Golf related injuries

Golf has become a very popular sport in the past 40 years for people of all ages, and in the US alone over 25 million people practice it, besides many millions more in Europe, the Far East and in Latin America.

In the last 15 years an increasing body of literature of injuries to golfers has been amassed, and the leading cause of consultation with orthopedic surgeons and specialists in Sports Medicine have been mostly injuries to the low back, followed by those to the elbow, the ankle and foot, the knees and the shoulders.

The reason for this lies in the particular mechanics and kinetics of the golf swing, which for proficiency, must be repeated time and time again. Most authors agree that the cause of low back pain in professional and elite golfers is from overuse, whilst in the amateur “high handicappers” it derives from a faulty swing technique. Being this so, the former should consult a medical specialist for his low back pain, whilst the amateurs of the latter group should consult a professional golf instructor!

Much has been said for  warming up before a round of golf as prevention of golf related injuries, both for and  against, thought it would seem that the evidence is in favor of some warming up prior to starting a round of golf, especially with what is known as dynamic stretching.

A prospective one year follow up was used to study injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers’ injuries sustained during the year, location of the injury, onset, mechanism of the injury, and whether injury occurred during the golf swing or at another time.   The overall one-year incidence rate of golf injury was 15.8 injuries per 100 golfers:  these were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18,3%), closely followed by the elbow/forearm, (17,2%), foot/ankle (12,9%) and shoulder/upper arm (11,8%).  A total of 46,2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23,7%) followed by the follow through (21,5%).   Multivariate analysis of the data collected showed, that the amount of game play and the last time clubs were changed were significantly associated with the risk of golf injury.  Other factors such as age, gender, handicap, practice habits and warm-up habits were not significant in this study.

Another interesting study comparing golfers of different proficiencies, showed that professional and elite golfers (HCP <0) had significantly greater hip strength, torso strength, shoulder strength, shoulder flexibility, hip and torso flexibility, and balance, than golfers in the lowest proficiency groups (HCP 10 to 20).

How much does one walk on a golf round?  Is it good exercise? SL Kobriger published a paper in the Mayo Clinic Proceedings, after having recruited 42 healthy volunteers (12 men and 30 women aged 30 to 80) with established United States Golf Association handicaps to complete an 18-hole round of golf on each of 3 municipal golf courses. The volunteers used a pedometer to record step data. Analysis revealed that each golfer took a mean of 11.948 steps (Standard Deviation +/- 1781 steps) during a typical round of golf. Consequently, in most cases, walking 18 holes of golf will meet the recommendation of walking 10.000 steps per day as part of a general physical activity plan.

There are increasing reports of head injuries produced by the careless swinging of a golf club; also the very occasional spectator, player or passer-by who is hit by a stray golf ball.  What is increasing at an alarming rate as reported by numerous Emergency Departments across America are injuries related to golf cart accidents. These occur mostly on golf courses (46% to 70%) and sport facilities, on streets and public property, and around a home or farm.  The most likely to be injured is the passenger, and fractures and intracranial bleeding has been occasionally reported.

Last, but not least, all golfers should bear in mind that their constant exposure to the suns ultraviolet rays increases their risk of developing skin cancer, and should consider the use of the many available “sun-blocks” to protect the skin, and the use of adequate head gear.

Dr. John Emery

MD Hospital Británico de Buenos Aires

 

References:

  • McHardy A, Golf injuries: a review of the literature. Sports Med 01-Jan-2006; 36(2): 171-87.
  • Kobriger SL, The contribution of golf to daily physical activity recommendations: how many steps does it take to complte a round of golf?. Mayo Clinic Proc – 01-Aug-2006; 81(8): 1041-3.
  • McGwin G Jr, Zoghby JT, Griffin R, Rue LW,  Incidence of golf cart-related injuries. J. Trauma 2008 Jun; 64(6): 1562-6.
  • Watson DS, Mehan TJ, Smith GA, McKenzie LB. Golf cart-related injuries in the US.  Am J Prev Med, 2008 Jul; 35(1): 55-9.
  • Parziale JR. Golf injuries and rehabilitation. Phys Med Rehab Clin N Amer 2006 Aug; 17(3): 589-607.
  • Moran KA. Dynamic stretching and golf swing performance. Int J Sports Med 2009 Feb; 30(20: 113-8.
  • Sell TC. Strength, flexibility and balance characteristics of highly proficient golfers. J Strength Con Res 2007 Nov; 21(4): 1166-71.
  • McHardy A. One-year follow-up study on golf injuries in Australian amateur golfers.Am J Sports Med  2007 Aug; 35(8): 1354-60.