Medicine for Africa - Medical Wellness Information Service       

OLF RELATED INJURIES

Definition:  

Golf is generally considered to be a relaxing quiet sport with a rather low risk of injuries. This, however, is not entirely the case. Golf is one of the most popular sport disciplines not only in America, England and Scotland where it started, but is also rising in popularity in other countries including Germany. Recreational golfers who usually play only on weekends, while in good physical condition, sometimes lack the musculature that is relevant in the sport and many have a suboptimal hitting technique.
 
The higher average age of a golfer combined with no or only very short warm-up exercises before the beginning of a game (see Prevention), lead to typical golf related injuries such as over-extension damage of the arms and shoulders, in addition to problems in the lower lumbar vertebra. The latter is the predominant site of injuries in men, followed by the elbow, while the elbow is the site of most injuries in women. The majority of injuries develop at the point where the tendons surround a joint. Injury also occurs when too much strain is put upon certain muscles or muscle groups. The typical 'golfer's elbow' distinguishes itself from 'tennis elbow' by its location. In golf, an inflammation develops usually at the medial aspect of the forearm which is the inside part of the elbow when the arm is extended with the palm up. This can occur in either the left or the right elbow at the point where the tendons of flexor muscles are attached to the bone. However, pain also occurs, even more often, on the lateral side of the elbow which is the outside part of the elbow when the arm is extended with the palm up in the right arm in a right handed person, or in the left arm in a left handed person.
 
Another site of characteristically golf related injuries is the left shoulder in a right handed person, and vice versa. Muscles can become impacted within the joint, or too much strain can cause the rotator cuff to tear and pull the shoulder joint out of its socket (subluxation or complete luxation), leading to acute pain and limitation of movement.
 
Golf may also lead to fracture of the uncinate bone in the wrist. This can develop in the left hand in a right handed person, or vice versa. In this injury, the hook of the uncinate bone breaks off due to the exertion required in swings. This type of injury is mostly seen in professional golf players, but can also occur in weekend players when they impact the grass or tree-roots rather than the ball.
 

Symptoms:
 
Symptoms depend largely on the place of injury and consist mostly of pain and swelling of the affected joint area.
During the golf swing, the player performs a strong rotation of the body and a wide swing of the shoulders at high speed. If the swing is bad or if the ball is not hit correctly and the player hits the grass, the follow through may be stopped abruptly, which can lead to damage of the lower back and the arms and shoulders. Impact of muscles into the shoulder joint not only causes pain but can also cause loosening of the joint capsule which can lead to instability of the joint (subluxation or luxation). Early diagnosis and appropriate treatment are of utmost importance to prevent permanent damage. Improvement of one's stance by standing a little further from the ball and by turning the body more from the hips, as recommended by golfing great Bob Hogan, can result in the prevention of negative impact on muscles or muscle incarceration.
The typical golfer's elbow (the medial part of the elbow) is characterized by pressure pain in the medial aspect of the elbow as well as by pain occurring upon pressing the hand or when flexing the hand against resistance.
Fracture of the uncinate bone in the wrist causes weakness in the hand grip, as well as swelling of the palm. Local pressure pain in the palm is usually a clear indication of bone fracture.
 

Diagnosis:
 
The diagnosis of golf related injuries can often be made during a thorough physical examination performed by a specialist, such as an orthopaedist, a physician for sports medicine or a physiotherapist. Typical pressure pain or pain during certain movements against resistance, guides the examiner to the injured group of muscles. The suspected diagnosis of a fracture of the wrist bone (the uncinate bone) can be confirmed by x-rays or perhaps a CT-scan. Misdiagnosing the fracture as a wrist sprain or an inflammation of the tendons (tendinitis) can result in permanent damage to the affected areas. In this case as in others, it is very important to make the correct diagnosis as early as possible to prevent permanent damage.
 

Therapy:

Immediate treatment after an injury should be conservative and should consist in resting the joint and the application of ice packs, especially when there is swelling. Ultra sound, laser or interference therapy can quickly reduce inflammatory reactions. In addition, non-steroidal anti-inflammatory medication should be taken (such as aspirin, ibuprofen). Immobilization of the joint should not exceed two to four weeks, and should be followed as soon as possible by physiotherapeutic treatment in order to prevent degenerative changes in the affected joints
or muscles. Intra-articular cortisone injections are, in most instances, not necessary and should, if at all, be used very sparingly. Many physicians totally reject the idea of intra-articular cortisone injections. Where these injections may be considered acceptable, for example occasionally in a tennis elbow, no more than one or, at the most, two injections should be given. Non-critical use of steroids can lead to further damage to the tendons. In questionable situations, it would be wise to get a second opinion.
 
Bone spurs (abnormal growth of bone) occur occasionally, especially in the elbow area. These spurs can break off (joint mice), causing considerable pain. At this time, an operation (arthroscopy) to remove these bone fragments might be indicated.
Changes in playing technique can relieve the strain to the elbow and/or wrist as well as lower back pain; therefore, part of the therapy should consist of a consultation with a golf professional (trainer) who can give valuable advice on how to modify one's play or to change one's equipment. A modification of the swing can be achieved by keeping the upper body straight and by increasing the bending of the knees, or by moving the body, shifting the weight more to the left foot and rising on the toes of the left foot. Shorter swings or an extra-long putter can also improve back problems.
 

Prevention:
 
Better than any therapy is, of course, prevention. Aside from general activities such as walking or jogging, gymnastics and stretching exercises, the golfer should also perform golf-specific exercises.

Stretching exercises can be done by placing a golf club behind one's neck or along the lower back on one's hips, holding it from behind with arms stretched and turning the body from one side to the other. Other stretching exercises as well as regular strengthening exercises of the back-, shoulder- and forearm-muscles should be performed with light weights; they can have a valuable preventive influence against over-use damage.
 
The warm-up period before starting a golf game should extend between 15 and 30 minutes in order to enable the often neglected musculature to achieve better blood supply, thereby better oxygen saturation and improved metabolic turnover. Ideally, a golfer should first hit a basket of balls (about 50) on the driving range. The golfer should start with a wedge or nine iron and slowly work up to a five iron before ending the session with swings using the driver.
Weekend golfers can also prevent injuries by asking a trainer from time to time for advice on how to improve or adjust one's swing/technique.
Should you feel pain when hitting a ball, you should stop playing immediately and consult a physician (orthopaedist, sports physician) or physiotherapist, who can examine you and determine the nature of the injury. This person may also be able to advise you how to improve your warm-up or which stretching exercises are best for you.
And finally, it is interesting to note, that the highest injury rate is among golfers between the ages of 35 and 50. This is almost exclusively caused by the belief of many of those players that they can play to the same extent as they did at 20 years of age. They expect too much from their bodies and put too much strain on them after having spent the winter months at rest behind a desk.
 
Regular stretching and sufficient warm-up exercises before playing a game will make golf again one of the healthiest and most relaxing sport for any age group.   

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