Course Instructor (P8)

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Muscle Pulls/Strains

These result when more tension than a muscle can bear is applied to it. Typically with pulls, the more intense the pain is, the more severe the injury is. The muscle pull is usually the result of:

  • Insufficient Warm-up – the amateur golfer is often rushed by rangers trying to pace play. The player needs to make time to warm-up prior to the first series of abrupt swings.
  • Muscle Imbalance – if one muscle or group of muscles are dominant, it can overpower and even damage the weaker antagonist.
  • Poor Flexibility or Improper Stretching – a routine of reproducing the sequence in the golf swing, along with the series of static stretches will decrease a quick elongation injury.
  • Mineral Deficiency – a decrease in sodium, potassium, magnesium and other minerals and electrolytes predispose the tissue to injury.
  • Structural Abnormalities – an actual leg length variant, spondylolysis or spondylolisthesis, lordosis, etc. can increase stress, further increasing the likelihood of injury.
  • Poor or No Training – the gradual increase of the workload and the speed of activity can lead to overstretch injury.
  • Poor Endurance – rhythmic endurance exercises thicken muscles, tendons and ligaments, consequently increased endurance would provide more resistance to injury.
  • Trauma – the golf course itself can be a hazard. Wet conditions, holes in the ground, missteps and the carting of the bag can all contribute to muscle pulls.

Knee And Thigh Injury

Biomechanics

Most torsional injuries to the knee involve the menisci and result from impact. Golf provides a repetitive shearing force that can impact both cartilage and ligaments. Most knee and thigh injuries in the golfer are muscular in nature.

Anatomy

Though it is the largest joint in the body, the knee is structurally weak. The weakness is attributable to its unstable bone structure. The femur, the longest and largest bone in the body sits upon the small main weight bearing bone, the tibia. The femur only has a small amount of normal rotation on the tibia, further contributing to instabilityof structure. Though the convexity of the femoral condyles articulates to the concave surface of the tibial plateau, flexion still incrementally decreases the joint integrity. The fibula is primarily non-weight bearing and is laterally articulated only to the tibia and serves as the point of attachment of the lateral collateral ligament and the biceps femoris muscle. The patella is incased in the powerful patellar tendon and will slide in the superior and inferior planes during flexion and extension. The bone instabilityof the knee is compensated by strong ligament and even stronger muscular support. Of course, the knee is stabilized bythe lateral collateral ligaments and the anterior and posterior cruciate ligaments. On the medial side, the medial collateral ligament secures the tibia to the femur and connects to the medial meniscus. Weaker is the lateral collateral ligament. This is not attached to the lateral meniscus. Anterior displacement is limited by the posterior cruciate and vise versa. Extension is managed by the quadriceps (rectus femoris, vastus lateralis, intermedius and medialis). Flexion is managed by the hamstrings (medially by semimembranosus/semitendonosus and laterally by the bicep femoris). The rotary movement of the tibia is controlled by the hamstring. The other supporting muscles include the sartorius, gracilis, popliteus, gastrocnemius, plantaris and tensor fascia latae/iliotibial band.

Common Injuries

The recreational golfer may be subjected to muscular weakness, poor posture, overuse syndromes, poor mechanics or even improperly fitted shoes.

  • Muscle Strain – is the result of any or all of the above.
  • Patellar Tendonitis – originates in the quadriceps muscles and the severity of the conditions will determine the amount of swelling. Almost always, the pain increases with play or overuse. Strength and flexibilityin the hamstrings is usually the main preventor of this condition and is the primary focus of rehabilitation.
  • Sprains – first degree sprains result in minor discomfort, point tenderness with little swelling and no abnormal movements. The second degree sprain has all of the above and loss of function for several minutes or more. Favoring the unaffected leg is common. The third degree sprain reflects a complete tear of one or more ligaments. The joint will demonstrate all of the above while joint instability and accompanying fracture is possible.
  • Chondromalacia Patellae – is a painful degeneration that results in softening of the cartilage on the posterior aspect of the patella. Flexion will elicit pain. Look to muscle imbalance or weakness as the cause.
  • The Female Golfer – the female golfer has the greatest susceptibility to chondromalacia patellae, patellar dislocation or subluxation. Structural differences in the pelvis increase the problems for women. The wider pelvis creates a sharper Q- angle. The Q-angle is an imaginary line originating from the anterior superior iliac spine (ASIS) to the intersection of an extended line of the patellar tendon. A sharper Q-angle changes the line of pull of the quadriceps and may cause the patella to be pulled in a lateral direction upon contraction.
  • Postural Affects of the Thigh – an indicator of tight hamstrings is the development of hypolordosis in the lumbar spine. This also may reflect tight gluteals or weak erector muscles. Differentiation and correction is fairly easy and the Straight Leg Raise test easily identifies tight hamstrings. Tight hip flexors or tight spinal erectors or weak abdominals can produce hyperlordosis. Tight quadriceps can cause knee joint crepitus. This is easily found during knee to buttock prone orthopedic testing.
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