Prolotherapy For Golfing Injuries And Pain (P2)

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Common Injuries in the Amateur and Professional

Golfer The most common injury reported by the amateur and professional golfer alike is in the low back/lumbar spine/sacroiliac region pain. This makes sense when looking at the powerful rotation and extension motion in the golf swing. In the professional golfer, the second most commonly injured area is the wrist or hand, followed by the shoulder. For the amateur, the second most commonly injured area is the elbow, followed by the wrist or hand, and then the shoulder. Overuse is a large component of injury both in the professional and the amateur golfer and, more often, the cause of injury than direct trauma. One study reports 82.6% of all reported injuries involve overuse, with more than 90% of low back injuries attributed to overuse. Only 17.4% of injuries reported in that study were attributed to single trauma events. Another report found that professional golfers’ injuries occurred primarily from overuse during practice (68%) with only 7% during competition. Wrist injuries occur most commonly in the lead wrist (left wrist in right handed golfers). This is also true of shoulder injuries where90% of shoulder injury involve the lead shoulder.

The Golf Swing

In order to correctly analyze golf injuries, it is important to understand the components of the golf swing itself. Golfers may give a history of symptoms that occur only during one specific phase of the swing and an understanding of the swing components will help in diagnosis. Problems with swing mechanics have been blamed for many of the injuries seen in golf, especially low back pain and shoulder injuries. The swing requires a coordinated and synchronized effort of muscle strength, timing and coordination on the part of the golfer to generate clubhead speeds often over 100 mph. It is no wonder then that many injuries are reported to occur during the golf swing, most commonly at ball impact, as well as follow-through and the backswing.

The Golf Swing
FIGURE 2. The golf swing causing injury to the low back in follow-through.

Contributing Factors

Since overuse is a large factor in golf injuries, there is a correlation between playing and practice time and injury, with significantly more injuries in golfers who play four or more rounds a week and hit at least 200 balls in one week. Since professionals spend more time doing both these activities, it is not a surprise that professional golfers suffer more injuries than amateurs despite having a better swing technique. It has also been found that golfers who carry their bag on a regular basis suffer significantly more injuries to the low back, shoulder, and ankle. There is also a correlation between stretching and warming up and injury. Amateur golfers who warmed up for at least 10 minutes were found to have less injuries than those amateurs that did not warm up prior to practice or play. However, even though professional golfers routinely stretch, they also spend so much more time playing that the positive impact of stretching did not appear to be as much of a factor as with amateurs.

FIGURE 3. The golf swing with correct mechanics in follow-through.

Low Back Pain

As noted above, low back injuries account for the highest percentage of reported golfing injuries. The most obvious contributing factor for low back injury is poor swing technique and mechanics. This is more often a problem in the amateur golfer. This is because these golfers tend to have erratic muscle control and do not duplicate the swing with each shot, versus professionals who tend to consistently activate the same muscles each time they swing. Hyperextending the back during follow-through is a common problem in amateurs and can result in a low back/ sacroiliac ligament injury (see Figure 2). Superior swing mechanics in the professional golfer result in increased power generation from hips and legs with less stress on the low back (see Figure 3). Prolotherapy is very effective in treating low back pain, sacroiliac injury, sciatica, and even disc disease because weakening of the spinal ligaments precedes disc herniations. For a disc to herniate, there must first be a primary ligament weakness and adeteriorating disc. While disc problems have gotten much of the credit for low back pain, ligament injury is a more important source of back pain. In fact, it has been reported that only 4 percent of low back pain is due to a herniated disc. Prolotherapy strengthens the ligamentous tissue around the disc, thus stabilizing and supporting that region. Prolotherapy is also very effective for sacroiliac ligament strain and sciatica (leg pain coming from the back). In fact, it has been stated that ligament laxity in the sacroiliac joint is the number one reason for sciatica and is one of the most common reasons for chronic low back pain.

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