Golfing Injuries

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Golfing Injuries

Golf is one of the highest participant sports and is one of the few sports that is truly played worldwide. The sport is a combination of a moderate walk interspersed by episodes of violent activity. The golf swing involves rapid rotation, sideways twisting and unusually, swinging of the shoulders and arms with most of the force of impact being transmitted through the hands, wrists and arms. Most participants are over the age of 50. Consequently there are a myriad of injuries which affect the golfer.

Golf is perceived as a low-risk sport for injuries compared to soccer, rugby or skiing. One recent study showed that during a two year period, 60% of golf professionals and 40% of amateurs suffered an injury while golfing. Over 80% of these were overuse type injuries.

Low back pain is the most common injury or complaint followed by injuries to the upper elbow and shoulder. Low back problems can occur as a result of the powerful twisting and rotation combined with lateral flexion and an extension motion in the golf swing. Increasing the range of motion of the lumbar spine can decrease the incidence of low back pain.

The elbow is the second most commonly injured area in golfers. The two most common problems are medial epicondylitis or golfer’s elbow, and lateral epicondylitis or tennis elbow. Both are a result of poor swing mechanics, grip and hitting the ground first. Both of these problems increase with age and frequency of play. Wrist
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and finger injuries are common but less so than shoulder injuries. There are specific muscles in the shoulder that are active in the swing. These are the rotator cuff muscles and in particular the subscapularis, pectoralis major and latissimus dorsi muscles. Shoulder impingement syndrome or tendonitis and rotator cuff problems are common particularly in the aging golfer with a poor swing and stiff rotation.

Arthritis and degenerate conditions are common in older golfers. Injuries are commonly cartilage or meniscal knee injuries, degeneration of the knee, spine or hip or knee arthritis.

Treatment of golfing injuries.

Good stretching of the upper extremity before play and a good muscle strengthening program have been shown to decrease the incidence of problems. A good warm-up routine and specific exercises that target the shoulder, lumbar spine, hips and knees can help decrease the incidence of injuries.

Overuse injuries such as golfer’s or tennis elbow, tendonitis at the wrist, rotator cuff tendonitis, hip or knee tendonitis, or some foot and ankle problems are treated with rest, use of a support or splinting and oral anti-inflammatory medicines or topical cream. Physiotherapy exercises to relieve the pain, swelling and stiffness and increased flexibility are often helpful in the acute phase and essential to avoid a recurrence after return to golf. Specific strengthening exercises for golf have been shown to have a significant beneficial effect. Coaching or a golf lesson to altering stance, position and swing mechanics and review of the equipment used is also essential but often overlooked.

Shoulder MRI

Splints and supports are often useful. Whilst grip, equipment and swing faults usually cause tennis or golfers elbow some relief may be obtained by use of a simple elbow tennis elbow support. These may be available from good sports shops or a physiotherapist. A neoprene knee support can provide some comfort to a sore or swollen knee. However unfortunately a sore and swollen knee is often a sign of an internal problem or derangement, which often requires an opinion from a Specialist Sports Orthopaedic Surgeon, and an MRI scan. Ankle problems can often be helped by an ankle support or splint. Foot problems commonly require the footwear and insoles to be adjusted. Custom made insoles or orthotics are of enormous benefit to many foot problems.

Sports Orthopaedic Surgery

Injections are commonly useful in the management of wrist, elbow shoulder and ankle problems, which do not respond to other measures. More recently an injection of
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platelet rich plasma or PRP has been shown to be of great benefit in sports injuries and hyaluronic acid injections helpful to relieve the symptoms of arthritis.

Knee Arthroscopy

Knee or shoulder arthroscopy or minimally invasive treatment of rotator cuff tendonitis and impingement in the shoulder or meniscal problems in the knee is commonly undertaken. With the latest surgical techniques and technology golfers can often return a few days or weeks after treatment. More significant problems with arthritis of the knee or hip may require a hip or knee joint replacement. However return to golf after a joint replacement should be achievable in most patients and may be as soon as six weeks after surgery. The newer techniques of minimally invasive surgery, partial joint replacement and resurfacing joint replacement have improved the speed of recovery and also improved the success and functional abilities. Sports Orthopaedic Surgeon, David Johnson, plays off a handicap of 6 but is often beaten by some of his patients who have had joint replacement.
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Prevention of golfing injuries

Warming up before golfing has been shown to decrease the incidence of golf injuries. One survey showed that over 80% of golfers spent less than 10 minutes warming up before a round. Those who did warm up had less than half the incidence of injuries of those who did not warm up before playing.

Golfers who carry their own bag have twice the incidence of back, shoulder and ankle injuries as those who do not carry their bag.

Many of the injuries and especially overuse problems can be improved by using good swing mechanics. A physiotherapist with an understanding of golf and the mechanics involved can be very helpful. One of the best ways to decrease your chances of being injured is lessons from a golf professional to improve the swing technique. A regular exercise program that includes core strengthening, stretching and strengthening all the major muscle groups can also help decrease your injury rate and increase your playing time.
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Sports Orthopaedic Surgery

David P Johnson is an internationally renown sports orthopaedic surgeon specialising in sports injuries, arthroscopy and knee surgery. The Bristol Knee Clinic specialises in all forms of knee surgery. Physiotherapy, splints, supports, podiatry, orthotics and rehabilitation is available at the “Glen” or the Bristol Spire Hospital. In order to make an appointment for consultation please telephone 01179 706655 or contact via boc@orthopaedics.co.uk More information is available from the web site www.orthopaedics.co.uk

Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.

Author: DAVID P JOHNSON MB ChB FRCS FRCS(Orth). MD
Consultant Orthopaedic Surgeon
www.Bristol-Knee-Clinic.co.uk

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