Golf injuries: the causes and how you can avoid them

Until recently I had dismissed golf as a mere leisure pursuit, a prejudice deepened by its practitioners’ shared phenotype of pastel-coloured jumpers and retina-melting breeks.

I was wrong.

Golf is a sport; indeed, playing golf could add years to your life, as the title of a 2009 study in the Scandinavian Journal of Medicine & Science in Sports implies. In "Golf: a game of life and death . . .", a Swedish study of more than 300,000 registered adult male and female golfers found that they had a 40 per cent reduced mortality compared with the general population.

And in 2016, a major analysis published in the British Journal of Sports Medicine noted that golf is played worldwide by more than 50 million people of all ages, observing: "Playing golf can provide moderate intensity physical activity and has overall positive associations with physical health and mental wellness, while golf may contribute to increased longevity."

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The study's lead author was Dr Andrew Murray, chief medical officer of the PGA European Tour; Ryder Cup Europe; the European Tour Performance Institute; and consultant in sports medicine at Edinburgh University.

In their 2016 study, Dr Murray’s team documented the undoubted physical and mental health benefits conferred by playing golf. But what about injuries? After all, energetic swings and high-speed balls must entail some measure of risk. The study found, however, that golf has an overall moderate risk for injury compared to other sports, citing an annual incidence of injury among amateur golfers of between 15.8 per cent and 40.9 per cent, with professionals who play more often having annual injury rates of between 31 per cent and 90 per cent.

Modern-day professional

Considering the professional game, in October 2018 Murray's team published a "Systematic review of musculoskeletal injuries in professional golfers" in the British Journal of Sports Medicine, stating that "professional golfers typically hit more than 2,000 balls per week with 73.3 per cent striking 200 balls or more per day on average. In contrast, only 19.4 per cent of amateurs hit more than 200 balls per week." This, together with the suggestion that modern-day professional golf swings generate increased torque, "may contribute to increased rates of lower back pain in professional golfers".

So what types of injuries does Dr Murray encounter most often among pro golfers? "Back, wrist and neck injuries are the most frequent," Murray told The Irish Times, "with injuries to the lower back and the left wrist – in right-handed golfers – the most common reason for missing tournaments".

As for amateur golfers, he says, “they have more elbow injuries than the pros. Most of the injuries among pros can be attributed to their volume of play. Pro swings are incredibly consistent, whereas amateurs have more variable swings and tend to acquire a wider range of injuries”.

So how easy, or difficult, are golfing injuries to treat? “Nine times out of 10,” explains Murray, “it’s pretty straightforward to know what to do. However, working with a golfer to find a solution that can be accommodated by their schedule can be trickier. Having a great team,” he adds, “including the player, a good physio and a sports doctor – plus, where applicable, coaches – can help ensure that everything is well covered.”

Aerobic exercise

What should amateurs do to avoid or minimise injury? “Do a warm-up,” advises Murray, “including a few minutes of aerobic exercise, some stretching/mobility work, and some practice shots before playing. A seven-minute warm-up will help you take shots off your score and lessen your injury risk. Ask yourself how often you have topped one off the first.”

Murray also recommends getting strong: “A weekly gym session helps lower injury risk and enables you to hit the ball farther. And if issues do arise, it helps to consult a physio and sports doctor.”

A 2016 review in the journal Retina considered 11 separate studies of golf-related eye injuries to 102 golfers. More were injured by golf balls (72 per cent) than golf clubs (27 per cent) or foreign bodies (1 per cent), and the authors concluded: "Reported ocular golf injuries occur less frequently than other ocular sports injuries but may result in devastating outcomes. Supervision of children using golf equipment should be encouraged." Murray agrees: "I'd also say it's worth ensuring your golf clubs are out of the way of children, who might be tempted to swing them around in the house, risking injury to others."

In October 2018, the journal Exercise Medicine published a review of golf and skin health. Co-authored by Murray, it notes that "the golfing population faces an increased risk of ultraviolet radiation (UVR) associated skin problems, most importantly skin cancer".

Recommendations include avoiding sunburn; recognising one’s own skin type and what levels of UV exposure lead to sunburn; being prepared for all weather eventualities and aware of UV exposure in cloudy or shaded conditions; and the liberal use of sunscreen of SPF 30 or above.

Finally, players should refrain from licking their golf balls.

In 1997, a report from Dublin in the journal Gut described how a retired engineer contracted "golf ball liver" through licking his golf ball clean during his daily round. Investigation revealed that he had ignored signs advising against the licking of golf balls because the selective weed killer 2, 4-dichlorophenoxyacetic acid had been sprayed on the course.

This compound was an ingredient of Agent Orange, a defoliant deployed during the Vietnam War.