Beyond Rehabilitation: Triangulating Return-to-Activity and Return-to-Sport Decisions in Golfers with Back Pain

Non‑specific low back pain (NSLBP) is highly prevalent among golfers and complicates return‑to‑activity (RTA) decisions. Existing return‑to‑sport (RTS) approaches often focus narrowly on biomedical criteria and lack golf‑specific, theoretically grounded frameworks. This study presents a preliminary conceptual framework (Phase 1) for RTA and RTS in golfers with NSLBP.

A hermeneutic systematic literature review was combined with qualitative expert interviews to integrate scientific evidence and clinical expertise. Seven studies on RTA/RTS and NSLBP were analyzed iteratively, and three experts in physiotherapy, sports science, and back pain research were interviewed using a theory-driven Phase 1 sampling approach. Data were analyzed via qualitative content analysis and triangulated to develop a context-sensitive conceptual model.

Psychosocial and functional variables such as motivation, self-efficacy, fear avoidance, and functional mobility appeared to be particularly important within the available literature and expert interviews, whereas biomedical indicators alone seemed insufficient to guide RTA/RTS decisions. Experts described RTA as an individualized, goal oriented, biopsychosocial process. The combined evidence yielded a three-stage RTA framework (pain relief, mobility restoration, return to meaningful activity) and a five-phase golf-specific RTS model (clinical stability, functional capacity, golf movement integration, performance readiness, competition readiness).

This Phase‑1 conceptual framework provides an evidence‑informed, context‑sensitive structure for RTA and RTS in golfers with NSLBP. It integrates biopsychosocial factors with golf‑specific performance demands. Future work (Phase 2) will validate this framework with golfer populations and objective performance metrics.