GOLF ANYONE?  INJURIES TO AVOID WHEN ENJOYING THE SPORT OF GOLF ON THIS LABOR DAY WEEKEND   Some say that the age of chivalry is past, that the spirit of romance is dead.  The age of chivalry is never past, so long as there is a wrong left unredressed on earth."  Charles Kingsley, Vol., II, Ch 28: "A good conscience is a continual Christmas." Ben Franklin

It is hard to believe that a sport with the beauty and grandeur of Golf can be hazardous to the uninformed.  When we look at the beautiful greens, the lovely estates and wonderful club houses, the thoughts of good safe exercise such as walking, all join together to form a quite innocuous appearance to the sport of golf.  It is interesting to note however, that fifty (50) percent of touring professionals have sustained an injury that requires them to stop playing competitively for an average of three to ten weeks.  The golf professional usually hits more than 300 full shots/putts for several hours and plays a full round of golf which requires no less than 10 hours of continuous activity per golf day. 

The intent of this article will be to present common golf injuries of both professional classification as well as amateur, which present for care.  In each section I will try to provide tips to reduce that type of injury.  And finally presented within the article will be a summary of the most common injuries to the professional golfer as well as the amateur golfer.

BACK INJURIES

The lower back is tied with the left wrist relative to the most common injuries sustained by the professional male and female golfer.  However, in the amateurs, the elbow is the most common area of injury for females, whereby the male population is consistent with professionals in that again the lower back is the most common area of injury. 

It is easy as a graduate with a Masters Degree in Biomechanical Trauma, ergonomics and work hardening to understand how golf done improperly could easily entail lower back complaints.  A golf swing, in and of itself, involves a momentous rotatory torque of the torso requiring both shoulders to move through a wide and unusual range of motion and at very high velocities.  It has been reported that a significant portion of golfers mention that lower back pain occurred while putting or chipping.   These apparent low-stress activities, that require the player to bend over sharply at the waist may increase the static stresses of the lumbosacral spine and musculature (lower back). 

Neal, Gall, and Hassa to name only a few medical sport investigators, have proven that, high torque placed on the lumbar discs during a golf swing has been shown to contribute to the high incidence of low back injuries in golfers.  Fifty-two (52) percent of recreational golfers, according to McCarroll and Mallon, complained of lower back pain.

It has been proven however that with biomechanical postural changes made by the golfer, a reduction in reported complaints after an initial injury can be achieved.  It has been suggested that to reduce spinal torso torque on the fairway, the golfer with back pain may try one of the following swing modifications.

1.  Reduce the torque of the swing as described below.

2.  Stand upright.

3.  Shorten the swing as noted below.

The "classic" swing requires less torque in the back muscles.  While performing the "classic" swing the hip and shoulder turn almost equally with the player often rising up on the left (or lead) toe.  While performing the "modern" swing, a large shoulder turn and minimal hip turn create excessive torque in the lower back muscles.  Usually the left foot is kept relatively flat on the left (or lead) toe.  In a shortened swing the right elbow is kept close to the body, preventing the collapse of the wrist.  Although the turn of the shoulders and hips is not shortened, the back swing of the club head is reduced, which is less stressful for the golfer reporting low back pain.

SHOULDER INJURIES

Although seldom thought of by the layperson, golf injuries involving the shoulders are quite common.  These injuries are generally divided into two types.  That of the Impingement or instability.  Golf patients with shoulder impingement problems, generally present with the chief complaint as inability to elevate the shoulder.  It has been suggested that golfers in this classification benefit from shortening their swing and flattening the swing plane, to minimize elevating the left arm. 

Golf patients who present with shoulder instability problems may report a sensation of looseness or slipping when the shoulder is in certain positions and with certain movements.  These conditions must be assessed by your own sports medicine practitioner.  In any event golfers with either impingement or instability symptoms during their golf swing may benefit from using the shorter "classic" swing which places less stress on the muscles about the shoulder.  The hips and shoulder turn almost equally, reducing stretch and torque about the shoulder girdle.

ELBOW INJURIES

Most lay persons also find it difficult to believe that elbow injuries are sustained in golf.  Or for that matter any sports.  Yet, it is the repetitive nature of the causation which is directly akin to workers compensation injuries of the cumulative micro trauma category.  For example, tennis elbow or lateral epicondylitis is the most frequent elbow problem in athletics.  Golfer's elbow or medial epicondylitis has also been called "medical tennis elbow" because of its direct correlation to the repetitive and specific demands of the task.  And thus medial epicondylitis is an overuse syndrome often associated with golf whereas lateral epicondylitis is associated with tennis in the classic medical literature.  Yet sports medicine investigators have clearly demonstrated different correlations with medial and lateral epicondylitis via statistical probability.  For example McCarroll and Mallon have reported that lateral elbow pain was almost three (3) times more common than medial elbow pain in golfers.  What was surprising was that this suggests that lateral epicondylitis is more common among golfers than golfer's elbow and occurs predominantly in the lead arm.  It was also suggested that lateral epicondylitis occurs in the lead arm as a result of pronation, and medial epicondylitis in the opposing elbow as a result of supination required at the time of and following the impact of the ball.

Further taking a divot or the knocking of a piece of turf loose with the club head puts a tremendous amount of stress on the wrist and forearm musculature.  A golfer may need to change his swing to follow a more elliptical line, with the club head coming less deeply into the ball so the ball is swept off the turf absent taking a divot.  Not keeping the left arm straight, places less excessive stress on the lead forearm musculature and elbow.

Relative to equipment, it has been suggested that a low compression ball and club with more flexible shafts may also lessen the stress occurring in the forearm and elbow by absorbing some of the shock of various impacts endured.

WRIST INJURIES

It has been firmly established that it is the repetitive nature of the sport and overuse of tissues which are the etiology of most golf injuries.  Wrist injuries are no exception.  Most wrist injuries are caused by overuse and involve tendonitis and possible triangular fibrocartilage tears.  Fractures of the hook of the hamate, albeit rare, occur almost exclusively in the sport golf advocates.  In the absence of a fracture or cartilage derangement, most injuries about the wrist involve soft tissue inflammation due to repetitive microtrauma, overuse and strain.

SUMMARY

It is now clear that although injuries occur in Golf they can not only be managed, but through changes in the plategrade biomechanics of the golfer, improvement in performance and enjoyment can be achieved.  It would be considered prudent to seek out advise from a qualified Golf instructor to make sure that your fundamentals are correct or for that matter the way you grasp you clubs to your stance and swing.  Further, if you are unfortunately injured, and rehabilitation is ongoing, modifications through advise from an expert (No certifications folks, real College didactic and in University Professional Master's Degrees which by the way originated from the University holding the up and coming Presidential Debates, Lynn University of Boca Raton Florida) could be beneficial as it has been for the professional golfer.  Of course today the Biomechanical experts team usually consists of a consultation with an Orthopedic specialist (MD) and the Chiropractic Orthopedist with the Masters in Biomechanical Trauma. 

Finally, if we combine the data on the professional and armature golfers, we can conclude that the left wrist and almost equally the lower back are the most common sites of golf injury.  With far less frequency, the left hand, shoulders and knee were the next most commonly injured areas.  Amateur golfers demonstrate that the lower back was the most commonly injured area among men, followed by the elbow, hand and wrist, shoulder and knee.  Among the amateur women, the elbow was the most commonly involved site followed by the back, shoulder, hand and wrist, and knee.  The lateral elbow or the condition known as "tennis elbow" was more frequently found to be a source of injury than the medial elbow or so called "golfers elbow" by a ratio of nearly five to one.  Have great luck in your future golf endeavors.