Spinal and metabolic loading during simulations of golf play

Upper Body Injuries in Golfers

PURPOSE OF REVIEW

Golf is a sport that can be played by an athlete of any age, which enhances its popularity. Each golfer's swing is unique, and there is no "right" way to swing the golf club; however, the professional golfer often has more of a consistent swing as opposed to an amateur golfer. A collaborative, team approach involving the golfer with a swing coach, physical therapist, and physician often can be informative on how to prevent golf injury, but also how to treat golf injury if it occurs.

RECENT FINDINGS

As a rotational sport, the golfer needs to be trained and treated with respect for how the body works as a linkage system or kinetic chain. A warm-up is recommended for every golfer before practicing or playing, and this warm-up should account for every segment of the linkage system. Though it has been thought of as a relatively safe sport, injuries can be seen with golfers of any age or skill level, and upper body injuries involving the cervical and thoracic spine, shoulder, elbow, and wrist are common. A narrative review is provided here of the epidemiology of golf injury and common injuries involving each of these upper body regions. In addition, treatment and injury prevention recommendations are discussed.

Competitive Golf: How Longer Courses Are Changing Athletes and Their Approach to the Game

Nutritional guidance for competitive golfers to improve performance is limited. Recommendations and study conclusions from older research used smaller golf courses compared to today and require a reevaluation of energy expenditure. This review identifies aerobic fitness, in addition to strength, as a key determinant of success. A novel nutritional approach that incorporates carbohydrate supplementation to support aerobic fitness without sacrificing the ability to build strength is presented since longer courses require more stamina. Strategies for training, competition, and recovery are outlined based on different skill levels. American College of Sports Medicine (ACSM) guidelines for carbohydrates, protein, and hydration intake are tailored specifically for competitive golf based on this approach. Putting requires precise movement and can be affected by fatigue. Nutritional studies in golf and similar sports that require focused movements are presented, exhibiting an improvement with adequate hydration and carbohydrate status and caffeine use. Competitive golf poses unique challenges to an athlete and commonly used ergogenic supplements that can improve performance in a variety of circumstances during training, competition, and while traveling are reviewed.

Golf-related injuries treated in United States emergency departments

OBJECTIVE

This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database.

METHODS

This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data.

RESULTS

During 1990 through 2011, an estimated 663,471 (95% CI: 496,370-830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18-54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7-17years old (22.1) and ≥55years old (21.8) compared with 18-54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12-6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization.

CONCLUSIONS

Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts.

Golf-related low back pain: a review of causative factors and prevention strategies

Golf is a popular sport with both perceived and real health benefits. However, certain injury risks are also prevalent, particularly to the lower back. Epidemiological studies have shown that lower back pain (LBP) from golf account for between 18% and 54% of all documented ailments, leading many researchers to regard the condition as the most common golf injury.

The purpose of this review was to examine the scientific literature to ascertain the risk factors associated with the development of LBP from playing golf and suggest methods to modify or limit these factors. Results of the review indicate that the high frequency of LBP appears multi-factorial although the asymmetrical and forceful nature of the swing along with excessive play and practice, particularly amongst elite players, appear to be common factors. Other factors include swing flaws leading to excessive side-bend and over-rotation of the spine, abnormal muscle recruitment, poor trunk endurance, restricted lead hip internal rotation and the use of unnecessarily stressful club transportation methods. Methods to help control or eliminate excessive stress on the lower back would include reducing the amount spent playing or practicing, seeking professional assistance to assess and adjust swing mechanics, improve trunk and hip flexibility, increase the strength and endurance of the trunk musculature, consider different footwear options and avoid carrying the golf bag. Adopting some or all of these recommendations should allow players to continue to enjoy the sport of golf well into their senior years.

The crunch factor's role in golf-related low back pain

BACKGROUND CONTEXT

The golf swing exposes the spine to complex torsional, compressive, and shearing loads that increase a player's risk of injury. The crunch factor (CF) has been described as a measure to evaluate the risk of low back injuries in golfers and is based on the notion that lateral flexion and axial trunk rotation jointly contribute to spinal degeneration. However, few studies have evaluated the appropriateness of this measure in golfers with low back pain (LBP).

PURPOSE

To objectively examine the usefulness of the CF as a measure for assessing the risk of low back injury in golfers.

STUDY DESIGN

Field-based research using a cross-sectional design.

METHODS

This research used three-dimensional motion analysis to assess the golf swings of 12 golfers with LBP and 15 asymptomatic controls. Three-dimensional kinematics were derived using Vicon Motus, and the CF was calculated as the instantaneous product of axial trunk rotation velocity and lateral trunk flexion angle.

RESULTS

Maximum CFs and their timings were not significantly different between the symptomatic and asymptomatic groups. Furthermore, for those golfers who produced higher CFs (irrespective of the group), the increased magnitude could not be attributed to an increased axial angular trunk velocity or lateral flexion angle, but rather to a concomitant increase in both of these variables.

CONCLUSIONS

The findings suggested that although the fundamental concepts that underpin the CF seem sensible, this measure does not appear to be sensitive enough to distinguish golfers with LBP from the asymptomatic players.

The effect of a carbohydrate-caffeine sports drink on simulated golf performance

A round of golf lasts approximately 4 h, during which time homeostasis could be challenged through either hypoglycemia or hypohydration. This might result in impaired motor skill or cognitive performance. Given the high cognitive demand of putting and the potential fatiguing effects from prolonged walking, the combination of a caffeine and carbohydrate drink could be beneficial in offsetting hypoglycemia and hypohydration. This study used a laboratory-simulated round of golf to examine the effect of an isotonic carbohydrate and caffeine sports drink on putting performance during a round of golf. After institutional ethics approval, 20 male golfers (mean +/- standard deviation: age 23 +/- 4 years, stature 176.4 +/- 5.6 cm, mass 72.8 +/- 17.4 kg, handicap 15 +/- 4, daily caffeine consumption 157.3 +/- 47.2 mg) consumed either an isotonic sports drink containing caffeine (6.4 g carbohydrate and 16 mg caffeine per 100 mL) or a no-energy, flavour-matched placebo drink in a double-blind, randomized, counter-balanced crossover design . Drinks were consumed preround (5 mL.kg-1 body mass (BM)) and at holes 6 and 12 (2.5 mL.kg-1 BM). Participants therefore consumed 1.6 mg.kg-1 BM of caffeine and 0.64 g.kg-1 BM of carbohydrate throughout the trial. Five and 2 m putting performance were assessed at each hole. Self-rated mood assessments were carried out every third hole. Putting performance over 5 m and 2 m and self-rated scores for alertness and relaxation showed a main effect for drink (p < 0.05). Ratings of mental fatigue and tiredness significantly increased during the round (p < 0.001). In experienced golfers, the consumption of an isotonic carbohydrate sports drink containing caffeine prior to and during a round of golf improved putting performance and increased feelings of alertness.

Effects of loading on spinal shrinkage in males of different age groups

A reduction in stature (shrinkage) has been used as a measure of the load on the spine. Musculoskeletal effects of ageing may influence individual responses to compressive loading on the spine and the resultant loss in stature. The aim was to apply the technique of precision stadiometry for assessment of spinal shrinkage in a comparison of responses of two different age groups performing a regimen of circuit weight training. In all, 20 subjects (10 aged 18-25 and 10 aged 47-60 years) participated in the study. Each performed two sets of a 12-station circuit of exercises, the loading being established relative to individual capabilities. Recovery procedures using a semi-supine posture intervened between the two sets and again post-exercise; altogether seven measures of change in stature were obtained using precision stadiometry. The two groups showed a similar pattern of spinal shrinkage, losses in stature being greater for the first set compared to the later set of exercises. Subjects gained height whilst in the formal recovery posture, but responses were inconsistent during warm-up, cool-down and active recovery. Irrespective of age, the spine was less responsive to loading as the duration of activity was increased. It was concluded that provided loading is related to individual capability, healthy older operators are not necessarily compromised by their age in activities that include handling and lifting weights.

Optimizing the benefits versus risks of golf participation by older people

Currently a strong emphasis is being placed in North American public health messages on the value of an active lifestyle for all age segments, including older persons. However, seniors do not usually take up physical activities, even though they often have extensive leisure time. Thus the purpose of this paper is to review current knowledge regarding the key health issues for physical therapists to consider when dealing with an older person who wishes to participate fully in an active sport. We have chosen the example of golf because of its popularity among seniors, as well as its usefulness in illustrating both the overall benefits and risks of participation. Although playing golf provides a moderate intensity exercise stimulus for seniors, musculoskeletal injuries can also result from unsafe participation, as can the aggravation of pre-existing musculoskeletal problems. Strategies for targeted management of the senior golfer's typical concerns are summarized into 4 categories consisting of: injury rehabilitation coordinated by therapists, warm up routines; club-fitting/coaching on proper technique, and pre-season conditioning programs. Educational programs for older people regarding the benefits of physical activity should also include information about injury prevention strategies that enhance long-term participation.

Injuries and overuse syndromes in golf

BACKGROUND

Although golf is becoming more popular, there is a lack of reliable epidemiologic data on golf injuries and overuse syndromes, especially regarding their severity.

OBJECTIVE

To perform an epidemiologic study of the variety of different musculoskeletal problems in professional and amateur golfers and to find associations of age, sex, physical stature (body mass index), warm-up routine, and playing level with the occurrence of reported injuries.

STUDY DESIGN

Retrospective cohort study.

METHODS

We analyzed the injury data from a total of 703 golfers who were randomly selected over two golfing seasons and interviewed with the use of a six-page questionnaire.

RESULTS

Overall, 82.6% (N = 526) of reported injuries involved overuse and 17.4% (N = 111) were single trauma events. Professional golfers were injured more often, typically in the back, wrist, and shoulder. Amateurs reported many elbow, back, and shoulder injuries. Severity of reported injuries was minor in 51.5%, moderate in 26.8%, and major in 21.7% of cases. Carrying one's bag proved to be hazardous to the lower back, shoulder, and ankle. Warm-up routines were found to have a positive effect if they were at least 10 minutes long.

CONCLUSIONS

Overall, golf may be considered a rather benign activity, if overuse can be avoided. If not, golf can result in serious, chronic musculoskeletal problems.

Cardiovascular load of competitive golf in cardiac patients and healthy controls

PURPOSE

Sports in cardiovascular patients (CVP) should serve for risk factor management, increase of exercise capacity, and reintegration into daily life. Competition of cardiac patients with healthy sportsmen is often discouraged and thus reintegration hampered. Golf, with its endurance component and exceptional rules (e.g., the handicap) should be an alternative.

METHODS

In 20 male golfers (65.2 +/- 6.1 yr, 1.4 +/- 0.3 W x kg(-1) body weight (approximately 4.8 METs)) with cardiovascular diseases and eight controls (C) (62 +/- 5 yr, 2 +/- 0.4 W x kg(-1) body weight (approximately 6.9 METs)), the performance assessed in the laboratory (ergospirometry, serum lactate) allowed for comparison of the cardiovascular load on the golf course (lactate, Holter monitoring, blood pressure, urine catecholamines).

RESULTS

In comparison with in the hospital, resting heart rates were significantly (P < 0.001) elevated in both groups immediately before the tournament (CVP: 76.1 +/- 10.8 vs 90.1 +/- 8.6 bpm; C: 74.8 +/- 6.3 vs 92.3 +/- 9.7 bpm). On the course, the mean heart rates of the patients were closer (P < 0.01) to the anaerobic threshold (105.4 +/- 11.0 vs 115.3 +/- 10.8 bpm) in comparison with controls (100.5 +/- 7.3 vs 125.6 +/- 16.6 bpm) corresponding to 0.9 +/- 0.3 W x kg(-1) (approximately 3.1 METs) or 76.0 +/- 13.1%VO2max (CVP) and to 0.9 +/- 0.2 W x kg(-1) (approximately 3.1 METs) or 55.3 +/- 9.1%VO2max (C). Serum lactate levels were 1.36 +/- 0.7 mmol x L(-1) (approximately 12.4 +/- 6.4 mg x dL(-1)) (CVP) and 1.1 +/- 0.4 mmol x L(-1) (approximately 9.1 +/- 3.6 mg x dL(-1)) (C). In patients, arrhythmias were lower in quantity and quality (LOWN) in comparison with other activities as registered by means of the 24-Holter-ECG.

CONCLUSION

In cardiovascular patients, competitive golf reaches an intensity that may positively influence cardiovascular risk factors, depending on the type of the course and may provide patients the desired integration with healthy sportsmen.

A review of injury characteristics, aging factors and prevention programmes for the older golfer

Participation in the sport of golf has risen considerably, particularly amongst senior players whose age is categorised as 50 years or more. However, golf presents both potential health benefits and risks for this older group of players. The health risks are compounded by the fact that the musculoskeletal and cardiovascular systems of senior players may not be as efficient at withstanding the strains and stress of this type of repetitive exercise. It was the purpose of this review paper to investigate the age-related health issues facing senior golfers and to discuss appropriate intervention strategies to help minimise these detrimental effects. The literature search identified only a minimal amount of epidemiological information pertaining specifically to the older golfer. A number of case reports were found which described a variety of musculoskeletal and cardiovascular incidents involving senior players. There was evidence from the literature that many of the age-related changes affecting older players' risk profiles were preventable or treatable through exercise. It was the conclusion of the authors of this review that conditioning programmes were highly recommended for all older players irrespective of their level of participation. Not only could the programmes prevent injury, they also had the potential to improve performance. Such programmes should incorporate flexibility, strength, endurance, speed and balance exercises specifically tailored to the demands of golf in order to be effective. Exercise equipment did not need to be elaborate and home-based programmes incorporating bodyweight, weighted clubs or elastic tubing resistance could be utilised. Future research needs to focus more specifically on injury incidence and mechanisms amongst groups of senior golfers whose participation rates vary. Randomised controlled trials are also recommended to investigate the efficacy of specific golf-related exercise regimens in this segment of the older population.

An Epidemiologic Survey of Injury in Golfers

In order to supplement the literature that describes individual injuries of the shoulder, carpal tunnel, and back in golfers, we administered a survey to demonstrate the incidence of golfers' injuries and describe the most frequent types. A questionnaire was administered to 1,790 members of the New York State Golf Association (amateur) under age 21. Three hundred sixty-eight players responded. Half of those responding had been struck by a golf ball at least on one occasion (47.6%), and 23% of the injuries were to the head or neck. Male golfers were 2.66 times more likely to be struck by a golf ball than females. Women and golfers with a higher handicap were at an increased risk for upper extremity problems, whereas younger and overweight golfers were more likely to have golf-related back problems. We concluded that golf is associated with a significant morbidity. Repetitious trunk and upper limb motions probably contribute to musculoskeletal disorders. However, an unexpectedly high incidence of trauma from projectile golf balls leads to the conclusion that no amount of stretching or muscular exercise is as important as increased alertness by golfers to decrease this hazard.