Common injury sites and conditions frequently occurring with golfers:

 

Each player is unique in their physical arrangement and set up. How they move and why they move in their own individual way is both original to them but also a potential cause of structural deterioration, damage and de-conditioning. This is often the cause of recurrent injury. 

 

Below are a few common injuries and conditions that golfers, like other sportspeople, can be vulnerable too. However it is always worth noting that each person’s underlying health factors are a continuous and considerable influence over any injury or symptoms.

 

 

Repetitive strain injury at wrist and elbow tendon attachment sites:

 

Tendinopathy: ‘Is a general term that describes tendon degeneration characterised by a combination of pain, swelling and impaired performance.’ British Medical Journal.

 

Tendonitis: ‘Is when a tendon swells (inflammation) after a tendon injury. It can cause pain, stiffness and affect how a tendon moves.’ NHS UK.

 

The key difference between the two is to distinguish if there is degeneration of the tendon and/or only inflammation. 

 

The most frequent elbow tendonitis issues, and well known, are golfers and tennis elbow (epicondylitis) - where the tendon becomes inflamed at its insertion into the bone that makes up part of the elbow joint (epicondyle).

 

However as a number of the muscles and tendons that control the movement and transmit the force and loading through the fingers, hand, wrist, forearm and elbow work in integrated and interconnected systems the soft tissue can become inflamed and irritated throughout any sections of the tissue. This can produce pain and limitations in the hand, wrist and upper limb which all affect and can impede the swing.   

 

Rotator cuff irritation and inflammation:

 

‘The rotator cuff is a common name for the group of 4 distinct muscles and their tendons, which provide strength and stability during motion to the shoulder complex.’ physiopedia.com

 

Located deeper within the shoulder joints, than the more superficial muscles of the shoulder complex, these muscles and tendons play a crucial role in achieving and maintaining precision movement and motion through the dynamic upper limb movements of the golf swing.

 

Because all 3 dimensional planes of movement are involved in the movements of the shoulder complex during the golf swing the muscles of the rotator cuff must coordinate and combine - at increased speeds - to successfully maintain joint alignment, force transference and effective movement control. Because of this, alongside their significant involvement in movement acceleration, stabilisation and deceleration, they can be susceptible to over/incorrect use injuries.

 

Lower (lumbar) spine pain, stiffness, restricted movement:

 

It is estimated that unto 30% of all golfing injuries are sustained at the lower spine (Chartered Society of Physiotherapy). A common component of the production and prevalence of lower spine injuries is the reduced control of rotational forces, although compressive forces and general misuse and overuse are also considerable influences on injury. 

 

The lumbar spine has a limited natural range of motion in rotation but is vital that this rotation is control effectively to prevent excessive torsion and shear forces on the joints and soft tissues. Over time if this is not prevented and corrected then injuries and longer term, more chronic, damage can be caused at the spinal structures. 

 

One significant compensatory cause of excessive or uncontrolled lumbar spine rotation is due to the lack of rotation range available or movement control, higher up at the thoracic spine.

 

Mid (thoracic) spine pain, stiffness, restricted movement:

 

Although less common in frequency mid spine injuries or restrictions are no less important in their role in contributing to other injuries due to suboptimal movement range and control. The thoracic spine is a location of regular stiffness and tightness which prevents effective and optimal movement. 

 

When this is the case, some other body areas will have to move more to accommodate these limitations at the spine. In this instance the cause of the injury (the culprit) maybe the stiff and tight spine but the site of the symptoms may be in another area that has had to compensate (the victim).

 

This is frequently seen during the golf swing when the player overuses the upper limbs (an arm shot) due to lack of rotation at the spine. As with the lumbar spine, poor movement systems can produce symptoms and pain both at the mid spine and other body regions within the movement chain. 

 

Hip: 

 

Along with the shoulders and spine the hips rotation action is integral to the swing. The flowing communication of energy production, transference and control between these regions acts as the central unit that enables full body motion that is then delivered into the club head and on to the ball. 

 

Obtaining optimal rotation both internally and externally at the hip, alongside effective soft tissue movement and control, will enhance the bodies full range of rotation capacity. By then linking this bi-directional rotation in arrangement with the spine and shoulders will increase the chances of swing technique progressions through movement development. Conversely, failure to rectify any existing tightness, stiffness and resistance through this joint movement will hinder the swing capability and increase the risk of injury occurrence. 

 

Because of the importance of the hip within the lumbar spine, pelvic and hip complex in all our daily activities and functions the imbalances, movement deficits and irregularities that are frequently found are relatable to the golf swing. These can include hip flexor and hamstring shortness and stiffness, reduced glutes activation and recruitment, hip instability and/or stiffness and ITB syndrome. However, there is an inexhaustible list of other hip issues and each person and player can be susceptible to their own specific and bespoke complications that can restrict swing movement.  

 

Knee: 

 

‘Your knees help support your weight and let your legs bend and move. Almost any movement that uses your legs relies on your knees.’ clevelandclinic.org 

 

Just like the lumbar spine above the true rotational range of movement available at the knee joint is not large. Therefore any force transference or excessive compensatory motion that is not successfully controlled can produce injury to one of the many soft tissue structures contained within the knee joint. 

 

As it is one of the primary weight bearing joints it’s function in kinetic force transmission between the body and the ground is indispensable. As the forces are absorbed, conducted and propelled during motion the knee, along with the rest of the lower limb, must do this is in timed sequence with a high degree of competency if it is to avoid accumulative micro-trauma. 

 

All of the general population are prone to knee structural injury and the universally known conditions of cartilage, meniscus, ligament, tendon and bursa irritations and damage are well reported. But continued suboptimal use of the knee’s loading and unloading mechanisms during weight transference and distribution can be a notable contributor to degenerative and arthritic changes at this joint. In this instance the effects can be multiplied whilst playing regular golf.     

 

Tendon Achilles Strain:

 

Another very common location of tendinopathy and tendinitis issues is at the Achilles tendon. As described above for the elbow and wrist the same irritability and inflammation factors of overload apply. In this case it is the fibrous connection between the powerful muscles of the lower limb and the bone of the foot. 

 

However the difference with the Achilles tendon is its role within load and weight bearing. In particular any significant load increase through a combination of resistance, speed, combination or impact can produce a powerful increase in the forces and energies travelling through the Achilles tendon and consequently the foot and the ground.

 

Because of its meaningful function in absorption, transference and propulsion of forces of body weight through the lower limbs, and the interaction with the ground, this is an area that can be easily overloaded and strained. Through the accumulation of loads that can be beyond the boundaries and capabilities of the tissue injuries can occur that limit these functions of the foot, ankle and lower limb and negatively affect and impede the swing. 

 

Plantar Fasciitis:

 

‘This is the most common form of heel pain, caused by damage to the fascia ‘band’ which connects the heel bone to the base of then toes. The condition can be caused in various ways including extensive running, walking or standing for long periods of time.’ rcpod.org.uk

 

As any player who has experienced this condition will attest to, the pain can be both severe and debilitating in equal measure. Any weight bearing or loading increase can see these symptoms worsen and prevent the player from continuing. 

 

Because the feet are the central contact point between the human body and the ground - their purpose in modulating forces between gravity, the body and environment is critical. Any irritation, damage or inflammation of the plantar fascia - or any other soft tissue of the foot - will have considerable consequences on the players ability to address the ball, swing and move between holes. 

 

As with all other non trauma acquired conditions, as the symptoms are being reduced and eliminated, the treatment and rehabilitation targets the cause. Asking the question of why the symptoms were produced and determining the corrective training.

 

Cause & Prevention:

 

When considering all non-traumatic acquired injuries it is essential to look at the accumulative and repetitive nature of the actions performed or tasks involved. In activity or sports specific injuries, not sustained by impact trauma, the focus is directed towards assessing the causal factors that produce the injury as well the most appropriate treatment and rehabilitation. 

 

The identification of the cause over the source of the symptoms approach is a crucial component in reducing and eliminating any symptoms and restrictions. However, more importantly, it is also the most successful method of prevention of injury reoccurrence. 

 

A concept driven by addressing all the mechanisms of injury has to give consideration to the quality, effectiveness and efficiency of the execution of the action. In this case how well the full body movement systems produces the individuals swing action. 

 

As discussed in the sections on the swing through movement approach and screen, how the body performs and executes the desired outcome is determined by the physical capability and any constraints within the motion systems. 

 

Small losses in precision, inaccuracies within alignment and suboptimal biomechanics through repeated activity can create imbalances in load, usage and force transference between the bodies structures. Over time these imbalances, discrepancies and obstructions within flowing movement and force transmission can cause overload strain and injurious loading inequalities. The resultant pain prevents, limits and restrains performance.  

 

Therefore successful treatment of any injury caused, or contributed to, by golf must review and evaluate the movement quality within the swing. This fundamental ingredient of rehabilitation of an injury also provides the corrective mechanics to movement necessary to minimise risk of further injury as well as optimising performance. 

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