G.U.R. - Golfers Under Repair

Upper Body Golf Injury Rehabilitation

Golf Injuries - Cause, Effect & Management

By Sandy Jamieson, PGA Professional and Ramsay McMaster, Physiotherapist

Introduction

The Melbourne Golf Injury Clinic has assessed and treated over 5000 golfers and this article outlines a template that doctors can use in their own practice to identify the cause, effect and management of golf injuries or patients who are unable to participate in the sport of golf as a result of predisposing injuries

When analyzing different golf groups, from club players to amateurs to club professionals and tour players, it is clear that each sub-group is more susceptible to specific injuries.

This short article is to increase awareness in the sports medicine professionals and physiotherapists about the causes of golf injuries as a result of: -

1. Poor swing biomechanics
2. Swing misconceptions
3. Ineffective co-ordination of the body segments within the golf swing.
4. Muscle imbalances and postural changes associated with a dominantly one-sided sport.
5. Underlying pathological and predisposing factors that inhibit golf participation and swing mechanics

It is widely known that many medical professionals participate in the sport of golf. Therefore, from our experience we shall discuss the common golf injuries incurred, and their cause, effect and management. Outlined are two doctors who attended the clinic, one with a lumbar spine disorder, and the other with tennis elbow. We have taken them through a golf specific musculo-skeletal and video screening.

Doctor 2:

45 year old female doctor – 17 Handicapper (right handed)

Subjective and Objective Summary:

Tennis Elbow

• Prolonged computer work that has caused upper body postural changes e.g. Increased upper thoracic Kyphosis. This leads to weakness in the shoulder girdle stabilizers, serratus anterior mid and lower trapezius and rotator cuff muscle group bilaterally.

• On examination the left latissimus dorsi and triceps were significantly weak this tends to occur in female within this age group. This will cause the hands to over compensate and cause the agonistic muscles to squeeze more readily on the golf club e.g. flexors digitorum fundus placing pressure on extensor carpi radialis longus which is further placed under strain.

• Her golf grips were worn and also too large for her hands.

• She practices on golf mats 3 times per week (300balls).

• She read a golf article on keeping the head down and the left arm straight.

Swing Faults / Misconceptions:

There is a close association between Tennis Elbow and a belief that the left arm should be locked straight during the backswing and downswing. Causing shortening and tightening of the muscles in the left arm placing extra stress and strain on tendons in the elbow especially at impact. Incorrect grip size has a direct effect on grip tension and in this case her grip tension was far too tight causing even more shortening of the muscles in her forearms. Grip tension should not be so tight that it wears furrows in the rubber where a golfer's thumbs and fingers are placed.

Driving range mats and very hard ground allow for very little give at impact and tend to refer the shock of the strike up into the golfers hands and arms and in a case such as this only flares intensifies the tennis elbow.

Common Points of Reference in regard to weakness in the Kinetic Chain:

• With triceps being weak on the left side this places extra stress on the extensor carpi radialis longus origin when the golfer extends their arm at impact.

• As stated poor shoulder stabilizers will cause over active hands thus using small muscle groups rather than the trunk stabilizers (golf muscles).

• Poor body awareness and skill acquisition will result in the doctor hitting the ball with their arms alone rather than using their trunk stabilizers full and efficient arm levers.

• Biceps may also be over active – Check the muscle tension, muscle length and tendon thickness on the left compared to the right.

• Poor range in the balance between the pronators and suppinators may also be an issue.

Common Physical Management:

• The physiotherapist who has an overall understanding of golf and the associated biomechanics can carry out a full upper body and trunk stability assessment.

• Grips can be assessed and changed by a local PGA Professional. The Arthritis Foundation also have grips.

• A referral to the local PGA Professional asking for a report in the form of a video analysis still print out can be provided.

• Deep massage to biceps extensor carpi radialis longus, pectoralis major and minor, long flexors of the wrist and fingers.

• Also stretches to the above.

• Thera- tubing stretching exercises triceps latissimus dorsi, serratus anterior rotator cuff group.

• Anti-inflammatory prescribed by the doctor.

• Local injection when the tennis elbow is more focal.

Common Technical Management – Coaches Advice:

An understanding that the left arm should be naturally extended not tense. Having a greater focus on the right arm in the swing to control the width of swing arc.

The fitting of correct sized grips and a focus on having grip pressure that enables a hold on the club without digging into the rubber.

Reducing the number of full shots hit in practice and if balls are going to be hit at the range to do so of the rubber tees provided thus avoiding the impact with the ground.

References and further reading:

• www.golfmed.net

• The Body and Golf CD Rom - Ramsay McMaster

• Poor Motor Patterns that Cause injury and Golf Rehabilitation Exercises CD Rom - Ramsay McMaster.

• Musculo-Skeletal Injury Questionnaire for senior golfers - E. Fox, DM Lyndsay and A,A Vandervoort.

• Strength Training and Injury Prevention for Professional Golfers - J.H Hellstom

• Back Pain in Novice Golfers a One Year follow-up – A. Burdorf et el

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