October 24, 2011

Injury Management Tips For Golfers

While generally thought of as a harmless activity, golfing is associated with a significant number of injuries. The average touring professional sustains on average two injuries each year.

Among the amateurs, the injury rate ranges from 59% for the high handicapper to 67.5% for those with a single digit handicap. The injury rate is also higher for those over 50.

The most common injuries involve the lower back, the left elbow (for right handed golfer) and the shoulder. They are generally overuse injuries related to excessive practice and, among the amateur population, poor swing mechanics and conditioning.

The golfer’s back injuries primarily affect the lumbar spine and are the most common injury among the amateur golfers. The mechanism is related to the golf swing, with the associated large shear, lateral bending, torsional and compression loads affecting the lumbar spine.

On average, the professional golfer generates significantly lower peak lumbar spinal loads while achieving better results compared to the amateur. The professional injuries are related to the hours spent on the practice tee honing their skills, while the amateurs are susceptible to injury due to their lack of conditioning and poor swing mechanics.

The elbow injuries involve the medial and lateral epicondyles. Lateral epicondylitis is traditionally known as tennis elbow while medial epicondylitis is related to golfing. In general the golfing population presents with lateral epicondylitis (tennis elbow) five times more often than medial.

The medial variety almost exclusively occurs in the left elbow (due to the high number of right-handed golfers), and is due to the pulling action of the left arm. Golfer`s elbow is usually due to striking the ground and the associated forces.

The shoulder injuries are primarily related to the rotator cuff and its repetitive overuse syndromes. Special attention must be given to the rotator cuff conditioning to avoid developing this problem.

In order to prevent injury, a golfer must work diligently with an overall conditioning program with special emphasis on the back and shoulder. But just as important are learning and implementing good swing mechanics.

I recently had a total knee replacement (TKR). How long will it be before I`m back on the links?

There are no published contraindications to playing golf following a total knee replacement, or TKR. Orthopaedic surgeons who perform TKRs were surveyed regarding their instructions regarding golf after the operation, and 77% recommended that their patients use a cart.

All their patients who desired to play golf were able to do so and showed no significant difference in their golf handicap after their operation. Most of these surgeons believed that their patients should not start playing for about three months after surgery when they are not using any assistive devices such as crutches or a cane.

At that time they can begin chipping and putting, and slowly progress to a full swing.

What is golfer`s back?

The term “golfer`s back” relates to an injury of the lumbar spine in the golfing population. These injuries can be described as mechanical (lumbar strains or muscle spasms), discogenic, spondylogenic or related to facet arthritis.

Mechanical back pain is generally localized to the lumbar spine. It is associated with significant muscle spasm and is exacerbated with activity, and many times it can be relieved with rest and nonsteroidal anti-inflammatory medication.

It is not associated with sciatica or referred pain into the legs. Prevention must include a trunk muscle strengthening program, use of proper body mechanics, and appropriate warm-up and stretching prior to play.

Discogenic back pain generally refers to disorders of the intervertebral disk, which results in nerve root irritation and it may also include a disk herniation or ruptured disk. The leg pain produced by a disk herniation is typically worse than the back pain. It is exacerbated by sitting, coughing and sneezing.

The sciatic leg pain associated with a herniated disk is increased by sitting, whereas the leg pain associated with spinal stenosis is relieved. In general, golfers with discogenic back pain do well with conservative management of active rest, local modalities and nonsteroidal anti-inflammatory medication.

As the symptoms subside, a comprehensive rehabilitation program is begun, starting with hamstring and back stretching exercises with instruction in proper body mechanics and progressing to back and abdominal strengthening exercises.

Spondylolytic back pain is stress related injury to the posterior bony element of the spine called the pars interarticularis. It is caused by the repetitive loading of the lumbar spine during the golf swing.

The pain is localized lateral to the midline and is exacerbated with hyperextension or bending backwards. While it often can be identified on oblique spinal x-rays, a bone scan is very sensitive for visualizing the stress fracture.

Symptomatic individuals should avoid repetitive loading activities such as golf. In order to return to full activities, a comprehensive back program should be followed with an emphasis on lower extremity and trunk stretching as well as trunk and back strengthening.

Facet joint arthritis is the result of aging and minor trauma. It encompasses a spectrum of changes. The forces primarily responsible for these degenerative changes include rotation and compression.

Physical examination will reveal a loss of the normal lumbar lordosis or curvature with a loss of motion. Palpation of the affected facet joint is painful and in advanced cases the corresponding nerve root may be pinched resulting in sciatica or leg pain.

This pain is relieved by sitting, which opens up the space surrounding the nerve as opposed to the pain of the herniated disk, which is worsened by sitting. During the symptomatic phase, activity should be limited and a lumbar support and anti-inflammatory medication should provide relief.

A comprehensive back program should be instituted as the symptoms decrease. Special emphasis should be given to proper swing mechanics and pre-play warm-up prior to return to the course.

How do I prevent injury when I play golf?

Preventing injury with golfing encompasses three areas: developing proper swing mechanics, improving your overall fitness level and appropriate warm-up prior to play. Your PGA professional is the best source for improving your swing.

A series of lessons and diligent practice will not only improve swing and lessen the loads on your back, but will also improve your on course performance (which may cover your lesson expenses).

Proper body mechanics for such on course activities as teeing or marking the golf ball and picking up the ball out of a hole is important to avoid injury.

Each golfer must realistically assess his or her physical capabilities including strength and flexibility. In addition to striving to improve these areas, the golfer must also play within their limitations.

Aerobic conditioning is also important as it delays the onset of muscle fatigue. Walking should be encouraged whenever possible.

Finally, the golfer must make the time for an appropriate warm-up before playing. While 45 minutes would be optimal, a 10 minute warm-up program is the minimum. The 10 Minute warm-up consists of four activities:

1. Stretching (Two minutes)

Before swinging a club, stretching will increase flexibility and blood flow to the muscles, preventing a strain. Five stretches should be performed for 20 seconds.

Neck rotations: Slowly roll your neck around clockwise and counter clockwise.

Shoulder stretch: Hold the golf club with both hands and raise it over your head, place the club behind your back and extend the shoulders and hold. Then grasp each elbow and stretch the posterior capsule of the shoulder by pulling the elbow across your body.

Trunk side bends: With hands on hips bend side to side.

Trunk rotation: Assume the address position with arms crossed across the chest and hands resting on the opposite shoulders, rotate the shoulders (not the hips) and hold in each direction.

Toe touches: Standing erect, bend forward from the waist and touch your toes; hold and rise slowly. For those with a back condition, this should be performed sitting on a bench and leaning forward.

2. Driving Range Practice (Three minutes)

Hit shots with a pitching wedge, 5-iron and driver, spending a minute with each club. Concentrate on tempo and use a half swing only with the wedge, three quarter swing with the 5-iron and a full swing with the driver. Focus on proper position and swing mechanics while avoiding over rotation of the shoulder.

3. Putting

Spend two minutes putting back and forth across the green, getting the feel of the green. Then for two minutes practice straight and breaking three foot putts.

4. Waiting to tee off (One minute)

Spend 30 seconds making practice swings with the club you plan to use on the first tee. Concentrate on tempo, a low take-away, balance, a full turn of the back swing, clearing the hips, and a full finish. Swing slowly, concentrating on rhythm and balance. Then spend the next 30 seconds relaxing and visualizing your drive.

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