Golf Series: Part One - Elbow, Wrist, and Shoulder Injuries
Golf is an “explosive sport”, a term used to describe the rapid development of force or power. The golf stroke includes the rapid acceleration of the club head toward the ball, a complex process that includes use of the lower extremities, hips, trunk, shoulders, elbow and wrist. If you participate in an explosive activity, you are at risk incur injuries, as tissues are stretched beyond their elastic limits.
Golf can also be seen as an endurance sport when one considers the repetition golfers perform as they work to perfect their strokes. In turn, this repetition causes overuse injuries. In this two-part blog series, we will identify common golf injuries, treatments, and prevention methods that will help keep you pain free on the course.
PART 1: COMMON UPPER BODY GOLF INJURIES
As spelled out in the comprehensive review article published in the January, 2018 issue of the Journal of the American Academy of Orthopedic Surgery:
Upper extremity injuries can affect the hands, elbow, and shoulder and are usually a result of the golf swing at impact.
Golf injuries can be either acute or chronic, resulting from overuse. Most injuries are the result of overuse, and left untreated, they can lead to chronic musculoskeletal problems.
To best illustrate elbow injuries in golf, a friend’s recent experience comes to mind:
Paul’s golf ball landed in the pine straw at the base of a tree. The ground was uneven so his feet were positioned with one higher than the other. As he swung, his lead foot slipped in the pine straw and caused him to hit the ground before the ball. Due to the force with which he hit the ground, he tore his rotator cuff and damaged the medial (inside) elbow.
Hitting the ground before the ball is unaffectionately called “hitting fat.” Hitting fat shots, which unfortunately many golfers know all too well, can cause partial tears and complete rupture of tendons in one fell swoop. It can involve either the medial (inside) or lateral (outside) tendons of the elbow.
Golfers are often subject to both medial and lateral epicondylitis, commonly referred to as golfer’s elbow (which my friend Paul was diagnosed with after the incident described above) and tennis elbow respectively. The medial forearm muscles are responsible for finger flexion, wrist flexion, and pronation (turning the hand to the palm down position.) Lateral forearm muscles oppose the medial muscles and extend the fingers and wrist and supinate (palm up position) the hand.
Proper technique, as in all sports, is imperative to prevent injury. Golfers should pull the club through with the lead arm rather than pushing it through with the trailing arm. Trouble occurs when bad technique puts excessive burden on the tissues surrounding the elbow. Overuse is also typical for the aggressive athlete who practices the same stroke over and over and does not respond to the warning signs of impending injury.
The wrist is also susceptible to injury from these traumas and therefore resulting injuries and pain are common. Tendon sheath rupture and even fracture of the hamate bone are frequently reported. Again, “hitting fat” is the most common cause of these problems. Overuse injuries are more likely associated with tendonitis, generally involving the ulnar (lateral) wrist.
Shoulder pain is a shared experience among golfers and most often attributed to rotator cuff disease and subacromial impingement. Although not an overhead activity, the extremes of abduction and adduction (movement away from and across the body) put stresses on the joint. This illustration, available from the Mayo Clinic, shows the anatomy of shoulder injuries most common to golfers.
Impingement syndromes occur when the rotator cuff gets pinched between the humeral head and the acromium. A detailed understanding of anatomy is not necessary to see in this illustration that the bursa that protects the tendons from rubbing against the unforgiving bone. Injuries that cause inflammation and swelling of the shoulder complex can result in damage to the tendons. Overuse is also a culprit activity that can cause damage to the tendons and is seen more frequently in low handicap golfers who have worked diligently on perfecting their swing.
To close the story on my friend Paul mentioned above, his necessary shoulder surgery to repair his torn rotator cuff was successful. By necessity, he had to rest his elbow as he was recovering from the shoulder surgery and this recovered as well. He has returned to both golf and tennis and is an avid supporter of Body Helix’s shoulder and elbow compression wraps, both of which he continues to wear to prevent re-injury.
UPPER EXTREMITY INJURY MANAGEMENT
Management of elbow, wrist, and shoulder injuries includes rest, ice, compression and avoiding the culprit activity. A visit to a coach, trainer, therapist, or physician can generate a technique review and correction of a bad stroke. If compression is desired, be sure to use a sleeve or wrap that does not restrict motion since this will likely throw off the mechanics and you’ll replace one injury with another. Body Helix compression sleeves are made of the highest quality compression material available and will stretch more than the human body. What this means for you is simple: you won’t need to alter your game when you play.
J Am Acad Orthop Surg 2018;0:1-8
Am J Sports Med 2003; 31(3):438-443
Am J Sports Med 2007;35(8):1354-1360
Br J Sports Med 1992;26 (1):63-65
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