What burdens golf players

Popularity of golf is growing every years, it is demonstrated with growing number of golf fields and golf players. Golf is often times wrongly considered to be undemanding activity, with some form of walking. However, it is a demanding game, not only physically but also psychologically, demanding you to be versatile. Adequate preparation is by any sport necessary if we want to avoid injuries.

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GOLF BIOMECHANICS

Golf swing is a complex movement, into which are involved most parts of our body. The main principle is to rotate the torso against the pelvis. This activity demands coordination, flexibility and strength (Tilley & Macfarlane, 2012). There is a modern and a classic golf swing and even their combination. It is also possible to play on the left side as well as the right side, according to which hand do we have lower when holding the golf club, and which foot is further from the hole. The basic condition for correctly performed swing is stable standing with correct position of each body segments against another. During the golf swing is generated big amount of energy, which is transferred from the upper limbs, through torso muscles into the legs.


PROBLEMS OF GOLF PLAYERS

The most frequently affected areas of the body are the ones with the biggest burden. There are differences in injury localization by professionals and recreational players, which is caused by different playing habits and differing biomechanics of the swing itself. Amateur golf players are most frequently affected by problems that are caused by an incorrect technique or insufficient preparation before the game, and therefore the occurrence of injury is more frequent by them (Cabri et. al., 2009). On the other hand, professional players suffer mostly with overloadings caused by intensive training (Cole & Grimshaw).

Large amount of force is affecting the spine when we swing the golf club, which in return results in frequent vertebral problems. Among the most frequently injured areas is the lumbar segment of the spine, it is followed with cervical and thoracic segments of the spine. The most common cause of the acute pain in the lumbar segment of the spine is local damage of the soft tissues. With regards to the restricted range of axial rotation in the lumbar segment and analysis of the forces involved in the swing, it can be said that repetitive burdening of the lumbar spine leads to muscle tensions in golf players, disc herniation, spondylolisthesis or fractured vertebrae (Gluck et. al., 2008).

Among other causes of pain in lumbar spine by golf players is also insufficient stabilization which results from dysfunction of the core muscles, dysfunction of the sacroiliac joint and unstable pelvis, as well as restricted range of movement in the hip joints, incorrect technique or inadequate training preparation.


INJURY

Among other problems is also golf elbow, syndrome affecting the rotator cuffs, plantar fasciitis and pain in the wrist. The most frequently affected area is the area of the lumbar spine, followed by problems in the elbow area, wrist and shoulder. Injuries in the area of the lower extremities are less frequent.


Elbow joint

Injury of the elbow joint is among the second most common injury occurring. They occur more frequently by amateur players. Most frequently it affects muscle groups of the flexors or extensors of the elbow, which can lead to lateral (Tennis elbow) or medial epicondylitis (golf elbow). Players who play on the right side, are more often affected by medial epicondylitis on the right side, and lateral epicondylitis affects players on the left side and it occurs 5 times more frequently. Golf elbow is caused especially by overloading and sudden stopping during the swing. The risk of being affected is increasing with higher age and number of played rounds within a week.

>> You can read more about this injury in article Golf elbow.


Shoulder elbow

Injury in the area of the shoulder joint is usually caused by overloading or by excessive rotation in the shoulder joint, after raising up the golf club to swing it (external rotation), as well as after the swing (internal rotation). In most cases it is the left shoulder being affected (golf players who play on the right side). Pain in the area of the shoulder joint forms due to acromioclavicular dysfunction, disorder of the rotator cuff, posterior subluxation of the glenohumeral joint or arthritis.


Wrist

Area of the wrist is by golfist usually affected by fractures, subluxations of the joints and overloaded ligaments. Left wrist gets injured more frequently. Incorrect technique or too strong grip the leading causes of the injuries.


Lower extremities

Injury in the area of the lower extremities are rather unique condition by golf players.


Study

Among other common health issues affecting golf players is inflammation of the tendons of the rotator cuffs, posterior glenohumeral subluxation, acromioclavicular dysfunction and arthritis of the shoulder joint (Bayes, Wadsworth, 2009; Hovis et. al., 2004; McHardy et. al., 2006). Another common health issue is epicondylitis, the area of the wrist and hand are affected by fractures, joint subluxations and overloaded ligaments (especially adductors, flexors and extensors) (Cabri et. al., 2009; Mueller et. al., 2000; Stockard, 2001). Stress fractures of the ribs are also common (Lin et. al., 1994; Lord et. al., 1996; Oraa et. al., 1994). The percentage of players injured in the elbow area is around 4 to 25 %, shoulder joint between 5 to 19 % and wrist between 2 to 20 %. Injury in the area of the lower extremities in golf players is less frequent than those in the area of the spine and upper extremities. Percentage of injured players in the area of the hip joint is between 1 to 3%, knee joint between 3 to 18% and ankle joint between 2 to 13%.

Nearly all these studies contain warm-up stretching and strengthening exercises, endurance training, plyometric training, stabilizing exercises and training of the golf swing itself, alternatively changed technique of the golf swing proved a positive effect. Only one study (Gregley, 2010), which followed the effect of 20 minute static stretching during warm-up for the gold swing by amateur players, found out that players should avoid longer static stretching of the whole body before training or he game itself, and instead spend time doing the dynamic warm-up with the golf club. Intensity of all these preventive measures have to be chosen according to the individual characteristics and actual condition of the player.

Higher burdening of the spine is a result of lower flexibility, strength and stability of the trunk and spine structure, which can play an important role in occurrence of an injury. Training focused on activation of the core muscles can serve as a prevention, as well as improvement of the rotational flexibility and increasing the whole stability. Because golf is a unilateral sport, there are certain differences in the muscles in the right side and the left side of the body, therefore it is important to do correct compensating exercises. Important role is also played by changes in the technique, which can lower the burden on the spine as well as sufficient warm-up before the actual game. Adjustments of the basic posture is also important.

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Picture: Localization of the injury by phases of the golf swing (Cabri et al., 2009, 362)


Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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