Golf Injuries (P1)
Golf is a popular international sport, with participation extending across all ages and abilities around the globe. Arising from its origins on the eastern links of Scotland as early as the fifteenth century, the game of golf has experienced a surge in popularity in the United States in recent history.
This can be attributed at least in part to expanding television coverage, the increasingly diverse array of golf courses designed by famous developers, the introduction of the game to younger players through golf instructional programs and camps, and the emergence of professional icons across several generations such as Bobby Jones, Arnold Palmer, Jack Nicklaus, and Tiger Woods. The National Golf Foundation estimates there were 28.6 million golfers in the United States in 2008, and more than 60 million golfers playing on over 32,000 golf courses around the world.
While sometimes considered a low-risk sport, the demands of the golf swing as well as the volume of practice and play required to improve one’s ability can contribute to a significant number of injuries in both amateur and professional players. A recent large epidemiological study found that throughout a 2-year period, 60% of professionals and 40% of amateurs experienced an injury that removed them from play. While some acute, traumatic injuries do occur, the majority of golf injuries are related to overuse.
Overuse injuries have been reported to account for up to 82% of all golf injuries. In one survey, too much play or practice was the most commonly reported mechanism of injury in both professionals and amateurs. Amateurs also commonly report poor swing mechanics and unintentionally hitting the ground as contributing to a large portion of their injuries. One study has established a correlation between increased time spent on the golf course or driving range and higher rates of injury. This study reported that golfers who hit more than 200 practice balls per week or played four or more rounds in a week sustained significantly more injuries to the back, shoulder, wrist, and hand.
Anatomic Distribution of Injury Golf injuries can be characterized by the region of the body affected, such as the upper extremity, lower extremity, spine, and head. Studies have reported that 54% of all golf injuries occur in the upper extremity, including the shoulder, wrist, elbow, and hand. The spine is typically reported as the next most frequently affected region of the body, followed by the lower extremity, and head. There is a reported difference in anatomic distribution of injuries between professionals and amateurs. The most common injuries in professional golfers include back injuries, followed by wrist, and then shoulder injuries. The top three locations of injury in amateurs have been reported to be the elbow, back, and shoulder, respectively. Furthermore, the distribution of injuries at the elbow, wrist, and hand tend to differ between professionals and amateurs. Professionals tend to be less prone to injury of the elbow, but appear to be more vulnerable to wrist and hand injuries. In this article, we will discuss the most commonly affected regions of the body with a more detailed look at the potential for both acute and chronic injury.
The severity of golfing injuries is often underestimated. Golf injuries have been reported to contribute to an average of 28 days of lost play per injury.
Professional vs. Amateur
Not surprisingly, the number of injuries per player increases along with skill level, likely due to the increased number of rounds of golf played and range balls hit while practicing to maintain or improve one’s ability. Multiple studies have reported between 1.16 and 2.07 injuries per player in amateurs, compared with professionals experiencing between 2.07 and 3.06 injuries per player. The frequency of injury amongst amateurs has also been stratified by handicap, with a 59% rate of injury in those with handicaps greater than 18, a 62% injury rate in those with handicaps between 10 and 17, and a 68% injury rate in those with handicaps less than 10.
The severity of golfing injuries is often underestimated. Overall, golf injuries have been reported to contribute to an average of 28 days of lost play per injury, with the injuries to the thoracic and lumbar spine, elbow, and wrist accounting for the longest absences from play. Minor injuries, defined as absence from golf for less than one week, are the most common, accounting for more than 51% of all injuries. Despite that, there is still a significant potential for major injury, with almost 30% of injuries leading to more than 1 month of lost time from play. A high percentage of those injuries that cause chronic symptoms, defined as lasting for longer than 1 year, have been reported to occur in the knee (30%) and back (18%).
In addition to the number of rounds played and practice balls hit per week, several other risk factors for injury have been identified in the literature. Failure to warm up for at least 10 minutes before playing has been shown to more than double one’s risk for injury (from 0.41 injuries per player who warmed up to 1.02 injuries per player who failed to do so). Carrying one’s golf bag also increases one’s risk of injury, contributing to a reported increase in injuries to the lower back, shoulder, and ankle. Finally, poor conditioning and faulty swing mechanics have also been shown to be independent risk factors for injury in amateur golfers.
Both male and female golfers, at both the professional and amateur levels, sustain more frequent injuries in the lead arm, i.e., the left shoulder, elbow, wrist, and hand for a right-handed golfer. Studies of the overall distribution of golf injuries by anatomical site looking for gender differences have shown a similar pattern for male and female golfers, with a single exception. There is an observed trend for a lower frequency of injuries in the spine as compared to the upper extremity in both professional and amateur females when compared to their male counterparts. There are several potential explanations for the relatively higher rates of spine injury in males, but the leading theory is related to swing mechanics. Males generally have higher swing velocities, which is at least in part generated by the increased torque generated from the mechanics of a greater trunk rotation during the swing. This increased spinal rotational movement, while contributing to faster swing velocity, is also thought to result in an increased risk of injury to the spine in male golfers.