Sports Medicine: Just the Facts

CHAPTER 84 • GOLFING INJURIES 497

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84 GOLFING INJURIES

Gregory G Dammann, MD

Jeffrey A Levy, DO

BACKGROUND

• Golf likely was invented in twelth century in Northern
  Europe (Mellion, Walsh, and Shelton, 1997).


• First golf course was built in the United States in 1888
  (Fu and Stone, 2001). It has significantly grown in
  popularity during the 1990s with greater than 14,000
  golf courses in the United States in 1994 (Metz, 1999).


• The National Sporting Goods Association estimates
  18–20 million Americans play golf at least two times
  per year.
  
  
  • As a sport, golf is classified as a noncontact, low
    intensity sport. Only moderate cardiovascular fitness
    is required.
  
  
  • Most injuries result from the golf swing, the equip-
    ment, or objects, excluding the ball, on the course.
  
  
  
  

THE GOLF SWING

• The swing comprised of multiple coordinated move-
  ments of different parts of the body: the hands, wrists,
  arms, trunk, and legs.


• There are four phases:
  
  
  1. Backswing: Rotation of the trunk, raising the arms,
     and cocking the wrists while drawing the club head
     away from the ball. This is often called coiling.
  
  
  2. Downswing: Movement of the club head toward
     the ball using the shoulders and uncocking of the
     wrists. Often called uncoiling.
  
  
  3. Acceleration and ball strike: The arms and trunk
     continue to rotate back toward the ball and the
     wrists are uncocked. The leading wrist also
     supinates while the trailing wrist pronates. This is
     the fastest portion of the swing.
  
  
  4. Follow through: Momentum of the swing contin-
     ues with rotation of the shoulders and trunk while
     raising the arms.
  
  
  
  

EPIDEMIOLOGY

• The number one site of injury for amateur golfers is
  the lumbar spine while it is number two for profes-
  sionals (McCarrol, Rettig, and Shelbourne, 1990;
  McCarrol and Gioe, 1982). The number one for pro-
  fessionals is the hand/wrist region (McCarrol and
  Gioe, 1982).
  •Twenty-five percent of amateurs are injured due to
  overuse, 21% from hitting the ground with the club
  during the swing and 19% are from poor swing
  mechanics (McCarrol, Rettig, and Shelbourne, 1990).


• Eighty percent of professional injuries occurred sec-
  ondary to overuse, 12% are from hitting the ground
  during the swing, and 5% are from twisting the trunk
  (excessive torque) during the swing (McCarrol and
  Gioe, 1982).

LOWER BACK INJURIES

• The lumbar spine rotates, sidebends, compresses,
  flexes, and hyperextends during the golf swings.
  These movements result in lateral bending, shear,
  compression, and torsional forces. These forces, espe-
  cially the shear force, are significantly higher in the