INJURY PREVENTION TABLE 1: INJURY PATTERNS BY GENDER AND PLAYING LEVEL Site

Lower back Elbow

Wrist/hand Shoulder

36

32.5 21.2 11.1

Amateur Amateur men

27.4 35.5 14.5 16.1

from the top of the back-swing through to the end of the follow-through. Research studies have shown that there is signifi- cantly greater loading in the lumber spine in amateur than professional golfers (2). This is mainly attributed to higher levels of paraspinal muscle activity in the lower level players (3). These loads are most notable in the torsional and shear direc- tions. Such loads may lead to injury either to the intervertebral discs, to the facet joints or to muscle strains.

Two factors greatly enhance the risk of back injury: 1) The tendency of lower level players to try to hit the ball too hard. In so doing they rely greatly on increased muscular effort, particularly of the trunk muscles and as a consequence run the risk of mus- cular overload. 2) The other risk factor is associated with poor timing of the trunk rotations. During the backswing, this may involve a greater rotation of the shoulders relative to the hips, creating a larger torsional load rather than keeping the trunk more neutral and rotating about the hips. During the follow- through if the trunk is extended whilst rotating then loading on the facets is greatly increased.

Elbow The other most common site for amateur golfers to get injured is at the elbow. Epicondylitis may develop in either the medial or lateral aspect of the elbow. This is more common on the lateral aspect despite the classic “Golfers’ elbow” being described as a medial epicondylitis. Generally the condition is associated with an excessive grip tension throughout the swing linked to the cocking and uncocking movements of the wrists during the down- swing and ball contact. Reducing grip ten- sion either by learning to relax or by changing the size of the grips on the clubs

12 Figure 1: Site of medial epicondylitis (golfers elbow)

Frequency of injury % women

25 7.3

29.6 11.4

Professional men

Professional women

22.4 6.0

44.8 7.5

the whole shoulder girdle to create a co- ordinated movement. Any failure to cor- rectly manoeuvre the scapular during the swing will increase the risk of impinge- ment. Even if the movement is well co- ordinated the scapula stabilisers (rhom- boids, serratus anterior and levator scapu- lae) and the rotator cuff (in particular subscapularis) are placed under signifi- cant load by the rapid motion of the upper limb bought about by pectorialis major and latissimus dorsi.

Reducing the range of the backswing will provide both relief and protection from such injuries and should not have a major impact in ball speeds. Some evidence exists to show that introducing a specific conditioning programme for the rotator cuff and scapula stabilisers can help reduce the risk of developing shoulder injuries (4).

Wrist and hand The final group of injuries to consider are those to the wrist and hand. These may occur as traumatic injuries in the less-able player as a consequence of a ground impact, or through overload during play from the longer grass and undergrowth of the rough. Such ‘ground impacts’ cause a sudden deceleration of the club head often accompanied by a forced rotation. This combination of loading may result in a Hamate fracture or strain to the extensor carpi radialis of the left arm and flexor carpi radialis (and ulnaris) on the right.

Figure 2: Site of lateral epicondylitis (tennis elbow) may have a beneficial effect (3).

Shoulder In the higher level golfer, errors such as over-hitting the ball, over-rotating the trunk or gripping the club too tightly gen- erally don’t occur. Rather these players fall victim to over-use syndromes associated with the large ranges of motion employed at the shoulder and wrist joints.

For the right-handed player the left arm undergoes an extreme range of adduction and internal rotation during the back- swing and then abducts and externally rotates during the follow-through. These movements require not just good gleno- humeral movement but place demands on

If the wrists are uncocked too early in the swing there will be an increased load on the extensor carpi ulnaris as a result of the early and excessive ulnar deviation. This can lead to tendonitis problems in the first dorsal compartment.

With all of the injuries described, the risk of occurance is greatly enhanced with an increase in shot frequency. Taking a buck- et of 100 balls on a driving range presents a much greater risk for the development of fatigue and overload than playing an 18 hole round. While playing an 18 hole round there should be regular changes in the club used and the distance required to strike the ball, along with relatively long rest periods between shots whilst the player moves to where the ball has landed. By contrast on the driving range, a player may hit 20-30 shots or more with the same club in quite a short time.

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