity of the problem. In the case of Jason Day, according to the book, Cheating Mother Nature, what you need to know to beat chronic pain, problems in golfers generally are caused by asymmetry in the way we stand and a torqued core. The core is torqued when the body loads the pelvis differently on both sides, which affects the abdominal muscles and other surrounding muscles in the back and legs, distorting the core. In the golf swing, a torqued core will reduce rotation in the hips leading to back pain, herniated discs and other problems that golfers suffer from because of the way the inertia of the swing rotates the body. In the case of golf, the joints in the pelvis and lower back will strain if the hips are torqued, resulting in the pain and strain with each stroke. Some of this torque and rotation in the hips are relieved by foot orthotics that can level the pelvis, reduce torque and ease rotation of the pelvis during the follow through stage of the swing. The golf swing is unique with each different pole since the different irons have different lengths. Muscling through the swing often results in pain and a poor follow through, and is usually a sign that your hips may be torqued, affecting your swing mechanics. A good swing is more about inertia than power and looks like a beautiful arc. That beautiful arc or form is one of the stand out features of Jason Day's golf swing, that helped him get a 68 the other day in the Barclays tournament. For regular folks who play on the weekends, watching someone like Day can be quite helpful when evaluating their swing as well. Since it is local, some of you probably went to the tournament (within walking distance of my home office). Athletes who know how to deal with the poor movement patterns are likely to suffer fewer bouts of lower back pain because of the way they take care of their backs, and train their muscles. Many also wear custom foot orthotics in their golf shoes which helps to level their pelvis, improving the dynamics of how their hips move when they swing. Many golfers rely on chiropractors who can help them get through professional tournaments such as these without having an injury that prevents them from reaching their potential on the tour. For those regular folks, they can benefit too. It is never about the lower back, but about the movement that caused them to hurt in the first place. Treating the back when the movement that caused the problem is not understood or addressed properly can be frustrating and lead to ineffective treatment. Active evaluation is the best way to effectively evaluate and treat back pain sufferers and reduce the likelihood of a reoccurrence of the problem while playing golf. You really do not require a personal trainer to play golf, just an understanding of your body mechanics, the right chiropractor and some inserts in your shoes. Just ask Jason.