Golf Injuries: A Review Of The Literature (End)
Stress fractures are the result of overuse and may occur in any area of the body that is subjected to a sudden increase in stress. Previous studies on stress fractures reported on 169 patients with a stress fracture and found that the ribs were the third most common injury site and that golf was the fifth most common sport (out of 19) for them to occur. In golf, there have been case reports of stress fractures of the ribs, the ulnar diaphysis, the tibia, the sternum and the hook of hamate.
A study was conducted on beginner golfers (<1 year of golf). It reported on 11 golfers with a chief complaint of anterior, posterior or lateral chest pain. X-ray and bone scan analysis resulted in the diagnosis of rib stress fractures. All lesions were found on the posterolateral segments of the ribs, six on the right and eight on the left (three golfers had two fracture sites). Of note, those players with right-side fractures had a history of divot taking with their swings. All patients reported hitting around 400 balls per week. The forces acting on the ribs by the serratus anterior due to the retraction and protraction of the scapular during the golf swing was the proposed mechanism for stress fracture of the ribs.
A case of ulnar diaphysis stress fracture was reported in a middle-aged golfer (handicap 30) who reported left wrist pain of no sudden onset. She reported playing golf everyday, and had been receiving professional tuition. There was no report of hitting the ground or casting of the club in the downswing. The mechanism of injury was thought to be supination and overuse of the flexor muscles of the hand. The authors proposed that the injury occurred during the follow-through.
Stress fractures of the tibia usually occur in the transverse plane, involve the diaphysis and occur in athletes and the military. Whilst it is uncommon to be found in golfers, a study reported the occurrence of complete distal tibia stress fractures in two professional male golfers. Both stress fractures occurred in the left shin, resulting in spiral fractures of the tibia and in one case the fibula as well. Both golfers reported a history of shin pain for a few months previous to the fracture with one receiving physiotherapy treatment for shin splints. Ultrasound aggravated this pain. Both felt sharp pain while making a drive, with one hearing a loud ‘crack’. X-rays revealed the fracture. Both returned to play 9–10 months after the incident. Repeated torsion of the left tibia during the follow-through in right handed golfers was the proposed injury mechanism.
Despite the fact that golf is a low-intensity sport, it is associated with a significant number of injuries. This review of the literature shows that the three most common injury sites are the low back, the elbow and the wrist. The shoulder followed by the knee are also sites frequently injured by golfers. Although uncommon, injuries sustained to the head and eye may occur, and are often serious or catastrophic in nature. Other injuries to occur include stress fractures, cardiovascular insufficiencies and environmental issues such as lightning strikes, sunburn and skin cancer. Poor swing mechanics and overuse are frequently associated with such injury, but injuries are also sustained from hitting the ground or being hit by a golf ball or club.
Whilst there are numerous case reports on golfrelated injuries in nearly every area of the body, there are a limited number of epidemiological studies on golf injuries. Much of our understanding of golf injuries relies on research conducted 10–25 years ago. During this time, advances in golf equipment may have made this research redundant as many variables that may influence injuries have changed. It is the recommendation of this review that further research into the epidemiology of golf injuries be conducted. The authors are presently conducting a large scale, prospective study on golf injuries in Australia that is aimed to fill the gap that is in the golf injury literature.