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.
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 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.
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.
