Dr. Cunningham: Common golf injuries and treatments (column)
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Golf is a great sport and people of all ages play the game. In 2009, it was reported that about 25 million people participated in golf in the U.S.
In one study, there were 0.5 injuries per 1,000 hours of golf played per person. The most commonly injured site is the low back, followed by the elbow, forearm, shoulder, hip and ankle.
Most golf injuries are related to overuse from playing or practicing too much and/or due to poor swing mechanics. In one study, approximately 80 percent of injuries were chronic, overuse conditions and only 20 percent were due to a single, traumatic event.
Professional golfers had a higher incidence of injury than recreational golfers. Those who carried their bag had a higher incidence of injury. Those that had warm up routines of at least 10 minutes had a lower incidence of injury.
As for shoulder injuries, pain from subacromial impingement was common. With this, the rotator cuff tendon on top of the shoulder impinges up against the overlying acromion bone. This results in rotator cuff tendonitis or tearing of the rotator cuff tendon.
With tendonitis or small partial rotator cuff tendon tears, most patients can be treated non-surgically utilizing physical therapy, NSAIDs and possibly a cortisone injection. However, full thickness rotator cuff tears are best treated with surgical repair in active people as they will not heal on their own and the tears get larger and further retracted over time.
Acromioclavicular (AC) joint inflammation is also a common source of shoulder pain in golfers. Most of us have AC joint arthritis by the time we are 40 years of age, but most of us do not have pain associated with this small joint getting arthritic. However, as a golfer repeatedly brings their arm across their body, there is compression of the AC joint, and this can inflame the arthritis and make it worse over time, leading to pain over the top of the shoulder where the AC joint is located.
STRAIN ON ELBOWS
Elbow injuries are common in golfers, usually as a result of overuse.
Players that grip the club too tightly cause increased strain in the tendons around the elbow. Epicondylitis is tendonitis that develops where the tendons attach to the bones around the elbow.
When a golfer hits the ground prior to hitting the ball, the sudden arm deceleration places high stresses on the tendons about the elbow, and this can lead to medial or lateral epicondylitis.
Normally, this can effectively be treated with physical therapy, limitation of play and NSAIDs. Physical therapy is focused on stretching, forearm strengthening and therapeutic modalities. Cortisone or platelet rich plasma (PRP) injections may be used. Some golfers benefit from going to lighter weight graphite shafts instead of steel shafts. If someone tears the tendons off the bone at the elbow, then these usually require surgical repair.
Low back injuries are the most common injury in golfers. There is significant rotational loads and shear and lateral bending forces in the lumbar spine with a golf swing.
Back injuries in golfers include muscle strains, disc herniations, vertebral body stress fractures and, with repeated stresses, facet joint arthritis. Exercises that help to improve core stability can help make one’s spine less likely to suffer from one of these injuries.
Hip injuries are not uncommon in golfers.
The high rotational and shear forces in the hip joint can cause acetabular labral tears usually in the setting of bony impingement that develops over time. Physical therapy can be effective at restoring normal balance to the hip musculature so that this condition is less bothersome, but some people will ultimately come to hip arthroscopy with labral repair, reconstruction or labral debridement with removal of the bony impingement.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team. Visit his website at http://www.vailknee.com. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.