Relationship Between Foot Posture,Balance And Reports Of Low Back Pain In Golfers

Background:Low back pain(LBP)has been the most common problems reported by both professional and amateur golfers of all ages.Foot posture has been suggested as a protective/risk factor for LBP in some sports population but has not been investigated in golfers.Objectives:To investigate the relationship between foot posture,static balance ability and reports of low back pain in golfers.Further,to determine the relationship between different foot posture and swing performance.Methods:49 golfers(43 males,6 females;age 44.00±12.83 years;handicap 15.63±7.20 strokes;BMI 25.79±3.77kg/m2)with and without LBP participated in the study.28 recruited golfers(57.1%)complained of LBP since they started playing golf and 26 of them were reported LBP was related to play golf by themselves.Prior to data collection,information related to low back pain and golf playing and practice habits was collected.Foot posture was assessed using the Foot Posture Index-6(FPI-6).Right and left single-leg balance(SLB)was timed with eyes opened and closed.Following a 10-minute standardized warm up,a randomized subset,27 of participants(25 males,2 females;age 42.30±14.18 years;handicap 14.56±6.84 strokes;BMI 26.63±3.66kg/m2),performed 5 swings using driver and 6-iron respectively.Club head speed(CHS)was obtained using the X-golf virtual reality simulator through its web-based exclusive analysis program.Chi-Square test was used to test the correlation between foot posture(Normal,FPI= 0-5;Abnormal,FPI<0 and FPI>5)of each foot and LBP.Further,Pearson's component correlation was used to test the correlation between two feet posture index.Paired T-test was calculated the foot posture difference between two feet of all golfers.Forward stepwise Binary logistic regression was to determine the relationship between LBP(YES/NO)and FPI-6 scores of each foot,BMI,age,handicap,practice frequency and duration of playing.Then,a receiver operator characteristic(ROC)curve was constructed to examine the relationship between the number of LBP and foot posture.To develop decision thresholds for the FPI-6 as a significant LBP predictor,sensitivity and specificity values and a summary measure,Youden's index were calculated for the range of FPI-6 scores.Independent T-test was analyzed to measure the difference of SLB for groups with and without LBP.2-tailed Pearson's Correlation Coefficients were calculated the relationship between FPI-6 score of each foot,handicap and CHS of the subset group.Results:1.There was a significant difference about the distribution between left foot posture(abnormal/normal)and LBP(Yes/No)(P= 0.001),while right foot posture seems not(P= 0.150).2.Two feet posture index of golfers had significant correlations(r= 0.737,p<0.001).T-test showed no significant difference(P= 0.060)in their left FPI and right FPI.3.Binary logistic regression analysis showed that left FPI-6 score was the only significant variable(Omnibus Test,X2=13.883,P= 0.03)as a risk factor of LBP.4.FPI-6 scores of more than 5(25 score point scale)were found to be associated with a significant increase in the risk of LBP.5.Participants with LBP had no difference of SLB with eyes closed(p= 0.207)and eye open(p= 0.246)compared with those without LBP.6.There was no difference in CHS of different FPI-6 scores and handicap.Conclusions:1.Left foot posture is associated with LBP in golfers.2.Static leg balance with eye open and eye closed seems not to be affected by LBP in golfers.3.There is no difference in golfers' swing performance between normal and abnormal foot posture.4.In addition,there is no difference between left and right foot posture.No relationship has been found between BMI,age,handicap,practice frequency and duration of playing and LBP.