A crisp morning gazing down a lush fairway at the start of a round of golf, chasing the allure of a dropping handicap and flawless shot.
South Africa's Zethu Myeki's full swing and follow through. (PC: iol)
Whether one is hunting for the reward of that powerful tee-off on the driving range or the perfectly sunken putt on the green there is something alluring about the sport that keeps golfers of all ages coming back for more.
However, the power and precision demanded by the game of golf can sometimes lead to unwanted injuries and distracting pain on the fairway.
Irrespective of the fact you could be a seasoned athlete, a relaxed retiree, a weekend warrior or a proud parent watching your child develop their game, awareness of common golf-related orthopaedic issues is essential.
By understanding these physical hazards, you can take steps to prevent orthopaedic injury and keep your swing – and your enjoyment – on course.
Improving your game and avoiding injury may require the help of experienced coaches.
The Physical Demands of Golf
Golf requires a unique blend of whole-body power, flexibility, and stability.
The repetitive nature of the sport places significant stress on various joints throughout the swing, rendering golfers susceptible to overuse injuries.
One of the world's most prolific players of this generation, Tiger Woods, has undergone several spine surgeries for degenerative disc disease.
Common Orthopedic Concerns
There is an association between the frequency of play in a higher risk of injury. A raised incidence of injury is noted in players who participate in four or more rounds a week (or more than 200 balls per week).
The most frequent orthopaedic complaints among golfers include but are not limited to:
Low Back Pain: Granted the ever increasing distances the ball needs to travel down the fairway, golfers have had to adapt their game to engage the entire trunk and the shoulders in generating a powerful drive shot. This extreme rotation and hyperflexibility of the shoulders and pelvis (the 'X factor') results in a forceful swing and can strain the muscles and ligaments of the lower back. This could result in multilevel degenerative disc disease – particularly in regular and/or older golfers. It is important to correct excessive tilting of the pelvis and hyperextension of the spine. By improving technique and appropriately strengthening muscles around the back and core, one can reduce the risk of chronic low back pain and strains.
Honorary starter at the Augusta Masters this month, prolific South African golfer, Gary Player tees off . Shoulder problems plague golfers with a myraid of overuse injuries seen in both shoulders.
Shoulder Injuries: A pivotal joint in generating swing power, golfers often suffer from 'golfers shoulder' stemming from the repetitive stress induced during play. This is a perfect storm of: The leading shoulder additionally suffers from acromioclavicular joint pain, while the non-leading shoulder also suffers with SLAP tears (the cartilage that deepens the shoulder joint is torn from the point of the insertion of the long head of the biceps tendon). The on the leading shoulder also develops dysrhythmia with shortening of the pectoral muscles and lengthening of the opposing muscle groups.
Subacromial impingement
Rotator cuff tears
Bursitis
Instability
Labral tears
Golfer's elbow: Also known as medial epicondylitis occurs due to poor technique, poor grip or overuse. It presents as pain on the inside of the elbow as a result of irritated tendons of the muscles that flex the wrist at their insertion point.
Wrist and Hand Issues: Grip strength and control of the club is crucial as any number of overuse and/or single event injuries may arise when the club strikes the ball or ground. Hamate fractures can arise from poor club control/rebound. Wrist tendonitis often affects the leading wrist. Carpal tunnel syndrome and tendonitis are commonly associated with golf and this pain can significantly impact one’s performance and enjoyment of the sport. 'Hypothenar hammer syndrome' as a result of repeated trauma of a stroke can induce a weakened ulnar artery wall, and this could stop blood flow to the fingers resulting in tissue injury and death leading to an orthopaedic emergency.
Repeated pivoting can cause meniscal tears, resulting in knee instability and early osteoarthritis.
Knee Pain: Pivoting and shifting one’s weight during the swing can lead to ligament and cartilage injuries. ACL (anterior cruciate ligament) tears can occur due to the sudden loading and force applied at the knee during pivoting movement when the foot fixed and planted. The risk of knee injuries is increased in older players but is unaffected by skill level and gender. Contrary to popular belief, the meniscus is not a shock absorber, but rather an imporatnt knee stabiliser. A defunctioned or torn meniscus accelerates deterioration in the knee and results in subsequent arthritis. Symptoms of a torn meniscus include instability, pain and 'locking' of the knee. Patella tendinitis caused by poor technique and overuse can also result in knee pain at the front of the knee joint. Improved swing technique, as guided by a trained individual - such as a coach - can help optimise one's individual's knee biomechanics.
Hip Pain: "It's all in the hips!" Golfers often suffer tendonitis, bursitis and labral tears in and around the hip joint. These injuries cause pain that hinder performance and result in muscle weakness and imbalance. The subsequent limited hip mobility can restrict swing mechanics and power generation resulting in a poorer and inefficient swing. A technically sound golf hip turn can diminish the risk of these injuries, and targeted strengthening of the back, hip and core muscles is essential.
Maintaining a fair level of fitness helps prolong one's enjoyment and longevity in golf.
Preventing Injury
The good news is that many golf-related injuries are preventable.
Here are some proactive steps you can take to safeguard your swing and your health:
Warm-Up: A gentle warm up and light cardio before hitting the course increases blood flow, improves flexibility, and prepares your muscles for exertion. Stretching before sport is controversial and can increase the risk of injury. Stretches should be done under guidance of an experienced physiotherapist or biokineticist by fit individuals.
Correct form ensures consistent outcomes and makes for enjoyable and efficient rounds of golf.
Establish and Maintain Proper Form: In-person coaching and recorded training sessions are fundamental in the analysis and improvement of your game and biomechanics – irrespective one’s level of experience. These ‘performance reviews’ conducted by knowledgeable individuals can be useful in focusing future training, optimizing play and the avoidance of injury.
Listen to Your Body: Pain can be a warning sign. Do not ignore discomfort: schedule rest days, reassess and correct your swing. Be sure to consult a healthcare professional if pain persists.
Practice makes perfect. Early guidance and training empowers players and helps grow the golfing community.
Conclusion
The sweet spot in creating that powerful and consistent swing is found in being both knowledgeable about the potential injuries associated with golf and in nurturing a proactive stance toward one’s health and fitness.
If you experience persistent pain, do not hesitate to seek professional medical advice early on.
With the right knowledge and approach, you can keep your golf game – and your enjoyment – flourishing for years to come.
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits) CIME
Zethu Myeki, coming from humble beginnings, has watched her career skyrocket as a South African golf Pro. (PC: Investec)
References:
1. American Academy of Orthopaedic Surgeons. (2022, January 11). Common Golf Injuries. https://orthoinfo.aaos.org/en/staying-healthy/golf-injury-prevention/
2. Mayo Clinic. (2020, August 14). Golf injuries. https://sportsmedicine.mayoclinic.org/service/golf/
3. The Royal Canadian Golf Association. (2021, March 23). How to Prevent Common Golf Injuries. https://rebalancetoronto.com/treatment-of-golf-injuries/
4. "Golf Shoulder Injuries." ShoulderDoc , 5 Jan. 2024, www.shoulderdoc.co.uk/article/1476.
5. “Golf Injuries to the Hand, Wrist, or Elbow.” American Society for Surgery of the Hand, 2024, www.assh.org/handcare/condition/golf-injuries.
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