Golf Injuries: A Review of the Literature (P1)
Golf is one of a few activities that people of all ages and skill level can play. Injury as with all sports can occur. The low back is the most common injury sustained whilst playing golf, and the dynamic action of the golf swing is a major contributing factor to injury. The golf swing is a complex movement that utilises the whole body in a coordinated fashion and when repeated frequently can result in injury. Injury can be overuse or traumatic in nature. Overuse injuries predominate in the professional golfer, and amateur golfer injury tends to occur secondary to an incorrect golf swing. Upper limb injuries are also common due to their role in linking the fast moving golf club with the power-generating torso. Fortunately, injury from a club or ball strike is rare. More common are the overuse injuries associated with the back, neck and shoulder. Most golf injury data have been collected retrospectively and further epidemiological study of a prospective nature is required to determine injury incidence and factor relating to the onset of injury.
Golf is a popular sport played worldwide by people of all ages and skill level. Part of its appeal is age ranges but are high in the older age brackets. This is partly due to the fact that the older/retired population have more leisure time to pursue activities and golf is low impact with a general aerobic component, which makes it a perfect recommendation for medical practitioners wanting their patients to exercise. Golf is a popular option as it also provides social interaction and can be played at all skill levels due to its handicap system. For many people who play ball sports, age results in decreased fitness, speed and endurance and they are unable to participate at the levels conducive to competition. For those people who like to remain active and competitive, golf is a popular option.
Although they are uncommon, injuries incurred while playing golf are an increasing problem. Considering the popularity of the game and the market that is golf (equipment, tuition, sponsorship), there have been only a small number of studies on golf injuries. Indeed, most of the injury rates in golfers cited, review research produced 10–25 years ago This observation is also made by the most recent study by Gosheger et al. who reported that most of our understanding of golf injuries relies on two publications produced >10 years ago, McCarroll et al. in 1990, Batt in 1992 and one produced >20 years ago by McCarroll and Gioe. This article examines the available literature on the epidemiology of golf injuries and investigates the differences in injury location and mechanism seen in professional golfers when compared with amateur golfers. The article determines areas of common injuries and where possible presents the likely mechanism of the common injuries that occur in golfers.
The investigators conducted a MEDLINE, SportDiscus and EMBASE search with the key words ‘golf’ and ‘injury’ between the years 1965 to present. The results were collated and those studies that examined injuries associated with playing golf were included. Initially there were 206 relevant papers included in the search criteria. On analysis of reference lists of selected papers, a number of references were from conference proceedings and these papers were included. In total, >250 papers relating to golf injures were collated and examined.
A good understanding of golf injuries requires the practitioner to consider the quality, quantity and type of golf swing employed by the golfer. Skill level is determined by how many shots/strokes they have to complete a game (or round) of golf of 18 holes. Par is the score that a professional would be expected to score on a championship golf course. The par for such a course is generally 72. For example, a person who scored 90 strokes on a par 72 course, would be rated at 18 over par. If this score was averaged over several performances, a handicap of 18 would apply. The lower the handicap, the more skilful the golfer.
The average Australian golf club handicap is 18.1 in males and 27.5 in females. A gradual increase in handicaps as age increases, with the 18–30 year age group being the peak age group for handicap players in Australia with an average handicap of 14.4 for males and 22.5 for females (see table I). In the US, the average handicap is 16.1 for men and 29.2 for. women. The American data also reveal that for men, the middle quartile (25–75%) for golf handicaps range from 10 to 20 with the females range being 22–35.
In Australia, golf participation rates by civilian persons >18 years of age during a 12-month period prior to census interview in 1999–2000 was 1.1 million, a figure that corresponds to a participation rate of 7.5%. This rate equated to golf being the fourth most popular non-organised activity behind walking, swimming, aerobics/fitness and the second most common organised activity behind aerobics/ fitness. In males, golf was the most popular sport accounting for 890 300 participants (12.4% of the population), while there were 193 300 female participants (2.6% of the population). Of golf partici pation, 50.3% was classed as organised (involving some form of club organisation), while the highest participation rate for golf was recorded in the 55–64 year age group (9.3% or 176 000 people), followed by those aged 45–54 years (8.8% or 233 700). In Australia (with a population of approximately 20 million), there were 477 084 registered golfers in 2002. In New Zealand, with a population of approximately 4 million, there are approximately 138 000 registered golfers. In both countries, to be a registered golfer, you must be a member at any one of the Golf Clubs affiliated to the Australian Golf Union or NZ Golf, respectively. The number of registered golfers in Europe is 3 741 680 as at March 2003, while in the US, the number of golfers with a handicap is 4.5 million and the number of golfers >18 years who have played in the last 12 months is 26.2 million.