Bringing golf injury prevention to the fore (P2)
Incidence of injury and characteristics
Golf injuries are usually a result of the collective effect of factors such as incorrect stance, poor posture, a weak or overtight grip, idiosyncratic swing mechanics and untrained or overused muscles. The cumulative effect of these characteristics make it difficult to isolate one overriding factor. The lower back has been reported as being the most common site of injury in a golfer, accounting for approximately 35 per cent of all injuries. Due to the mechanics of the swing the lower back can be subject to large ranges of rotational motion while in flexion. The subsequent muscular forces associated with this action result in musculoskeletal injury such as muscle strains/pulls and muscle tendon attachment injury, often caused by a forceful golf swing or a sudden shift into the downswing. The elbow is also a commonly injured area with approximately 34 per cent of golf injuries being reported in this anatomical region. The two most common problems are medial epicondylitis (golfer’s elbow) and lateral epicondylitis (tennis elbow). Both are thought to occur as a result of poor swing mechanics at impact. Medial epicondylitis is thought to be caused by hitting the ground first while lateral epicondylitis may be caused by over-swinging. This is often evidenced by a high elbow at the top of the swing which then ‘snaps’ or adducts quickly as the club is brought through the downswing into impact.
Professional and low-handicap golfers tend to experience more wrist and hand injuries than amateur golfers (27 per cent vs 20 per cent). This type of injury is linked to technique and specifically the timing of the medial rotation of the wrist at impact. The golfers will purposefully aim to ‘hit’ through the ball, resulting in an increase of impact force (evidenced by the taking of a divot post impact) while the wrist is rotating. Therefore the firmness of the grip, grip size, swing coordination and timing are imperative in reducing the incidence of this type of injury.
Some common aspects are noted in Table 1 above. Although other factors need to be considered such as warm up, play time, handicap and age, the majority of injuries are in effect self-induced because these occur at some point in the golf swing. Unskilled recreational golfers attempting to imitate professionals may induce muscle sprains because their less efficient swing styles (poor coordination and timing) are typically compensated for by greater muscular exertions and poor posture.
Injury treatment, rehabilitation and prevention
As a therapist there are several factors to consider when objectively assessing an injured golfer. These include:
- wrist and elbow rotation and flexibility;
- shoulder mobility (external rotation);
- thoracic spine range of motion;
- gluteal strength;
- core strength;
- hip mobility (internal rotation);
- hip flexor/hamstring/calf flexibility.
The objective assessment of these factors, specific to the injury, can provide a clear indication of the potential cause of the injury linked to the golfer’s individual playing characteristics. For example a golfer complaining of elbow pain may have medial epicondylitis and this could be the result of an incorrect grip or incorrect positioning of the elbow at the top of the back swing. In this case the therapist would treat accordingly and refer the golfer to the local professional at his or her golf club for swing/ grip correction.
The management and prevention of many golf injuries can be obtained through the alteration in technique, reduction in practice regimes and adequate warm up phase.
An appropriate warm up for golfers should include a period of aerobic exercise to increase body temperature, followed by stretching of the ‘golf muscles’ (hands, wrists, forearms, shoulders, lower back, chest,vieetsieu hamstrings and groin). A series of golf swings with a progressive increase in range of motion and vigour should then be performed. Only a small proportion of amateur golfers perform appropriate warm up exercises. The therapist could educate golfers about the benefits of warming up with appropriate warm-up routines.