Golf Injuries (P4)
Golf has increased in popularity in the past fi ve to 10 years. There are an estimated 40 million participants. Golf injuries are on the rise as the average golfer plays approximately 37 rounds per year and spends more time practicing. In a recent study, 40 percent of amateurs suffered either an acute or overuse injury. This is due to the fact that though the golf swing may appear to be a relatively benign activity, it requires a synchronized effort of muscle strength, timing and coordination to generate high club head speeds, often in excess of 100 mph. Professional and elitelevel golfers usually sustain an overuse injury from repeated swings during frequent practice sessions.
Types of Injuries
Low back pain is the most common complaint in all golfers. Lumbar strain is the result of the powerful rotation and extension in the golf swing. A 2004 study suggests that increasing range of motion of lumbar extension and rotation of the lead hip may decrease the incidence of low back pain.
The elbow is the second most commonly injured area in amateur golfers. The two most common problems are golfer’s elbow (medial epicondylitis) and tennis elbow (lateral epicondylitis). Both are the result of poor swing mechanics. Golfer’s elbow is thought to be due to increased stress on the wrist fl exors as they insert into the elbow in the lead arm. Tennis elbow is more due to over-swinging with the right hand leading to persistent wrist hyperextension and stress on wrist extensors. Good pre-round stretching and a consistent strengthening program can decrease the incidence of these problems.
Injuries to the wrist are actually second only to low back problems in the elite and professional golfer. The majority of these are overuse injuries of the wrist extensors and fl exor tendons. Such injuries are treated with rest, splinting, and oral nonsteroidal anti-infl ammatory drugs, such as aspirin and ibuprofen. Therapy exercises focusing on strengthening forearm and hand muscles are benefi cial.
Finally there are the shoulder injuries. To effectively be able to appreciate the shoulder problems that affl ict golfers, one must be able to understand the biomechanics of the normal golf swing and the forces created on the shoulder girdle. The golf swing can be divided into fi ve phases:
- Take away
Though golf is not strictly an overhead sport, it does require elements of shoulder elevation and rotation to perform a mechanically sound swing. It is at these extremes of motion such as the backswing or the end of follow-through that a golfer may experience the symptoms of rotator cuff disease or subacromial impingement. Moreover, patients with rotator cuff disease may be weak with the initial takeaway leading to poor swing mechanics and further injury of the elbow or low back while compensating for the injured shoulder.
Shoulder instability and superior labrum/biceps disease is on the rise in young elite-level golfers. To generate power during the swing these golfers will attempt to maximize their shoulder turn relative to their hip turn. This requires a great deal of shoulder fl exibility. Because of overuse and repetitive microtrauma, capsular and labral structures often become injured in the same manner as baseball pitchers.
The initial management of all injuries in golf starts with an initial period of rest and consideration for a short course of anti-infl ammatory medication. For whatever the injury may be, it is critical to be in a focused rehabilitation program. After the initial symptoms of the injury resolve, and rehabilitation goals have been met, the golfer should focus on the prevention of recurrent or further injury.
Working with a certifi ed golf instructor to change poor swing mechanics can be very helpful. Amateur golfers will often have poor swing mechanics which lead to adaptive maneuvers to compensate. This can place excessive strain on the shoulder, elbow, and back. In addition, consideration should be given to limiting the number of practice balls hit until swing modifi cations and strengthening have been adopted. Often I have my golfers continue with putting and short game work while in a therapy program.
A golf specific exercise program has been shown to benefi t golfers in returning to play and preventing further injuries. Specifi cally, a regimen consisting of a daily fl exibility and core strengthening program, a cardiovascular and aerobic conditioning program, and a consistent pre-round stretching and warm-up will all reduce the likelihood of recurrent injury.
Those golfers who are unsuccessful with a conservative program and continue to have rotator cuff disease/impingement may benefi t from a subacromial injection with further focus on cuff strengthening exercises. The need for possible surgical intervention after prolonged conservative treatment should be a discussion between the patient and his or her orthopedic surgeon.