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Prevention of Golf Injuries
Where to start?

Golf is a physically demanding sport and it is not uncommon for golfers to feel sore occasionally after consecutive games without adequate rest.  There are many different reasons for golfing injuries, namely faulty swing mechanics, poorly fitted equipment, poor posture and muscular imbalances in the body or over training.  In this issue, the discussions on golf injuries mainly focus on the physical aspects of our body as a key contributing factor to injuries. 

Typical golfers in Singapore are in their late 40s or above, have achieved good success in career and financial stability.  With more time on hand with grown up kids, they have decided to pursue their recreational interests (such as golf) that had taken a back seat due to the long working hours during their younger days. Most have had few official golf lessons from professional golf instructor but yet there are a handful of others who pick up the game through informal tips from golfing buddies/golf books. At the beginning stage of picking up the game, most golfers feel some form of soreness in their body but most attribute that to lack of training and conditioning. 

While most golfers do in fact recover well, and developed good muscular adaptations with practice, there will be a handful of golfers who don’t.  Some might be able to get back to their regular game after a longer break, some may still be plagued with persistent tightness or discomfort in their body. There are yet others who are setback by repeated injuries that not only recur more frequently to affect their golf performance, but also prevent them from continuing this sport.  

Some common strategies that golfers used for temporary reliefs of their pain include massage, medications, and alcohol!  If above resonates with any of a golfer patient, it may be time for them to read on and understand more about what’s going on in their body that contributes to golf injuries!

Golf Injuries – Who are at risk?

In Singapore, the middle age golfers made up a large proportion of recreational golfers.  They also belong to the baby boomers generation who are mostly educated and predominantly engaged in long hours of deskbound vocations during the younger days.  What may not be as obvious to many are the implications of the adaptations occurring in our body from years of unnatural posture adopted at work.

Two of the most common postures observed in typical desk bound people are “kyphotic-lordosis” and “sway-back” postures (see Figure 1).  This may translate to the less than ideal golf set up alignment commonly seen in golfers practicing in the range (illustrated in Figure 2).  A good posture alignment is most relevant in golf injuries prevention as it is the platform for promoting good golf set up posture to ensure an injury-free and efficient golf swing.

Spending hours in front of the computers predispose us to forward head posture that can result in tightness in selected muscles such as superficial neck and chest muscles.  In addition, most also has adapted stiffness in the hip and upper trunk over time.  Such poor posture, if not actively corrected through a balance of physical activities in upright postures (e.g. physical exercises, walking etc), may encourage muscular dysfunctions and joint mobility issues that predispose to musculoskeletal conditions such as neck, shoulder and back problems later in life.  It is not uncommon for these problems to become symptomatic in the 4th and 5th decades of age.  This could possibly be due to cumulative stress and loading on our body that started to show its form with weaker musculature due to disuse and age

Having said that, aging does not signify the end of physical health as many older adults are still managing well functionally with regular exercises and physical activities to keep their mind and body active.  However, particularly for middle age late starters in golf, it is important to understand the muscles strength, flexibility, and joint mobility requirements in golf so that they can better prepare their body to keep up with the physiological and biomechanical demands of golfing to prevent injuries.

To non golfers, golf appears to be a slow and therefore low-impact sport that is most suited for our older counterparts.  This is, however, untrue as our spine sustains a load of 8 times body weight during a golf swing as compared to 3 times equivalent during jogging activities.  A golf swing is a complex movement that utilizes whole body in a coordinated fashion and therefore a golfer requires certain levels of flexibility, strength and power to execute the swing smoothly.  Any breakdowns in any of these physical attributes may result in the use of compensation by another part of the body.  These could lead to poor shots, inconsistency on the course and potential golf related injuries in the longer term.

Figure 2 (Adapted from Titleist Performance Institute, Golf fitness instructor manual, 2007)

What are Golfers’ risks?

Many golfers associate overuse injuries to only golf professionals who are clocking in many hours of golfing weekly.  This perception of overuse may be inaccurate.  Overuse injuries occur when there is an overloading on our musculoskeletal tissues beyond their normal capabilities.  Therefore, for someone who just started a new sport with a history of physical inactivity for the last few decades, the load on the person’s body tissues may be considered as excessive as he/she is inadequately conditioned to handle the stress that it has been subjected to.  Therefore, overuse injuries may still be evident in amateur golfers although they may not practise as much as a well trained professional golfers who not only use their golf-specific muscles more frequently, but also invested more time in physical conditioning in preparation for the sport’s requirement. 

Golf injuries presented in a spectrum of severity, ranging between minor discomforts that reduce golfing performances to considerable pain that incapacitated golfers from continuing the game.  A golf injury research on US amateur golfers found that higher handicap golfers are in greater risk of hip, elbow and knee injuries due to poor swing mechanics while older golfers may be more susceptible to injuries due to decreased strength and degenerative joints.  Among the various types of injuries, lower back, shoulder and elbow injuries are more frequently noted in middle age golfers.  This report matches up with our clinical observations that most injuries presenting at our clinic occur at the lower back and shoulders. 

Conclusion

The management of a golfing injury is incomplete by merely treating the local pathology. A complete understanding of the key underlying factors leading to the local injury (e.g. back strain) is essential for successful rehabilitation of a recurrent injury in a golfer.  This may be tackled from a holistic injury prevention and management approach via a comprehensive golf specific musculoskeletal screening and golf swing video analysis that help to identify the relevant deficits in the physical attributes of a golfer that may lead to poor swing mechanisms that are not due solely to technique issues. 

While the intention to pick up a new sport at the later decades of our lives is encouraging to promote active ageing, the lack of knowledge of the demands of a sport prior to engagement may lead to preventable injuries.  Our advice to golfers (esp the late starters) are:

  • Learn proper golf swing techniques from a qualified golf coach.
  • Ensure adequate warm up leading to eventual golf swing sequencing before teeing off the first hole.
  • Include a regular exercise regimen besides golf: flexibility exercises for your shoulders, trunk and hip joints; and strengthening of core muscles to protect your spine.
  • Listen to your body: seek consultation early if you detect any persistent musculoskeletal discomfort/pain during or after your game.

Like any sporting injury, early identification of key musculoskeletal dysfunction that contributes to faulty swing mechanisms permit corrective measures to be taken to alleviate the risk of more severe injury that can debilitate golfers from continuing their favourite game into older age. 


Soak Yee, Lee

Senior Physiotherapist

Urbanrehab Pte Ltd

M Sports Physio (Aust)

Self-screening tests - Do you have the body for golf?

Below are two simple self screening tests that golfers may perform to have a quick self appraisal of the readiness of your body for golf.

Posture Drill Test:                

Good Posture is essential to ensure good upright posture at address.  This is critical not only for performance in your game, but also to reduce stress on your spine.

Check if your:

  • Shoulders against wall                         
  • Wrists against wall                               
  • Middle of back against wall                            
  • Skull against wall                            

Shoulder Flexibility Test:      

Flexibility at the front of your forearm muscles and pectoral (chest) muscles are important to maintain an ideal swing plane during your golf swing without compensating with your spine.

 Check if your:

  • Middle and lower back remain straight
  • Elbows parallel to ground
  • Head remain in line with spine              

Download the above Do You Have The Body For Golf Screener here

Those interested to find out more about golf injuries and prevention screening, please send any queries or email to

soakyee@specialistrehabgroup.com

The author specialises in management of sports and musculoskeletal injuries, with special interests in the management of golf injuries and shoulder, knee and ankle conditions.

She has also taken keen interest into screening and prevention as she believes that correction of dysfunctions beyond management of local pathology provides a more holistic care and generates lasting therapeutic benefits to patients.

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