Bringing golf injury prevention to the fore (P1)
Approximately seven per cent of the UK population participate in golf. Although not traditionally considered a physiologically demanding activity, as a closed skill the margin for error, at all levels of play, is very small therefore regular practise, on and off the golf course, is imperative. The nature of the golf swing requires significant timing and coordination of the musculoskeletal system and as such brings its own unique injuries and associated characteristics. The purpose of this article is to highlight the characteristics of injury in golf, identifying potential treatment and rehabilitation modalities and providing an insight into the intricacies of the game for the therapist.
Characteristics of the golf shot and golf’s physical demands
During a round of golf the golfer will normally hit 18 tee shots, approximately 14 approach shots to the green and two putts on each green. For the average club golfer, the total shots played could range from 80 to 100 per round. Of these, 60 to 80 shots require complex coordination of joint rotations and muscular actions. Carrying a golf bag weighing between 10 to 30kgs, walking intermittently for approximately four to five hours and covering between 8 to 12kms across variable topographical terrain will provide an environment that can physiologically strain the body.
The act of carrying a golf bag weighing 20kgs or more can cause lower back pain because of the potential imbalance in the distribution of weight across the shoulders. Most golfers who carry their bag have a dual strap system where the weight is distributed across the shoulders. However, if the bag is loaded on to and off the shoulders between 80 to 100 times per round, the physical act of doing this will put strain on the shoulders and lower back. In addition to this, the height at which the bag is carried, which is dictated by the length of the straps, can put the weight of the bag below an individual’s centre of mass/gravity. This induces poor posture through excessive forward lean and will influence the onset of low back pain. Therefore the combined cumulative effect of walking distance, terrain, intermittent load carriage, height of the load carriage, the act of loading and unloading and the idiosyncratic joint and muscle action could be classified as high physical demand and contribute to the onset of specific injuries.
The complete golf swing is often characterised by the grip, stance and swing. Each of the characteristics not only have variations, depending on the type of shot and golf club used, but can also have idiosyncratic variations that can affect the onset of injury. The grip on the golf club is often the key element to a successful shot. The grip should be firm and secure with interlocking fingers across the hands. It is the firmness and stability of the hands, wrists and elbows at impact that make the golf shot successful. The stance is often characterised by the feet a shoulder width apart, with back, knees and hips slightly flexed. The degree of hip flexion is dependent on the length of the golf club and there are often variations to this posture depending on the flexibility of the structures around the joints. Reduced flexibility will result in a more upright posture. The swing is often very individual to the golfer and this can be evidenced even at the professional level. However, at upswing the body should be stable with the majority of the movement coming from the arms, shoulders and trunk. During the downswing the hips will translate horizontally with the rear hip internally rotating simultaneously. A similar combination of movement is often evidenced at the knees while the feet remain stable until impact where the rear foot elevates onto the toe. This combination of movement is present through impact as the golfer controls the momentum of the energy transfer.
The stability of the feet, the rotation of the shoulders and trunk, hip translation, asymmetrical hip and knee rotation and the flexion of the back, hip and knees all influence the effectiveness of the golf shot. However, the potential for injury through incorrect posture, timing of muscle activation, inflexibility and lack of coordination through muscle weakness is often clearly evident.