Golf-related Injuries – a Physiotherapist’s view

I can see it now: Physiotherapist turned professional golfer. Okay, so maybe I’m not going to be the next Patty Berg or Nancy Lopez, but I definitely have a new-found appreciation for the game of golf given that my sister recently married a golf pro. As a long-time runner and triathlete, I had always considered golf to be a low level activity, posing more of a mental than a physical challenge. Boy was I wrong. After four frustrating hours on the practice fairway, I felt as though I had been run over by a Mac truck. Everything from my shoulders to my feet hurt.

Common golf injuries

To the untrained eye, a golf swing looks rather innocuous. But as I started to dismantle the game of golf in my mind, I began appreciate the numerous motor skills involved as well as the importance of core strength and flexibility. If the golf swing is performed incorrectly, it can cause injury in many parts of the body. The most common injuries include:

• Lower back strain: rarely a first-time event, often related to pre-existing back problems
• Rotator cuff tear: often with pre-existing pathology present
• Fractured hook of hamate: related to hitting a large number of golf balls, or contacting the ground/mat repeatedly. This injury is more common in golf than in any other sport.

The more maddening issues are often those that arise over time, and commonly affect a swing mechanics, endurance (inability to withstand playing 18 holes of golf) and score.

How certain golf techniques can cause aches, pains and injures

Casting
When a golfer uses excessive of wrist action in their back swing in an effort achieve a greater range of motion that will increase the force to which they are able to hit their golf ball, it can be problematic. When this happens, there is a considerable eccentric contraction of the “lead” arm and concentric contraction of the forearm flexors on the other forearm. Repetition of this motion can lead to ‘tennis elbow,’ or ‘golfers elbow.’ Both strains are more common in women and in people with weak trunk muscles or lack flexibility in their spine, so use their arms instead of their core to achieve a longer shot.

Sway
When a golfer attempts to generate momentum by shifting his or her hips backward with the back swing and then sways forward as they bring the club through, in time, they are likely to experience back and hip problems as well as an inconsistent shot.

Weight Shift
One of the most important components of a good swing is the proper shifting of weight. Golfers who don’t transfer their weight from the back foot to the front foot as they swing their club will frequently experience lower back pain. Golfers who don’t weight-shift also have a tendency to use a shoulder turn or thoracic spine rotation to create club head speed and are potentially at risk for rib stress fractures, thoracic sprains and sprains or injuries to the rotator cuff.

Golf Equipment and golf-related injuries

Graphite versus steel clubsThe type of shaft material in a golf club can have an effect on the golf swing. Graphite tends to be lighter and more flexible, whereas steel, the preferred choice of the advanced golfer, is often stiffer and heavier.While the steel club allows the advanced golfer to achieve more distance it can cause older and less mechanically efficient golfers lower back pain

The type of golf bag
To understand a client’s aches and pains, it’s essential to know how they carry their golf clubs. Pushing, pulling or carrying a 40 pound set of golf clubs over a 4 hour period provides insight into the nature of the injury. For a golfer who is is experiencing back or hip problems, it might be a good idea to suggest a double strap if they like to carry their bag, and if the problem persists they may want to opt for a push or pull cart.

Common Injuries in order of frequency of occurrence

• Lower back strain
• Elbow (golfers’ and tennis elbow)
• Wrist and hand sprains
• Shoulder: rotator cuff irritation
• Knee: anterior knee and medial joint stress
• Rare and specific to golf: fractured hook of hamate

References:

1. Electromyographic Analysis of Muscle Action About the Shoulder. Clinics in Sports Medicine-Vol 10, No. 4 October 1991, p799-801.

2. A Survey of Golf Injuries in amateur golfers. British Journal of Sports Medicine. 1992; 26(1), p. 63-65.

3. Injury Clinic: Golfing Injuries. Batt, M., Sports Medicine 16 (1); 1993. 64-71.

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