What happened to Tiger Woods’ back?

• July 19, 2019

It was heartbreaking to watch Tiger Woods grimace in pain during the first round at the British Open. Many of us have ridden the roller coaster of Tiger’s struggle with his back pain for years. There were four surgeries. Opiate addiction. And his amazing triumph at the Masters in Augusta following lumbar fusion surgery two years earlier. Just when you thought his long-standing problems were over, one swing of iron in the rough on a downhill and the whole thing seems to start over again. 

Tiger Woods’ back pain was hard to watch, but it shouldn’t be a surprise. Back pain is the most common cause of doctor visits outside of the common cold. Seventeen percent of all patients having a spinal fusion this year had a previous spinal fusion within the last four years. If you’ve had an episode of back pain this year, there’s a 70% chance you’ll have another within the calendar year. That’s because the spine functions as a unit to spread force and provide range of motion for everyday movements and sports. When you alter the function of one part of the spine, it creates changes that are then foisted on the areas above the fusion, as well as the areas below the fusion. 

In Tiger’s case, the area above the fusion is the L4/5 level. Pain that is to the side of the back, radiates to the buttocks, and really feels like it’s in the hip without numbness or weakness is almost always from a joint. When fusion surgery is performed through the belly to reach the spine, like Tiger’s, the facet joints in the back of the spine don’t always heal completely. That means Tiger’s L5/S1 facet joint could be the source of his pain as well. 

Below the level of Tiger’s fusion of the L5 vertebral body to the S1 is the sacroiliac joint. This is a very unusual joint, which really help women to open the pelvis for the baby’s head to pass in childbirth. Pain from the sacroiliac joint is usually lower than typical low back pain and feels like it’s in the back pocket of your jeans. When you sit down, it feels like you’re sitting on it and have to shift your weight. It even hurts at night and can wake you up from sleep with a severe ache. The usual treatment for that is a steroid injection into the joint. If that relieves the pain, but it comes back, fusion of the joint can be considered. 

There are other possibilities. Tiger could have a new disc herniation above his fusion. Discs are like cushions: The outer fabric can tear and allow the stuffing to come out where it can irritate the adjacent nerve roots. Tears in the fabric of the disc can hurt by themselves, too. He may also just have overdone it and strained the muscles of the back. Finally, the golf swing puts a lot of pressure on the hip. Remember a guy named Jack Nicklaus? Tiger could even have a hip injury that has nothing to do with his back. Hip pain usually spreads into the groin, while back pain goes to your rear end. But sometimes it’s hard to tell what’s causing the pain. It just hurts. 

I don’t know for sure what’s causing Tiger Woods’ back problem. But the immediate treatment is rest, moist heat and anti-inflammatory medications. Most of the time (94%) spinal problems heal on their own without intervention in 12 weeks. That’s a long time to live with severe pain. Acupuncture and chiropractic treatment help some—but studies show the benefits are usually temporary, so they have to be repeated or they wear off completely.  

If none of that works, and the pain is indeed coming from the facet joints at or above the fusion, then the next step is to have a radio frequency ablation procedure. Burning the pain fibers with radiofrequency can relieve the pain for 10 months in 60% of people. A test shot is given before the ablation procedure to see if it will work. If radiofrequency ablation doesn’t work, or the effect wears off, then you can get permanent relief by cutting the pain fibers under direct vision. That’s called a direct visualized rhizotomy, or DVR for short. 

I was really sorry to see Tiger suffering again with back pain. I’ve been there before. As a spine surgeon of more than 20 years, I’ve treated over 20,000 people with pain like Tiger’s. Today we have amazing, minimally invasive surgeries like DVR that can help. One thing I’ve noticed over the years is that famous people often get really bad health care. Doctors call it “VIP syndrome.” It’s great to be a celebrity in a restaurant, but not a hospital.

Tiger is one of my heroes, and I wish him the best. Almost no one could have made it back to do the things Tiger did at Augusta. But then again, there’s almost no one like Tiger Woods.