Golf Injuries: A Review Of The Literature (P2)
A number of studies have been conducted that professional golfer is more likely to aggravate an examine the occurrence of injuries in golfers.Both amateur and elite/ professional golfers, as well as male and female player groups, have been the focus of these studies. A summary of epidemiology studies is shown in table I. Researchers have used varying methodological procedures to report these statistics. Research data have been collected from the distribution of surveys by mail, direct interview of players, and data collection at hospitals and sports medicine clinics. Common injuries of the different sub-groups of golfers is shown in table II.
In professional golfers, the most common site of injury for males was the low back, followed by the left wrist and left shoulder (in right handed golfers).
In the female professional, the most common site of injury was the left wrist, followed by the low back and left hand. Overall, the two most common injury sites in professionals was the left wrist closely followed by the low back, although Sugaya et al. found that the lower back followed by the neck were the two most common injury sites. The most common mechanism of injury for professional golf ers (male and female) was the high frequency (repetitive) of practising the golf swing, followed by hitting an object other than the ball while swinging the golf club or a golf swing injury that occurred during competition.
Professionals are susceptible to overuse injuries due to the amount of practise they perform in their pursuit of excellence. Even though professionals are adapted to withstand a higher frequency/intensity of play, excessive play can promote overuse injury. As the professional depends on earning a living from golf, they often continue with practise even though they have an injury. As a result, the professional golfer is more likely to aggravate an injury condition more than the amateur golfer.
In amateur golfers, common injury sites include the low back, wrist, the elbow and the shoulder. Several researchers reported the lower back as the most common injury site in males while Batt reported the wrist as the most common site injured. Theriault et al. and McNicholas et al. did not split the upper limb into regions and hence found it the most common injury site. Elbow injuries, particularly in females, were a common injury site in golfers.
Most of the golf-related injuries seen at hospital emergency departments involved the head, while Nicholas et al. reported that being struck by a golf ball occurred mostly in the lower extremity, with the trunk and then the upper extremity less likely. In the case of elbow injuries, most injuries that occurred were diagnosed as lateral epicondylitis (‘tennis elbow’), particularly in the left elbow (non-dominant) of the right-handed golfer. The most common mechanisms of injury in golfers are overuse (too much play/practise), poor biomechanics of the swing and hitting the ground of an object during the swing. Catastrophic injury may occur as a consequence of being struck by either a golf club or golf ball, although this is rare. Excessive play/practise was reported to be the most common source for injury to occur. Incorrect swing/miss-hit (poor swing mechanics) was reported by Batt to be the most common mechanism of injury in which the wrist or back were the most likely to be injured. Theriault et al. reported technical injury (53.9%) as the most likely reason to sustain an injury (most likely relates to poor mechanics). Being hit by a golf ball was the most likely reason for an adult to be admitted to hospital for a golf-related injury, while for a child it was being struck by a golf club. Adult injuries were most likely to occur on a golf course, whilst a child was most likely to be injured in the home environment.
In reviewing the data produced by these studies, a number of methodological issues need to be considered. The response rate of surveys should be reported or otherwise evaluated, as the response rate indicates how representative the data collected is of the whole golfing population. The higher the responserate, the more representative the data is of the golfing population. Response rates of the retrospec tive studies reviewed ranged from 20.6% to 57% and 78.4% in prospective studies. The type of data the survey is trying to obtain also reflects on the results produced. Retrospective studies are easier to produce as they are examining what has occurred in the past, while prospective studies involve looking at what happens from a set of time forward for a defined period of time, a year for example. This prospective type of study is harder to institute because of increased costs and time spent on the study, as well as having problems associated with dropout rates, but produces stronger conclusions. The golf literature is primarily retrospective in nature. Many of the retrospective studies ask the participant about injuries sustained in their career, which gives rise to the phenomenon of recall bias. Recall bias is the inaccurate reporting of data that results from alteration in recollection of events that occurred in the past. If a golfing career has only been 3–5 years, injuries can be more readily recalled than if the subject has been playing golf for >40 years. Gosheger et al. has also noted this potential limitation of the golf literature.
The data produced by a study need to be large enough to be able to draw conclusions. The more subjects in a study sample, the more representative is that study sample of the population it is trying to represent. Sample sizes ranging from 34 (8 in females) to 1144 participants appear in the golf literature.
The above data demonstrate that there is a paucity of high-quality, large studies examining the epidemiology of golf injuries. Further studies into the epidemiology of golf injuries require redress of methodological issues identified above that affect the accuracy of collected data. The next discussion will present a closer look at the data of specific injury sites.