Golf is high-velocity sport that requires the same joints and soft tissues to rotate in one direction with every swing. As a result, most golf injuries develop over time rather than during a single swing, explains physical therapist and golf fitness trainer Scott Robin, DPT. “The golf swing is a complex movement that requires the entire body to work together to produce consistent and accurate shots,” says Dr. Robin. “The body works together in what’s called the kinetic chain, with each segment having a specific role like an assembly line. When one segment is not functioning properly (such as a stiff hip), the next segment in the assembly line (in this case, the lower back) is forced to compensate in an unnatural way. These movement compensations increase injury risk and become a greater threat the more golf you play.”
Here, Dr. Robin explains the five body regions that golfers injure most often…why these injuries occur…and how to prevent them altogether…
Low back
During a golf swing, the compressive forces on your low back reach up to eight times your body weight. When you add up the thousands of swings during a season, it’s no surprise that most golfers experience back pain at some point.
Causes of golf-related low-back pain
Early extension and reverse spine angle are the most common swing technique errors causing lower back pain in golfers. Early extension occurs when your hips move forward toward the ball during the downswing before contacting the ball. Reverse spine angle occurs when your trunk leads toward the target at the top of the backswing.
The two most common golf lower back injuries are…
Osteoarthritis: The surfaces of the small, paired joints at the back of each vertebra (known as the facet joints) that act as hinges to allow spinal movement in your low back—or lumbar spine—rub together, causing cartilage to wear away over time and resulting in osteoarthritis.
Disc herniation: Repetitive rotation of the spine can cause an intervertebral disc to bulge or herniate. When this happens, disc material protrudes into the spinal canal and can place pressure on nearby nerve roots, causing pain, numbness, tingling and/or weakness in the legs. This is commonly referred to as sciatica.
Prevention strategy
Stretching the hips and spine, while strengthening the core and glute muscles will improve the stability of the lower back and help prevent poor technique. A sedentary lifestyle can lead to both stiffness and weakness, so get moving and limit the amount of time spent sitting.
Elbows
The wrist and forearm play an important role in guiding the orientation of the clubface when contacting the ball. The muscles that control the wrist and forearm originate at the elbow. The tendons associated with these muscles are vulnerable to tendinitis, an overuse injury described as degeneration and micro-tearing of the tendons. A sudden injury only happens in rare occurrences when a club gets stuck in the turf or smacks an exposed tree root.
Causes of golf-related elbow pain: The most common cause of elbow pain in golfers is a rapid increase in playing without allowing enough time for the tissues to recover and adapt. Another notable contributor: An arm-dominant swing rather than rotating with the hips and trunk. Lastly, hitting off low-quality, unforgiving mats—rather than off real grass—can send shock through the elbows.
The two most common golf injuries to the elbow include…
Golfer’s elbow (medial epicondylitis): Pain on the inner part of your elbow. You are more likely to develop golfer’s elbow in the trail elbow (the right elbow for a right golfer…the left for a lefty) due to the nature of the swing.
Tennis elbow (lateral epicondylitis): Pain on the outer aspect of the elbow. Tennis elbow tends to affect the lead elbow (the left for a lefty golfer…the right for a righty).
Prevention strategies
Gradually increase the number of rounds you play each week. Work on grip strength at the gym with weight exercises that target the wrist and forearm muscles. Hit off grass during practice when possible.
Knees
Injuries are more common in the lead knee (the left knee for a righty golfer and the right knee for a lefty golfer) because the lead leg anchors the swing. The knee is not designed to rotate, but if your lead hip and ankle don’t rotate well, your knee will take on that rotational torque, which can irritate the joint surfaces and wear away cartilage and connective tissues. In particular, the meniscus, which acts as the knee’s spongy shock absorber, can be torn. Being overweight adds to the risk. If you have natural age-related wear and tear on the knees (as well as back and hip joints), playing golf can exacerbate it.
Other risk factors: Weakness in the muscles that surround the knee…awkward hitting stances, such as with bunker shots and sloped terrains…technique issues, including not extending your knee naturally when rotating toward a target…and having a swing fault called a slide—you’re supposed to transfer your weight to your lead side to strike the ball effectively, but some people do it too much. Sliding aggressively toward the target puts too much pressure on the outer part of the knee.
Prevention strategies
Stretch your hips and ankles before each round. Correct your swing technique. Wear a compression brace to control swelling if you have knee arthritis. Elevate your legs and apply ice after playing. Lastly, if a physician has medically cleared you to take ibuprofen or naproxen, these over-the-counter anti-inflammatories can reduce pain.
Hands and wrists
These injuries tend to affect professional golfers more than amateurs. Any time you’re hitting a ball in the rough or near exposed tree roots, your wrist can get pushed beyond its normal range of motion, leading to a ligament sprain. You also can get tendinitis of the tendons that cross over the wrist joint from repetitive overuse, especially if you’re swinging with poor technique.
Prevention strategy
Get properly fitted by a golf professional who will ensure that your club size matches your body type. This will allow your wrists to sit in a neutral position. Strengthen hand and wrist muscles with free weights to lessen pressure on ligaments.
Lead hip
Similar to the lead knee, this area is prone to injury because of the natural weight shift and rotation required in the downswing and follow-through. Both rotation and weight-bearing forces can irritate joint cartilage (labrum). Tendinopathy or tears of the outer glute muscle of the lead hip can occur if the muscle isn’t strong enough to take on that stress.
Prevention strategy
Strengthen your glutes and core muscles. When you are setting up the ball, make sure your back is straight—excessive curve or rounding in the back will throw off the position of your hips. Avoid sliding your hips too far laterally toward the target during the downswing.
Preventing Injuries
The following steps can help you prevent common golf injuries or a recurrence after an injury…
Recognize the importance of a warm-up
A lot of people go straight from the parking lot to the first tee. Others get in a few swings at the driving range, thinking that’s enough to warm up their body.
Better: Before you go to the range, spend 15 minutes on dynamic stretching targeting the hips, spine, shoulders, elbows and ankles. A proper dynamic warm-up improves flexibility, lubricates joints, increases blood flow to muscles, and enhances swing speed. Examples of effective dynamic stretches: Toe touches…back bends…squats…hip airplanes.
Bonus: Dynamic stretching improves neural activation—your brain’s ability to communicate with your muscles faster—and your coordination throughout your swing. Note: Static stretching (when you hold a stretch for 30 seconds or so) can decrease your neural recruitment despite improving range of motion, so save these stretches for after the round.
Correct swing technique
Get an evaluation from a golf instructor, including a video analysis of your swing. Look for a golf instructor with the Titleist Performance Institute (TPI) (MyTPI.com) certification. The TPI certification is a continuing-education course for golf instructors, fitness professionals and medical professionals on how to evaluate a golfer’s physical capabilities, such as strength, range of motion, balance and coordination, and how to understand how those capabilities impact swing. A TPI-certified golf instructor will show you how to clean up mechanical faults to make sure you’re swinging with the least amount of stress on your body.
Strength train
Get yourself into shape by developing all the muscle groups that support the joints and ligaments required for golf. Examples: Train your core to be strong in a neutral mid-range position—not excessively extended or excessively flexed—to reduce pressure on joints, discs and nerves when rotating. Bridges, squats, deadlifts and hip thrusts can address lower-body strength. If you need guidance, ask a TPI-certified fitness professional or physical therapist to create workouts tailored to your golf needs. If you increase your strength and mobility and improve your swing mechanics you not only will reduce your risk for injury…you will increase your performance.
