The recurring nature of Tiger Woods' back injury must be a source of despair for the man who holds the record for most weeks ranked number 1 in the Official World Golf Rankings. After he withdrew from the Bridgestone Invitational in visible pain and missed the cut at the PGA Championship, it was clear that Woods is not the athlete he once was.
The reality is that Woods' body will never be the same, because he's had multiple surgeries—and especially because he had back surgery. Taking that shot on the edge of the bunker at Bridgestone and landing awkwardly showed discerning fans that his body is no longer primed for the rigors of professional golf.
Let's take a closer look at Tiger Woods' back injury and what it tells us about recovery.
The Tiger Woods Injury Log
The number of injuries Woods has suffered since the beginning of his career is significant. He had his first surgery—on his knee—while at Stanford University 20 years ago. Many of his injuries are uncommon among professional golfers. He has had a torn Achilles tendon, an ACL rupture and repair, and a herniated disc in his lumbar spine that required surgery. These injuries usually occur in athletes who sprint, jump, cut and tackle.
Woods has historically tried to play through his injuries rather than get them corrected quickly or take time off. This adds to the lore of his mental toughness, but it has proven to be a drain on his body in the long run.
The Back Injury
Woods' most recent injury was a lumbar disc herniation, which he played through for some time during the 2013 season. Most, if not all, disc herniations in the lumbar spine (the soft tissue between the lowest five vertebrae) are caused by repetitive stress and strain. The disc has a jelly-like substance in the middle and attaches to the bones above and below. Surrounding the "jelly" (nucleus pulposus) is a stronger fibrous tissue, much like a ligament, called the annulus fibrosus. This tissue attaches to the bones above and below and the nucleus. Half its fibers run diagonally left to right and the other half right to left. When you twist your body, half the fibers slacken and the other half tighten. When you bend forward, you add further pressure to the fibers. When you add resistance or torque, like with a golf swing, the stress is even higher, leading to injury.
Woods' injury resulted in a tear of the annulus followed by herniation (movement of the nucleus out of position onto the nerve roots nearby.) A disc herniation such as this causes back pain, spasm and then leg pain.
In April, Woods underwent a microdiscectomy, which is similar to a knee scope. To limit damage to muscle and ligament tissue, a small incision is made near the spine. The damaged disc tissue is removed with the aim of alleviating pain and reducing recovery time after the procedure. The surgeon tries to preserve disc tissue rather than remove it all. The difference in the spine is that removing a portion of the protective annulus leaves the nucleus exposed to increased stress and greater risk of further injury.
The Back Spasm
Woods had his surgery and returned to competitive golf 12 weeks later—a very quick return to high level competition in a sport that requires aggressive twisting and torque. Four to six months would be a more cautious timetable for return. It is obvious Woods was not ready. What he experienced at the Bridgestone was a protective spasm. When he took the swing, there was no apparent pain, but Woods' shot landed awkwardly in the bunker.
When part of the disc is gone, the body responds quickly to slight trauma. This is called the pain spasm cycle. Whether the disc was at risk doesn't matter. The body's defense mechanism kicked in and literally locked up the muscles to prevent movement in the area.
Back spasms can hurt for days or even years. Prior to the PGA Championship, less than a week before his withdrawal, Woods said, "I'm in no pain." But his lumbar musculature was clearly not strong enough to stand up to the challenges of golf.
The pain spasm cycle didn't appear to affect Woods during the PGA tournament, but it can often return during the recovery process. According to this article from The Golf Channel website, Tiger's worst season as a professional is over. He may play in a charity event, or in the Ryder Cup, or he may return in October, but he will not play regularly for the remainder of this year. His best finish was 25th place, and his total earnings will be less than in any other season during his pro career.
Woods must now take time to listen to his body, get off the course and fully restore his strength and mobility. Rest is not what he needs most. He needs strength. The muscles around the spine prevent shear, rotational stress and excess compression during athletic movements. Woods must focus on strengthening his erector spinae muscles, his abdominals and obliques as secondary stabilizers, and his posterior chain for function.