Golf is growing in North America. The 1990's saw a steady increase in the game's popularity and there are now 20 million players in the US. In Canada, there were almost 5 million players aged 12 and up, according to a 2001 survey by the Royal Canadian Golf Association. Almost 700,000 of those players live in British Columbia, lured to the greens by our mild climate and the opportunity to play golf year-round.

Although compared to many sports, golf appears to be a relatively low risk activity for injuries, the biomechanics of the golf swing can cause acute and chronic injuries. Dr. Brad Yee who is President of the B.C. College of Chiropractors, and Chair of Health Care Services for the 2003 Greater Vancouver Classic Golf Tournament, sees amateur and professional golfers in his practice. He asserts that a high proportion of players do become injured, although younger players who take up the sport are often better conditioned than older golfers. However, Erica Mahon, a physiotherapist with City Sports Physiotherapy in Vancouver, says that in her practice, younger golfers span the gamut of fitness levels.

Those who are already in good physical shape from other sports may make the mistake of "jumping into the game" without adequate preparation, while others don't believe that the sport requires much fitness. She stresses that prospective players need to "get fit to play golf, not play golf to get fit,"as the sport definitely highlights weaknesses, predisposing golfers to injury. And with increasing numbers of younger players heading for the greens in the past few years, health care professionals are now seeing a wide range of golfing injuries.

Yee, who is known as "the golfing chiropractor," says the commonest injury by far is low back pain, followed by elbow, hand and wrist and shoulder injuries. Overuse is the overriding cause of back pain, says Lee: "don't go and hit five buckets of balls without a warm-up." he says. Studies show that about a third of amateur golfers, aged from the mid-30's to the 60's experience low back pain. Older players lose flexibility in the rib cage, limiting thoracic rotation, resulting in compensatory hip rotation. If arthritis is present in the back or hip, the player is especially susceptible to injury. According to The Physician and Sportsmedicine: Managing Golf Injuries (07-99), most injuries are caused by overuse, followed by hitting a "fat shot" and poor swing mechanics.

Injury Prevention:

Lee and Mahon recommend the following preventive measures before players hit the greens:

• See a health professional for a conditioning evaluation. This applies particularly to older players with arthritis or other conditions that limit mobility. This preventive checkup is especially important for those who are new to the game. Lee performs neurological and orthopedic examinations, assesses strength and range of motion, and videotapes the patient's golf swing. By sharing the videotape with the patient's golf professional, the player "gets two perspectives, the biomechanical and the golfer's," explains Lee. He also gives patients strength and mobility programs and discusses any needed modifications to their swing technique with the golf professional. Mahon puts flexibility at the top of her list of pre-game preparation, particularly in the spine, hips and lower limb.
• Get properly equipped, with club fitting from a pro shop, a club fitter or at a reputable golf-specialty store. Graphite shafts are suitable for younger players, but Lee recommends steel shafts for senior golfers for their increased stability and reduced vibration. Clubs need to be the right length or they can cause back pain.
• Wear soft spikes on your golf shoes, as they will be easier on your back. The average golf course covers 7000 yards of varying terrain and walking that distance gives many players foot pain, says Lee. Mahon says that while golf shoes have improved in their technical construction over the last 5 years, they have not kept pace with the changing needs of today's golfers. Wet and hard ground conditions combined with the amount of walking required to complete a round of golf gives some patients plantar fasciitis (heel pain) and other foot conditions, she says.
• Learn proper lifting techniques. Lee says some players injure themselves before even reaching the course when lifting their golf bags out of the car. Using a pull cart to get the clubs around the green will reduce back strain. For players with pre-existing back problems, Mahon recommends pushing the cart, rather than pulling it and alternating hand holds on the cart. She also recommends using a double strap-type golf bag to reduce back strain.
• Warm-up: Hit a few balls, going through all of your clubs, not just the drivers, suggests Lee. Mahon recommends trying to incorporate a cardiovascular warm-up by parking a moderate distance from the course and walking to the first hole.
• Practice good swing mechanics. "A good instructor is priceless," says Lee. Mahon agrees: "I am a firm believer in lessons from day one," she says.
• Listen to your body for nagging pains that "don't go away," advises Lee, and seek appropriate treatment. Fatigue and aching in the lower back are common signs to watch for, says Mahon.
• Stretch after playing, before heading to the clubhouse – especially wrist, elbow, hip and back muscles.

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