Golf injuries take a swing at rehab and prevention

Golf has hit its stride, blossoming into a popular sport that attracts followers worldwide, including the Philippines. Professional and amateur golf tournaments are now played practically all year round, in golf courses that are sprouting all over the country. Media coverage of star athletes such as Tiger Woods and Michelle Wie is also helping turn golf into a sport that can be enjoyed by people from all walks of life.

Though perceived as a low-risk sport compared with the likes of basketball, soccer, or boxing, golf racks up its share of injuries, too, studies show. And as the sport gains popularity, the injuries are also rising. The recent surgery of Tiger Woods for a ligamental tear of the knee highlights the problem of injuries in golf.

Poor Swing: Unsafe At Any Speed

Getting hit by an errant ball or a careless backswing are some of the ways a golfer can get hurt on the course. But a study at the University of Muenster in Germany, published in the May 2003 issue of the American Journal of Sports Medicine (AJSM), found that nearly 83 percent of all reported injuries were related to overuse from repeated swings during practice sessions. The researchers analyzed injury data from 703 randomly selected golfers. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Only 17 percent of injuries were caused by single-trauma events. Simply carrying a golf bag, for example, proved to be hazardous to the lower back, shoulder and ankle, according to the study.

In 2007, in a follow-up study conducted at Macquarie University in Sydney, Australia and published in the August issue of the AJSM, researchers reported on injuries among 588 golfers after one year. They found that the overall incidence of golf injury was 15.8 injuries per 100 golfers. The study found that nearly 16 percent of all Australian amateur golfers are likely to sustain a golf-related injury per year. The researchers concluded that most of the injuries will affect the lower back region.

At first glance, the golf swing may appear to be a relatively uncomplicated activity. On closer inspection, however, the swing requires a synchronized effort of muscle strength, timing, and coordination, all designed to generate high club head speeds, often in excess of 100 mph.

Understanding the biomechanics of the golf swing is helpful in diagnosing and managing golf-related injuries. In its most simplified form, a normal swing can be divided into a sequence of five phases: takeaway, backswing, downswing, acceleration, and follow-through. To generate power and club head speed, the skilled golfer will attempt to maximize the shoulder turn relative to the hip turn during the backswing. While injury can occur at any phase of the golf swing, golfers may have a history of symptoms affecting the back, shoulders, and elbows that may take place only during one specific phase of the swing.

Back Injuries

Low back pain is the most common injury reported among both professional and amateur golfers, and occurs most often as a result of the powerful rotation and extension motion that are part of the golf swing. Golf fitness instructor Sean Cochran, who regularly works with PGA Tour professionals, claims that half of all golfers will incur a low back injury at some point in their careers. “The execution of the golf swing placed the musculature of the lower back under a large amount of stress,” Cochran says. “Over time, if the lower back does not have the flexibility, muscle strength, and endurance to execute the swing, injury will occur.”

Flexibility exercises designed to increase the range of motion of lumbar spine extension and rotation of the lead hip (the left hip in right-handed golfers) may reduce the incidence of low back pain. Strengthening exercises of the abdominals and increasing trunk flexibility may provide additional benefits.

Sore Shoulders

Shoulders are a vulnerable component in the golfing equation. The lead shoulder, or left shoulder in the right-handed golfer, is particularly vulnerable to injury, according to a study from the Harvard Shoulder Service at Massachusetts General Hospital in Boston and the Kerlan-Jobe Orthopedic Clinic in Los Angeles, published in the July 2004 issue of AJSM.

The majority of patients with golf shoulder problems will respond to nonsurgical treatment, including rest and a structured program of physical therapy, according to the researchers’ review of the literature. In addition to an initial period of rest from golfing, injury management should focus on a rehabilitation program, from which the majority of golfers should see improvement. Golf swing modifications, such as shortening the backswing or follow-through, or adjusting the grip of the club, may also prevent further injury in these patients.

Elbow Rehab

Many golfers, whether amateur or professional, are subject to cumulative trauma injuries to the elbow. The two most common problems are medial epicondylitis (also known as “golfer’s elbow”) and lateral epicondylitis (more commonly known as “tennis elbow”). Both are thought to occur as a result of poor swing mechanics. Golfer’s elbow, in particular, is believed to be brought on by hitting shots “fat,” or striking the ground first, while tennis elbow may be caused by overswinging the club with the non-lead hand (e.g., the right hand in right-handed golfers). Both of these problems increase with age and frequency of play.

The major objectives of rehabilitation from elbow injuries are to improve the elasticity of the elbow joint and to gradually increase pain-free range of motion. Recommendations for treating golfer’s elbow, published in the website of the sports medicine division of the University of Pittsburgh Medical Center, included resting until pain dissipates; applying a cold pack to the elbow for 15 to 20 minutes, four times a day for several days, along with taking ibuprofen to help reduce inflammation and pain; and wearing a counter-force brace on the affected forearm to limit the force generated by the forearm muscles when they are in use.

When the acute pain is gone, gentle stretching of the wrist and elbow can begin as long as the affected golfer stays within pain limit. Strengthening exercises for the wrist extensor muscles can also start, followed by a gradual return to sport. One approach is to practice gentle arm motions to simulate golf swings.

Injury Prevention

Overall, the best way to avoid injury on the golf course is to prevent it with proper conditioning and swing mechanics. And having a stellar athletic physique and a perfect swing aren’t enough, according to Andrea Fradkin, an assistant professor of exercise science and athletics at Bloomsburg University in Pennsylvania. “Only a small percentage of golfers performs an appropriate warm-up prior to play or practice. The message isn’t getting across. There is a need to tell golfers to warm up, and not just hit balls.”

According to Fradkin, an appropriate warm-up consists of three parts: aerobic exercise to increase the temperature of the body; sport-specific stretching (including the shoulder, trunk, chest, lower back, hamstring, forearm, and wrist); and a period of activity that starts slowly, builds in intensity, and incorporates movements similar to the actual sport (e.g. air swinging).

Many golfers are embracing a three-pronged fitness regimen. It consists of a daily flexibility and strengthening program, including shoulder exercises and focusing on trunk, core, and lower extremity training; a cardiovascular and aerobic conditioning program; and a stretching and warm-up routine before a round of golf. Many professional golfers attribute their increased driving distance, better endurance, and overall better play to following this type of fitness program.

If you want to prevent golf injuries through proper conditioning and swing mechanics the scientific way, you may contact the Golo Golf Performance Center at the Department of Rehabilitation Medicine of the Asian Hospital and Medical Center (telephone number 876-5749). Using state-of-the-art biomechanics equipment, your golf swing will be analyzed, and your joints and muscles will be examined. You will then be placed on a rehab program that will train your muscles and joints to produce that perfect swing — with less injuries and an overall better golf game!