Golf Injuries and Treatment
TIPS FOR GOLFERS
INTRODUCTION: A variety of acute and chronic injuries are common
to professional and amateur golfers. Generally considered a benign
activity, many players experience numerous minor and major
ailments.
Studies reveal that professional golfers experience an average of
two injuries per year. Many repetitive practice swings required of
a professional lead to overuse syndromes, the most common type of
injuries seen in professional golfers. The amateur golfer often
experiences injuries secondary to poor conditioning and poor swing
technique.
The most common injuries in professional golfers include those to
the lower back, wrist, hand, shoulder, knee and elbow. Similarly
in amateur golfers, injuries to the lower back, elbow, hand/wrist
and shoulder are most common.
BACK PAIN IN GOLF: Lower back injuries are the most common of all
golf injuries in the professional and amateur. Studies indicate
that the mechanics of the golf swing generate significant forces on
the lumbar spine and surrounding tissues. Improper swing
mechanics, especially in the amateur, lead to lower back injuries.
Mechanical low back pain consisting of muscular strains and sprains
is very common. These will often begin with diffuse pain in the
lower back and episodes of recurrent exacerbation. This pain is
usually aggravated by activity and relieved with rest and anti-
inflammatory medication. Prevention of mechanical low back pain
includes a trunk strengthening program, use of proper body and
swing mechanics, and appropriate warmup and stretching prior to
play.
Herniated discs often present with a more acute history of low back
pain and spasm, followed by leg pain, numbness and weakness.
Treatment includes rest, local modalities, medications, and medical
evaluation. Often symptoms improve and golf may be resumed after
a rehabilitation program. Occasionally surgery may be required for
persistent or progressive problems. Other causes of low back pain
are discogenic back pain, arthritis, and spondylolisthesis.
Prevention of reinjury is important in lower back disorders.
Improving swing mechanics and using proper body mechanics during
teeing, marking a ball, and picking the ball out of the hole are
important. Appropriate warmup prior to play is also vital in
preventing low back pain. A minimum of 10-15 minute warmup should
include stretching exercises, driving range practice, putting and
practice swings. Stretching will increase flexibility and blood
flow to the muscles. Exercises should include neck rotation,
shoulder stretch, trunk side bends, truck rotation, and toe
touches. A lower back and trunk conditioning/strengthening program
should be considered for most golfers.
SHOULDER PAIN IN GOLF: Shoulder pain is less common in golf than
overhead sports such as tennis, but is still frequently seen from
overuse. Multiple repetitions lead to inflammation, most notably
to the subdeltoid or subacromial bursa. Overuse also leads to
strains of the muscles of the shoulder girdle.
As golfers become older, degenerative changes begin in the
shoulder, such as subacromial space narrowing, spur formation, and
rotator cuff thinning. Repetitious positioning of the arm across
the body may lead to spur formation under the acromioclavicular
joint, impingement of the rotator cuff on spurs, and partial
rotator cuff tears.
The younger golfer may also be susceptible to overuse with rotator
cuff tendonitis and posterior capsulitis. These syndromes are
inflammatory in nature in response to excessive repetitive trauma.
The younger golfer may also have shoulder pain associated with
instability or excessive laxity.
An exercise program for stretching and strengthening the rotator
cuff and shoulder girdle muscles is helpful in preventing some
causes of shoulder pain. Often anti-inflammatory medications and
rest are helpful in treating overuse injuries of the shoulder.
Occasionally injections are advantageous in treating inflammatory
conditions, such as rotator cuff tendonitis and bursitis. Surgery
is required in some golfers with prolonged conditions not
responsive to other measures. Decompression of the rotator cuff,
repair of cuff tears, and repair of the unstable shoulder are the
more common surgeries.
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ELBOW PAIN IN GOLF: Elbow pain and injuries are common with higher
reported incidences in amateurs than professionals. The lead elbow
(left arm in right handed golfers) is more commonly injured.
Overuse conditions, improper swing mechanics, improper
conditioning, and inadequate warmup all play a role in elbow
injuries in golfers.
The most common types of injuries are medial and lateral
epicondylitis. Lateral epicondylitis more commonly occurs in the
non dominant lead elbow and medial epicondylitis in the dominant
elbow. Findings include tenderness to direct palpation and
reproduction of pain with resistant flexion of the wrist. Often
ulnar nerve symptoms are associated with medial epicondylitis.
Treatment includes icing, rest, and a decrease or abstinence from
golf until symptoms improve. Also anti-inflammatory medications
are frequently helpful. Often when symptoms are mild, counter
force bracing is beneficial during play. Muscle and tendon
conditioning is also useful with use of resistive cords and bands.
For persistent symptoms, steroid injections may be required. Play
is generally limited for a period of time after injections.
Surgery is considered for lateral and medial epicondylitis in
patients with symptoms lasting for months in spite of a
rehabilitation program, forearm bracing and injections.
Debridement of degenerative tissue is performed, followed by
splinting of the elbow, and physical therapy. Return to golf
commonly occurs after several months.
