Sports Medicine: Just the Facts

amateur versus the professional golfer (Fu and

Stonem, 2001).

• The amateur golfer typically has a more varied stance
  and leans away from the ball at impact and follow
  through. This results in the “reverse C” position of the
  lumbar spine at the end of the follow through and
  increases the torque on the vertebrae (Fu and Stonem,
  2001). The professional’s swing is smooth and refined
  from repetition, which results in coordinated muscle
  firing throughout and an upright stance at the end of
  follow through (Metz, 1999).


• These increased forces put many golfers at risk for
  muscle strains, herniated nucleus pulposus(HNP),
  facet arthopathies, and spondylosis/spondylolisthesis.
  
  
  1. The lumbosacral strains typically occur during
     activity and are relieved with rest. There is tender-
     ness over the affected soft tissue area and no radi-
     ologic abnormalities.
  
  
  2. The HNP and sciatica are almost always associated
     together. Ninety-five percent of all HNPs occur at
     L4–L5 or L5–S1 and these nerve roots provide
     sensory and motor functions to the lower extremity
     (Fu and Stonem, 2001).
  
  
  3. Facet arthropathies and spinal stensois are related
     as a dysfunction that develops at the posterior facet
     joints producing a narrowing of the spinal fora-
     men. The pain is often increased with extension
     and sidebending to the affected side.
  
  
  4. Spondylosis (disruption of neural arch) and a
     resulting spondylolisthesis (anterior displacement
     of one vertebral body on another) occur from the
     significant torque produced during the coiling and
     uncoiling of the lumbar spine. This torque causes
     fractures at the pars interarticularis, which allows
     the vertebral body to slide either anteriorly or pos-
     teriorly. This displacement can cause impingement
     of the spinal nerve roots or cord.
  
  
  
  


• Most injuries can be managed conservatively as
  greater than 90% recover in 4 weeks after injury (Fu
  and Stonem, 2001); however, some “red flags” should
  alert the clinician of underlying pathology: back pain
  in a patient over 50- or less than 20-year old; a history
  of cancer; constitutional symptoms of fever, night
  sweats, weight loss, and the like; bowel and/or blad-
  der dysfunction; and saddle anesthesia. If any of these
  are positive, a more complete work up with imaging
  studies would be indicated. If no red flags are present,
  the patient should be encouraged to perform activities
  that their pain tolerance allows (active rest), use ace-
  tominophen and nonsteroidal anti-inflammatory
  drugs(NSAIDs) as required, perform flexion, and
  extension strengthening exercises with or without
  physical therapy and have their golf swing mechanics
  reviewed on return to play.

SHOULDER INJURIES

•Overuse injuries predominate shoulder injuries in golf

(Jobe and Pink, 1996). The leading, nondominant

shoulder is typically affected due to its range of

motion during the swing. The shoulder goes through

internal rotation, adduction, abduction, and then

external rotation.

• The acromioclavicular joint or region is the most
  often injured area followed by impingement and rota-
  tor cuff tendinitis, posterior glenohumeral subluxa-
  tion, rotator cuff tears and glenohumeral arthritis
  (Mallon and Colosimo, 1995).


• History of the timing of the pain during the swing
  helps with diagnosis. Anterior leading shoulder pain
  during the back swing is often a sign of impingement
  or acromioclavicular(AC) joint arthritis.
  •Treatment of the degenerative AC joint includes short-
  ening the backswing and weight training with a focus
  on the rotator cuff muscles. Reviewing the swing
  mechanics will also be beneficial.

ELBOW INJURIES

• The most common upper extremity injury in the male
  and female amateur golfer (McCarrol, Rettig, and
  Shelbourne, 1990). Most elbow injuries occur at
  impact secondary to the requirement of significant
  counteracting forearm muscle force to maintain con-
  trol of the clubface.


• The two most common elbow injuries are medial and
  lateral epicondylitis. These are most frequently asso-
  ciated with overuse and excessive grip strength
  (McCarrol, 2001).
  
  
  1. Medial Epicondylitis (golfer’s elbow)
     a.Overuse injury of medial aspect of elbow
     involving epicondyle of the humerus, wrist and
     finger flexor muscles, and pronator muscles.
     b.Right medial epicondylitis in a right handed
     golfer results from extension of right elbow
     during impact phase of swing, while right wrist
     remains dorsiflexed.
  
  
  2. Lateral epicondylitis
     a. Overuse injury involving lateral epicondyle of
     humerus, wrist and finger extensor muscles, and
     supinator muscles.
     b.Left lateral epicondylitis in a right handed
     golfer results from forceful contraction of left
     elbow extensors during impact phase of swing
     (Metz, 1999).
  
  
  3. Three common therapies for these elbow injuries
     are counterforce bracing, equipment modification,
     and physical therapy.
  
  
  
  

498 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS