Golf-Related Injuries In Australian Amateur Golfers (End)

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Those golfers who sustained a recurrent injury from participation and injury incurred in another sport / activity may have done so due to incomplete healing of a previous injury. Such mechanical inefficiency due to the previous injury may have resulted in compensatory muscle activity and secondary muscle activation, altering the efficiency of the golf swing.

This is a well-known injury factor, resulting in increased injury potential. A prospective cohort study could be used to further ascertain the relationship between swing mechanics and injury, using a representative sample of injury-free golfers.

Surprisingly, wearing golf gloves was associated with an increased risk of injury. Golf gloves are designed and used to improve the grip on the club, reducing the risk of slippage through greater friction between the club and the glove. However, variable grip pressure has been noted during the golf swing, with change in the forearm flexor force during the swing. Change in grip pressure and positioning of the forearm during the golf swing may lead to excessive cocontraction of the forearm extensors, potentially reducing the available range of motion to be exercised during the dynamic movement, thereby predisposing to increased eccentric muscle loading and injury. Variability in grip pressure may be related to injury rate and should be investigated further.

inimise or reduce injury rates. However it is felt that whilst warm up prior to activity may be able to prevent muscular injuries, improper or excessive stretching and warming up can predispose to injury. Surprisingly, in this study range of motion exercises were associated with an increased risk of injury. Often this type of activity includes bouncing the body through the movement when the tissues are cold, akin to ballistic stretching. It is now believed that ballistic stretching (i.e. bouncing) is associated with increased injury rates. This predisposes the golfer who performs range of motion exercises to injury. Those performing air swings and hitting the ball as part of a warm-up process did not increase the risk of injury compared with the no warm-up group. In this cohort, golfers appeared to be more responsive to these types of warm-up activities. Further prospective investigation is required into the type of warm-up used (range of motion, air swings, hitting the ball, stretching), as well as how long and how often the warm-up exercises were performed prior to play in relation to injury generation.

Strength work, which was reported by respondents to be golf-specific, significantly increased the risk of injury, raising the question whether such activity benefits the golfer at all. As this survey was self-reporting of activity at a very cursory level, it is difficult to speculate why golf-related strengthening appeared to be associated with increased injury risk. It may not be causative at all and may constitute an aberrant statistical finding of association only. However, possible factors include overuse-related injuries and performing activities that are not conducive to improving the golf swing in terms of strength, speed or quality of movement; this may predispose players to injury due to the generation of incorrect muscle-firing patterns when compared with the ideal.

 

Golf-Related Injuries In Australian Amateur Golfers (End)

Univariate analysis found that the amount of chip-putt full shot practice and game play were significant in injury generation, with those who performed more activity in each group more likely to be associated with injury. However, after taking into account the potential for confounding, where the effect of one factor on an outcome is distorted by a second factor, it was found that play / practice habits were no longer significant.

A limitation of the study was the self-reporting nature of the survey and reliance on the responder to answer questions correctly. This is particularly the case when asking about injury mechanism and when the injury occurred. Whilst an aberrant swing as an injury mechanism was not identified by someone else (for example a golf professional), golfers have a basic concept of their golf swing. As such an individual would be able to determine that their golf-related injury was predisposed by their swing. In a similar way the golfer would be able to identify that the pain during his/her golf swing could be broadly categorised into the phases of the golf swing, viz. backswing, downswing and follow-through. The response rate achieved in this survey was 21%. Compared with a 60% and over response rate, which is considered excellent, this is a low value. Many studies improve response rates by mailing multiple reminders / surveys to non-responders, which can increase response rates to over 70%,1,25 but such studies generally involve smaller, discrete sample sizes and/ or very large budgets. It is likely that without large budgets, repeated national mail-out would be too costly. The accepted survey response rate for a single mail-out to a large sample size is 15 – 30%,6,9,12,13,19 a range which the present study falls within.

The primary concern with a low response rate remains how representative the respondents are of the population being examined. However, a low response rate does not automatically imply that a non-representative sample has been selected. Researchers appear more concerned about the likelihood of bias in the collection of the sample rather than the specific sample size in isolation. Analysis of the latest Australian Bureau of Statistics data on sports participation and Australian Golf Union data on average handicaps show that the present study achieved a comparable maleto-female breakdown ratio (82.2% vs 17.8% and 80.5% vs 19.5%) and comparable handicaps (male 18.1 and female 27.5 compared with 18.1 and 26.3). We conclude that our data appear to be reasonably representative of the general population of golfers. The above data will become baseline data for a prospective study that will determine the 1-year golf incidence rate in Australian amateur golfers.

Conclusion

This epidemiological investigation of golf injury found that the lower back, elbow and shoulder are the most commonly injured areas, and that these injuries were most likely caused by some part of the golf swing. Three-quarters of all injured golfers sought treatment for their ailment. Risk of injury during golfing varied according to age group, warm-up status, conditioning habits, whether the player wore a golf glove, and whether the golfer was injured in other sports/activities. Golf is one of the most popular sports played by the older population and the general age and golf participation rate are still rising. This makes it important to do further study on golf injury incidence, mechanism, management and other related issues, which will assist the golfing community to reduce the risk of injuries associated with golf.

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