How common are golf injuries and who gets them?

Golf may be a 'gentleman's sport', but it certainly isn't as gentle and innocuous as it appears. Golf injuries occur with surprising frequency to both the professional and the amateur golfer alike. It is estimated that about 60% of golfers will experience a sport related injury at some point in their lives.

All golfers, regardless of the level at which they play, should know what causes the most common injuries, what their symptoms are, and when they should seek the help of a physician.

Incidence of Golfing Injuries†

PROFESSIONALS

AMATEUR

Injuries to the upper limbs (shoulder, elbow, wrist, and hand) account for more than half of the total injuries sustained while playing golf. The majority of these injuries occur to the left (lead) side of the body. Interestingly, gender may also have an impact and female professional golfers are particularly prone to wrist and hand injuries (which amount to about one-third of injuries to women) while male professionals suffer wrist and hand injuries at about half that rate.

What are the causes of upper limb injuries in golf?

Golf requires both focused force and repetitive actions. The vast majority of golf injuries are not the result of a single traumatic incident but occur as a result of tissue damage sustained over time. In general, professionals suffer as a result of overuse; while most problems among amateurs result from poor technique, especially swing mechanics or technical errors near impact.

It is often a combination of several factors that contribute to amateur golfer injuries. These include:

• Overuse (excessive play or practice)

• Failure to warm up properly

• Poor swing technique / mechanics

• Poor physical conditioning (fitness and flexibility)

• Hitting the ground or an object during a swing.

The metacarpal and finger bones in the hand are connected to the wrist by an intricate web of ligaments, tendons and tissue. The wrist and hand absorb the brunt of the impact whenever the head of your club strikes the ball (or the ground!). Over time, repetitive strain and improper wrist motion can cause fractures, sprains, and inflamed tendons, which may eventually cause chronic pain and decreased mobility.

What common types of golf injuries affect the upper limb/wrist and hands?

Most golf injuries fall into the general categories of strains, sprains, fractures, and tendonitis. Some of the more common upper limb injuries include:

Tennis Elbow / Golfer's Elbow

Golfer's elbow (medial epicondylitis) is an inflammation, soreness or pain on the inside of the upper arm near the elbow, whereas Tennis elbow (lateral epicondylitis) is an inflammation, soreness, or pain on the outside of the upper arm near the elbow. Interestingly, Tennis elbow is actually more common among golfers than golfer's elbow.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a repetitive stress disorder that affects the nerves of the hands causing tingling 'pins and needles' and numbness of the fingers and clumsiness of movement. When severe, carpal tunnel is extremely painful and sometimes incapacitating. If neglected, muscle weakness can be progressive.

De Quervain's Tendonitis

De Quervain's causes pain in the wrist near the base of the thumb, especially during thumb extension and forceful pinching. It is caused by an inflammation in the tendons that control the thumb.

Trigger Finger

The condition is caused when the flexor tendon sheath is inflamed and inhibits smooth gliding during finger excursion. This causes fingers to lock up and results in the characteristic 'clicking' or 'snapping' of the finger and pain in the palm.

Wrist Impaction Syndrome

Impaction syndromes of the wrist result when the wrist bones clash into one another due to excess or repetitive movements, causing synovial inflammation, cartilage wear and tear, chronic wrist pain and swelling.

ECU Tendon Subluxation

Extensor carpi ulnaris (ECU) tendon subluxation is caused when the sheath holding the wrist tendon begins sliding in and out of its groove, causing recurrent wrist pain.

Fracture of Hamate Bone

The hamate is a small bone on the pinky side of the wrist and has a small prominence called the hook, which protrudes into the palm. The way most golfers grip their clubs puts the butt-end of the club right up against the hook of the hamate during the swing, which can fracture during impact.

Shoulder Pain

Shoulder pain in a golfer might be caused by any of several different underlying conditions, including: rotator cuff tendinitis, or a tear or impingement in the rotator cuff; A-C joint arthritis; or instability in the joint.

How do we avoid or minimise golfing injuries to the upper limb?

Spending some time with a Golf-Pro can go a long way to help developing good habits and technique such as proper swing mechanics and club grip. They can also provide advice to customise the content and frequency of your training sessions so that you can make the most of your time on the course and at the range, while still having enough time to rest and recover.

Investing in proper equipment that suits your technique, body type and gender, can help minimise excessive strains on the body, and allows you to enjoy the game even more.

Avoid overtraining, but proper conditioning is important. Engage in other sports or exercises like running and cycling, swimming or going to the gym, between your sessions of golf. This can in fact increase your overall fitness and endurance, improving your game; while allowing different regions of your body the intervals it requires to recuperate.

And don't forget to warm-up before your game! Warming up before golfing has been shown to decrease the incidence of golf injuries. One survey showed that over 80 percent of golfers spent less than 10 minutes warming up before a round, but those that did warm up before playing had less than half the incidence of injuries of those who did not.

When should we seek medical/surgical therapy and what are the goals of treatment?

When pain or other symptoms persists despite rest, icing and simple pain medications, seek help from your doctor. Early diagnosis of the cause and proper treatment can make a significant impact on the speed and quality of recovery.

Treatment begins with clinical diagnosis, rest, medication, splinting, and simple non-surgical treatments. When surgery is required, minimally invasive approaches can now be offered. Doctors and the therapists we work with, aim to formulate individualised plans that allow a safe, comfortable and graduated return to training, and participation in their favourite sport of GOLF!

Golf Digest Article

Dr. Jonathan Lee has contributed an article which is to be published in the September issue of Golf Digest magazine. Full-sized version can be downloaded here (PDF).

† McCarroll J, Gioe T: Professional Golfers and the Price They Pay. The Physician and Sports Medicine 10(7): 64-70, 1982. McCarroll J, Rettig A, ShelbourneK: Injuries in the Amateus Golfer. The Physician and Sports Medicine 18(3):122-26, 1990.