Common golf injuries

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By MDC Physiotherapy

Although a perfectly executed golf swing may not look like an overly stressful activity, it is a highly complex movement that requires a high degree of coordination. The golf swing brings the trunk, hip, shoulder and wrist joints through extreme ranges of motion at a high velocity. Due to the repetitive swinging, injuries in golf are mostly overuse injuries related to cumulative load (i.e. repetition) rather than a single traumatic event (1).

What are the biggest risk factors for golf injuries?

  • Inadequate warm up before playing
  • Poor muscle strength & endurance
  • Poor swing mechanics

What are the most common golf injuries?

  • Lumbar spine (low back) 34%
  • Hand/wrist 30%
  • Shoulder/upper arm 18.6%
  • Foot/ankle 9% (2,3)
MDC Common golf injuries3

What causes injury to the low back?

There are multiple risk factors that can lead to a low back injury in golf. The golf swing is repeated over and over for long durations when playing and practicing which can lead to fatigue and ineffective muscle recruitment patterns. This reduced muscular support can increase stress placed on passive tissues of the spine (ligaments, bones, disc etc.) thus increasing the likelihood of suffering and injury to the low back. Low back pain occurs more often on the trail side. Other risk factors include poor trunk muscle endurance, swing flaws leading to excessive side-bend and over-rotation of the spine, abnormal muscle recruitment, restricted lead hip internal rotation and carrying golf bags (1).

Carrying golf bags?!

Yes you read that correctly, studies have shown that carrying golf bags is associated with a higher risk of injury to the low back, shoulder and ankle (4). This can be due to accidentally tripping with the bag on your back or simply from the fatigue of carrying the bag on your back as you carry it around for 18 holes! So if you can, use a trolley or buggy!

 

MDC Common golf injuries4

How do elbow and wrist injuries occur?
Lateral elbow tendinopathy (also known as tennis elbow and lateral epicondylitis) in golfers typically affects the lead arm. It causes pain on the outside of your elbow. It can be caused by gripping the club too tightly or the repetitive twisting/rotating the forearm during the golf swing.

 

Medial elbow tendinopathy (also known as medial epicondylitis or golfers elbow) typically occurs in the trailing arm in golfers. It causes pain on the inside of your elbow. It can be caused by trauma when hitting the ball “fat” (i.e. allowing the club head to strike the ground before hitting the ball) or when hitting through heavy rough (i.e. thick high grass). This results in a sudden deceleration that places high strain on the forearm flexors.

A common mistake when swinging the club is to push the club through the swing with the trail arm during forward swing and acceleration which causes strain on the elbow flexors. Correct swing mechanics should involve pulling the club through the swing with the lead arm, this will reduce the strain on the elbow flexors.

 

During follow through of the golf swing, the lead wrist undergoes ulnar deviation and supination (tilts and rotates), this can result in tears in the triangular fibrocartilage complex (TFCC) which can lead to instability in the wrist joint. (5)

 

How to reduce the risk of injury in golf?

Improving muscle strength, endurance and power, improving swing mechanics and having an adequate warm up are some of the best ways to reduce your risk of injury in golf.

 

Warming up before playing can

  1. Reduce risk of injury
  2. Improve golf performance

 

Recreational golfers are 3.2 times more likely to report an injury when they do not perform a warm-up! However, studies show that only 4-8% of golfers always warm up before playing! (6).

 

How does warming up help?

A good dynamic warm up can

  • Enhance stretch tolerance
  • Allow for greater energy absorption of the musculotendinous unit
  • Improve flexibility & mobility
  • Improve performance by enhancing general measures of strength, power, and athletic performance.

 

Studies have shown that dynamic warm-up resulted in

  • straighter swing paths
  • significantly higher shot quality

In comparison to static stretching, golf club only warm up or no stretching.

 

Golfers who warmed up for greater than 10 minutes had a better average handicap than those who did not (14.3 vs. 22.0) (7).

 

So why isn’t everyone warming up??

Reasons that golfers chose not to warm-up included

  • Believing they do not need to (39%)
  • Not have enough time (36%)
  • Could not be bothered to (34%)
  • They do not know how (10%)
  • No one else does (7%)
  • They do not believe warm-ups work (4%)

 

In terms of knowledge, 85% of golfers reported not knowing how to properly warm-up to reduce injury risk and improve performance (7).

 

So what should I do in my warm up before golf?

You will see a lot of golfers’ warming up by simply performing some air swings with the golf club and some stretches. However, this is inadequate. Golf is a full body sport therefore we need to prepare all the joints and muscles in the body for the activity.

 

A good warm up should consist of a mix of mobility, strength and power exercises of the upper limbs, trunk and lower limbs and should last approximately 10 minutes.

 

What exercises should I include in my warm up?

Lower body mobility exercises:

Hip rotations, squats, Leg swings

 

Upper body mobility exercises:
Worlds greatest stretch, T spine rotations, arm swings, windmills, walls slides

Lower body strength:
Squats, walking lunges, banded monster walks, RDLs, Glute bridge, Calf raises, Step ups, Hip abductions, hip adductions

 

Upper body strength:
Push ups, overhead press, lateral raises, external + internal rotations with bands, banded rows, pallof press with rotations

Lower body power:
Double leg hops, CMJ, box jumps, kettlebell swings

Upper body power:
Med ball slams, Med ball rotations, Plyo push ups

References:

  1. Lindsay, D.M. and Vandervoort, A.A., 2014. Golf-related low back pain: a review of causative factors and prevention strategies. Asian journal of sports medicine, 5(4).
  2. Murray, A. D., Daines, L., Archibald, D., Hawkes, R. A., Schiphorst, C., Kelly, P., … & Mutrie, N. (2017). The relationships between golf and health: a scoping review. Br J Sports Med, 51(1), 12-19.
  3. McHardy, A., Pollard, H. and Luo, K., 2007. One-year follow-up study on golf injuries in Australian amateur golfers. The American journal of sports medicine, 35(8), pp.1354-1360.
  4. Gosheger, G., Liem, D., Ludwig, K., Greshake, O. and Winkelmann, W., 2003. Injuries and overuse syndromes in golf. The American journal of sports medicine, 31(3), pp.438-443.
  5. Zouzias, I.C., Hendra, J., Stodelle, J. and Limpisvasti, O., 2018. Golf injuries: epidemiology, pathophysiology, and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 26(4), pp.116-123.
  6. Fradkin, A.J., Windley, T.C., Myers, J.B., Sell, T.C. and Lephart, S.M., 2008. Describing the warm-up habits of recreational golfers and the associated injury risk. In Science and Golf V Proceedings of the Fifth World Scientific Congress of Golf. Mesa (AZ): Energy in Motion.
  7. Ehlert, A. and Wilson, P.B., 2019. A systematic review of golf warm-ups: Behaviors, injury, and performance. The Journal of Strength & Conditioning Research, 33(12), pp.3444-3462.

 

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