Sedate game capable of taking its toll

GOLF:IN CONTRAST with other sports, golf is a rather sedate, even benign, activity. Unlike hockey or hurling, there are no flaying sticks made from hickory or ash clashing with bone or muscle. Unlike rugby, soccer and Gaelic football, there are no crunching or sliding tackles or off-the-ball shenanigans to worry about.

And, yet, as professionals and amateurs alike have discovered, there are no shortage of injury concerns associated with the sport.

No one is immune. Tiger Woods, the long-time world number one, has been dogged with injuries – mainly associated with the knee – which have necessitated numerous operations and long spells away from tournament play. He is not alone. A large number of tour players have, at one time or another, been subjected to injury ranging from knee to back to elbow and wrist amongst others.

Not surprisingly, medical studies in the United States, Europe and Australia have pinpointed lower back pain and wrist injuries as the most common complaints – among both professional and amateur players – followed by injuries to the upper extremities, elbow and shoulder. In these studies, it found that professionals experienced a higher number of wrist injuries and amateurs were more susceptible to elbow problems.

Dr Suzi Clarke, from the Sports Surgery Clinic in Santry, Co Dublin, has encountered all of these injuries, from the common to the more bizarre. Apart from back complaints and such like, the more unusual include people falling into bunkers, ditches and rivers, being hit by golf balls or clubs on the backswing of their playing partners, or – not related to the actual playing of the game – being hit by golf carts or involved in cart crashes. The most unusual? “Does someone choking on their steak at the 19th hole count?” she wondered.

“Lower back is probably the most common, as there is often an exacerbation of previous (medical) conditions and also it affects people with degenerative changes, wear and tear, leading to disc problems,” she explained, adding: “The biggest thing any player can do to prevent injuries is to have an adequate warm-up. And, if you do get injured, it is important to get the injury attended to as soon as possible.

“I know stats show that the majority of professionals will at one stage or another play through injuries on the basis that, if they don’t play, they don’t get paid.”

However, she finds that amateur golfers – including high handicappers – can be quite stubborn in attempting to play through injury and, in many cases, exacerbating those injuries.

“That’s the hardest part about sports medicine, telling people not to play. Most of the time, doctors are trying to get people to be active then, when they come in, and they’re coming for a reason because they are injured, you’re telling them to rest,” she said.

In terms of injury prevention, Clarke is an advocate of pilates.

“Really, really good . . . it strengthens up your core, (gives) a strong lower back, strengthens all the abdominal muscles and your lumbar muscles as well as hip, flexors. It’s my biggest recommendation . . . people that are playing golf are in an older age category, so tend to be dealing with a lot of pre-existing conditions. My advice is to strengthen up as much as possible. It’s easy stuff. For example, just by lifting a can of beans (repeatedly), you can strengthen up your wrist flexors.”

One Australian study highlights the frequency of injuries in golf amongst club players, putting the likelihood of sustaining an injury at 16 per cent. The lower back (18.3 per cent) was the most likely area to be affected, with the elbow/forearm (17.2 per cent), foot/ankle (12.9 per cent) and shoulder/upper arm (11.8 per cent). It was found that 46.2 per cent of all injuries were reportedly sustained during the swing and injury was most likely to occur at the point of ball impact (23.7 per cent), followed by the follow-through (21.5 per cent).

Another study in the British Journal of Sports Medicine found that technique combined with preventative measures can minimise injuries of the back, shoulders, elbows and hands.

“Rotating the shoulder and hip a similar amount during the backswing and keeping the spine vertical during the follow-through can reduce lumbar spine strain . . . shortening the backswing can decrease pressure on a degenerative acromioclavicular joint,” it argued.

Woods’s plight with his knee injury in recent years has served to highlight this particular complaint. As Clarke observed, “Knee injuries tend to be overuse injuries than anything. They tend to be the lead knee – so, in a right-handed golfer, it’s most often the left knee; in a left-hand golfer, it is the right knee. That’s how it tends to be. It comes on the downswing. You get a lot of pressure on the outside of the knee. And, from a golf point of view (at club/social level), you also get people walking for four hours that probably wouldn’t walk for four hours in any other circumstance, so you tend to get exacerbations of previous problems from a knee point of view.”

Apart from knee injuries, the other big one is the elbow. Although there is a complaint called Golfer’s Elbow – “Medial Epicondylitis” – which is very painful, golfers can also get Tennis Elbow – “Lateral Epicondylitis” – which, according to Clarke, is actually more common in golfers.

One of the treatments now used for these elbow injuries is platelet rich plasma therapy which Clarke explained as, “therapy where we actually take blood out of you, spin it down and get the plasma which is the yellow stuff that comes to the top.

“Inside of that are platelets, and inside the platelets are growth factors, there are six different growth factors, and they are injected back in if there is a tear into the tendon origin and that stimulates regrowth of the tendon area. It has quite good success.”

As ever, prevention is the key and medical advice is that good pre-round stretching have been shown to decrease these problems. The key to prevention for ordinary golfers would seem to be proper warm-up routines.

One US survey showed that over 80 per cent of golfers – at club level – spent less than 10 minutes warming up before a round. Those who did warm up were found to have had less than half the incidence of injuries of those who did not warm up before playing.

Lower handicap and professional golfers were more than twice as likely to warm up for more than 10 minutes as compared to other golfers.

PAIN GAME: Golfers and their injuries

Tiger Woods (Knee)

Tiger Woods hasn’t played since withdrawing from The Players Championship in May. Woods suffered a Grade 1 medial collateral ligament (MCL) strain to his left knee and a strain to his left Achilles tendon during the third round of the Masters at Augusta in April. The MCL is the ligament that reinforces the inner aspect of the knee joint, running from the femur (thighbone) to the tibia (shinbone).

Shane Lowry (Scaphoid fracture)

The Offalyman suffered a fracture of the scaphoid bone in his right wrist when he fell on ice after getting out of his car over the Christmas period last winter. The slow-healing injury led to Lowry missing a sizeable chunk of the early part of the season, before he reappeared in the Sicilian Open in March – some 119 days after his last outing on tour.

Tim Clark (Elbow)

The South African – winner of The Players Championship in 2010 – noticed pain in his left elbow after finishing runner-up in the Sony Open on the US Tour in January. He attempted to play in the Masters in April (missing the cut) and only made it through one round of the Players at Sawgrass before calling it quits. He hasn’t played a tournament in three months.

Lee Westwood (Calf muscle)

The Englishman suffered a calf muscle injury in last year’s French Open which originally kept him out of action for a fortnight. However, Westwood exacerbated the injury in the WGC-Bridgestone Invitational in early-August, missed the US PGA and didn’t return to competition until the Ryder Cup at Celtic Manor.

Vijay Singh (Arm/Knee/Back)

It’s a case of take your pick with the Fijian, who has been plagued with different injuries throughout his career. In 2008, he missed two months of the season due to tendonitis of his forearm and, then, in 2009, he underwent knee surgery that saw him miss six weeks of the season before undergoing a second surgical procedure. This year, his season has been blighted by a back injury apparently caused by compensating for the knee complaints.

ACHING JOINTS: Most common golfing injuries

1 Back

The swing puts great pressure on a the back. The pain might be mechanical or disc-related, arthritis or caused by a stress fracture, among other possible causes.

2 Elbow

Golfer’s elbow is pain and inflammation on the inner side of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow. The pain may spread into the forearm and wrist.

Also known as medial epicondylitis, it is similar to tennis elbow. But it occurs on the inside, rather than the outside, of the elbow

3 Knee

There are various causes of knee problems related to golf. Many are due to the rotation throughout the body required during the backswing and follow-through.

4 Shoulder

Shoulder pain is caused by several underlying conditions, including rotator cuff tendonitis or a tear or impingement in the rotator cuff; by A-C joint arthritis, or instability in the joint.

5 Wrist

DeQuervain’s Tendonitis causes pain near the base of the thumb and is caused by an inflammation in the tendons that control the thumb.