Minimizing injuries and enhancing performance in golf through training programs

Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis

OBJECTIVE

To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency.

DESIGN

Systematic epidemiological review and meta-analysis.

DATA SOURCES

PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023.

ELIGIBILITY CRITERIA

Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites.

RESULTS

20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week.

CONCLUSION

Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies.

PROSPERO REGISTRATION NUMBER

CRD42023408738.

Injuries and Persistent Pain in Elite Adolescent Archery Athletes: A Cross-Sectional Epidemiological Study

This cross-sectional epidemiological study aimed to evaluate the prevalence of injuries among young archers engaged in high-intensity training during the European Youth Championship. A total of 200 participants (104 males/96 females) from 34 countries were included, with a mean age of 16.9 years and average competitive experience of 6.5 years. Structured questionnaires, administered by four physiotherapist interviewers, gathered comprehensive data. Results revealed that 43.5% of participants experienced shoulder pain during training, highlighting the vulnerability of upper limbs in archers. Additionally, 30% required medications to facilitate training, underscoring the impact of injuries on continued participation. Physiotherapy was utilized by 52.3% of participants, emphasizing the need for therapeutic intervention. Furthermore, 31.8% had to cease training due to injuries, indicating a substantial hindrance to athletic progression. The mean pain duration was 3.9 months, with an average intensity of 5.94, and 8% exhibited symptoms of central sensitization. In conclusion, this study demonstrates a noteworthy prevalence of injuries, particularly in the upper limbs, among young archers undergoing intensive training. The findings underscore the importance of targeted injury prevention strategies and comprehensive rehabilitation approaches to ensure the well-being and sustained participation of young athletes in competitive archery.

Enhancing Athletic Performance: A Comprehensive Review on Kettlebell Training

A kettlebell is a weight made of cast iron shaped like a ball with a handle. Commercial kettlebells are offered in capacities that vary from 3 pounds to 100 pounds (or more). The kettlebell has a variety of possible clinical applications, including dynamic flexibility exercises and power training. Players' efficacy during the game can be improved by developing their strongest potential prior to exercising and efficiently converting that strength to power as the event draws near. Strengthening has been recommended as an effective means to avoid injuries, build muscle strength, and enhance one's health in relation to performance in the game. This type of training focuses on the hip, thigh, core, and abdominal muscles to help with appropriate lower-limb alignment and the recruitment of muscle patterns. Kettlebell training is a flexible and useful strategy for improving players' performance in a variety of sports. It adds value to athlete training programs by enhancing strength, power, endurance, explosive power, and postural coordination.

Open Foot Stance Reduces Lead Knee Joint Loading During Golf Swing

Foot stance and club type's relationship with lead knee joint biomechanics and possible involvement with injury incidences in amateur golfers have not been evaluated. This study included 16 male right-handed amateur golfers who performed golf swings with 2 different foot stances (straight and open) using 4 different club types (driver, 3 iron, 6 iron, and 9 iron) while standing on 2 force plates in a motion capture laboratory. A custom program calculated the kinematics and kinetics of the lead knee. Overall, the open stance reduced most translations, rotations, forces, and torques of the lead knee in all 4 club types when compared with the straight stance. The open stance reduced the rotation motion (-28%), compressive force (-5%), and rotation torque (-9%) when compared with the straight stance, which are the highest contributors to grinding of cartilage. The driver club had significantly larger values in most translations, rotations, forces, and torques when compared among the 4 club types. The open stance reduced the rotation motion, compressive force, and rotation torque in the lead knee joint compared with the straight stance. Lead knee joint biomechanics should be monitored to reduce injury in amateur golfers.

Etiology and Prevention of Common Injuries in Golf

ABSTRACT

Golf is a popular sport played by individuals of varying age and skillsets. The golf swing is unique and complex, creating potential for various musculoskeletal injuries in both amateur and professional golfers. Understanding the basic biomechanics of the golf swing and its relation to injury etiology can assist the health care provider in recognizing and preventing musculoskeletal injuries secondary to golf. Most injuries occur in the upper limb and the lumbar spine. This review describes musculoskeletal pathologies seen in golfers with respect to anatomic area and golf swing biomechanics, while summarizing effective prevention strategies and swing modifications to address these potential injuries.

Lower Limb Biomechanics during the Golf Downswing in Individuals with and without a History of Knee Joint Injury

Although prevention is better than treatment, after a knee injury occurs, the adjustment of the movement technique back to the posture before the injury and the restoration of accuracy is very important for professional and amateur players. This study aimed to compare the differences in lower limb mechanics during the golf downswing between those with and without a history of knee joint injury. A total of 20 professional golfers with single-digit handicaps were recruited for this study, 10 of whom had a knee injury history (KIH+), while another 10 players were without a knee injury history (KIH-). From the 3D analysis, selected kinematic and kinetic parameters during the downswing were analyzed using an independent samples t-test with a significance level of α = 0.05. During the downswing, individuals with KIH+ exhibited a smaller hip flexion angle, smaller ankle abduction angle, and larger ankle adduction/abduction range of motion (ROM). Moreover, there was no significant difference found in the knee joint moment. Athletes with a history of knee injury can adjust the motion angles of their hip and ankle joints (e.g., by avoiding excessive forward leaning of the trunk and maintaining stable foot posture without inward or outward rotation) to minimize the impact of changes in their movement patterns resulting from the injury.

FUNDAMENTAL MOVEMENT AND DYNAMIC BALANCE DISPARITIES AMONG VARYING SKILL LEVELS IN GOLFERS

BACKGROUND

Sports medicine professionals have instituted easy to use on field screening tests to determine physical readiness and identify athletes who may have increased injury risk. Currently there is little research on fundamental movement and dynamic balance abilities in golfers.

PURPOSE

To examine differences in fundamental movement patterns and dynamic balance in varying competition levels in golfers.

STUDY DESIGN

Cross-sectional Cohort.

METHODS

The Functional Movement Screen^TM (FMS), and Y-Balance Test Upper Quarter and Lower Quarter (YBT-LQ/UQ) were performed on middle school (MS), high school (HS), college (COL), and professional (PRO) golfers. The FMS^TM was assessed for individual tests and composite score. The YBT-LQ/UQ reaches were averaged normalized to limb length. Statistical analysis was completed with a series of Kruskall-Wallis tests with Dunn's post hoc for the FMS™ and YBT-LQ/UQ asymmetries, and a series of ANOVAs, with Tukey's post hoc for the YBT-LQ/UQ reaches (p<0.05). Effect Size Indices (ESI) were also calculated to determine clinical relevance.

RESULTS

A total of 53 MS, 129 HS, 207 COL, and 29 PRO golfers were included in this study. Significant differences were observed between COL and HS in two FMS™ tests (push up; p=0.001), active straight leg raise; p=0.0019). PRO golfers YBT-LQ posteromedial reaches were greater than MS (p=0.0127, ESI = 4.3552). PRO YBT-UQ medial reaches were greater than COL (p<0.0001, ESI = 0.8915), HS (p<0.0001, ESI = 1.2640) and MS (p<0.001, ESI = 1.4218). PRO inferolateral (IL) and superoloateral (SL) reaches were greater [IL: COL (p=0.0427, ESI = 0.4413), HS (p=0.0002, ESI = 0.5851)], [SL: COL (p=0.0005, ESI = 0.5990), HS (p=0.0004, ESI = 0.6068)]. YBT-UQ composite scores were greater for PRO compared to COL (p<0.0001, ESI = 0.7657), HS (p<0.0001, ESI = 0.8161) and MS (p<0.0001, ESI = 1.085).

CONCLUSIONS

Differences were observed in golfer's fundamental movement patterns in relationship to competition level. These data can be utilized to design personalized training programs that focus to improve movement quality.

LEVEL OF EVIDENCE

2b.

Audit of toxic effects of body paint in the tiger dancers (Hulivesha) of Mangalore, India: an investigational study

INTRODUCTION

Tiger dancing or Hulivesha, where the volunteers paint their bare body like a tiger and dance in a ritual during the Navarathri festival in Mangalore, India. There are no scientific studies done with the Hulivesha dancers at all, and therefore, we investigated the adverse effects of painting body like a tiger and dancing in the volunteers.

OBJECTIVE/AIM

In this study, we investigated the clinico-haematological effects of topical application of lead-containing paint and dancing for three consecutive days in these dancers to ascertain the toxic effects of whole body painting and dancing.

MATERIALS AND METHODS

This was a case-control study and was conducted during the Dasara festival in 2013 in the Huliveshadaris (study group) and the accompanying drummers (controls). Clinical, dermatological, and musculoskeletal examination were done before (day 0) and after the three days of the function (day 3). Blood was also collected and examined for alterations in the hematological parameters, lead, antioxidant glutathione, and lipid peroxidation levels.

RESULTS

The results indicated that the all Hulivesha volunteers had severe musculoskeletal pain, while few also complained of skin reactions (61.6%), headache (25%) and nausea, and vomiting (18.75%). The results also indicated that topical application increased the levels of blood lead, caused a change in the haematological profile, decreased glutathione and increased lipid peroxidation (p < 0.03-0.0001).

CONCLUSIONS

The results from this study clearly shows that topical application of the acrylic paint increases lead, changes haematological parameters and imparts adverse skin reactions.

Analysis of Pelvis-Thorax Coordination Patterns of Professional and Amateur Golfers during Golf Swing

The aim of this research was to quantify the coordination pattern between thorax and pelvis during a golf swing. The coordination patterns were calculated using vector coding technique, which had been applied to quantify the coordination changes in coupling angle (γ) between two different segments. For this, fifteen professional and fifteen amateur golfers who had no significant history of musculoskeletal injuries. There was no significant difference in coordination patterns between the two groups for rotation motion during backswing (p = 0.333). On the other hand, during the downswing phase, there were significant differences between professional and amateur groups in all motions (flexion/extension: professional [γ] = 187.8°, amateur [γ] = 167.4°; side bending: professional [γ] = 288.4°, amateur [γ] = 245.7°; rotation: professional [γ] = 232.0°, amateur [γ] = 229.5°). These results are expected to be a discriminating measure to assess complex coordination of golfers' trunk movements and preliminary study for interesting comparison by golf skilled levels.

The relationships between golf and health: a scoping review

OBJECTIVE

To assess the relationships between golf and health.

DESIGN

Scoping review.

DATA SOURCES

Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts.

REVIEW METHODS

A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary.

RESULTS AND DISCUSSION

4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences.

CONCLUSIONS

Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated.

Comparison of knee characteristics between professional and amateur golfers during the downswing

Evaluating the biomechanical and performance factors of the knee joint during golf swing can provide objective and quantitative information about improving the performance and development of efficient physical training, as the legs are important for achieving an efficient swing and maximum speed of the club head in golf. In the present study, kinematic movements of the knee joint were identified during the downswing by using 3-dimensional motion analysis, and isokinetic strength was measured with driver and 5-iron clubs in 15 professional (PRO) golfers and 10 amateur (AMA) golfers. Results showed that PRO golfers had a narrower minimal angle between the thigh and lower leg in the trail knee than the AMA golfers, regardless of the club used, and the angular velocity of the lead knee was faster during the downswing with a 5-iron club in the AMA golfers than in the PRO golfers. The PRO and AMA golfers had a wider minimal angle between the thigh and lower leg, smaller total range of movement, and slower angular velocity of the trail knee when swinging a 5-iron club than when swinging a driver club. These results are expected to provide useful information to prevent golf-related injuries that usually arise in the knee joint and help improve the golf performance of amateur golfers.

Potential Mechanisms Leading to Overuse Injuries of the Back in Alpine Ski Racing: A Descriptive Biomechanical Study

BACKGROUND

Overuse injuries of the back are a common complaint among top athletes and of competitive alpine skiers in particular. However, there is limited understanding about the sport-specific causes of these injuries that is essential for their prevention.

PURPOSE/HYPOTHESIS

This study was undertaken to describe the sport-specific, overall trunk kinematics and skiers' loading during giant slalom turns and to assess the plausibility of the hypothesis that a combination of frontal bending, lateral bending, and/or torsion in the loaded trunk might be a potential mechanism leading to overuse injuries of the back in alpine ski racing.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Eight European Cup-level athletes performed giant slalom runs with 2 different pairs of skis (varying in length, width, and sidecut). They were analyzed with respect to selected kinematic variables related to spinal disc loading. The overall trunk movement components (frontal bending, lateral bending, and torsion) were measured using 2 inertial measurement units fixed on the sacrum and sternum. Total ground-reaction forces were measured by pressure insoles.

RESULTS

During the turn phase in which the total ground-reaction forces were the greatest (up to 2.89 times the body weight), the highest average values of frontal bending (38.7°), lateral bending (14.7°), and torsion (7.7°) in the trunk occurred. Similar magnitudes were observed when skiing on longer, giant slalom skis with less width and sidecut.

CONCLUSION

The typical loading patterns of the back in alpine ski racing include a combined occurrence of frontal bending, lateral bending, and torsion in the loaded trunk. Because these factors are known to be related to high spinal disc loading, they may be considered important components of mechanisms leading to overuse injuries of the back in alpine ski racing.

CLINICAL RELEVANCE

Prevention measures should aim to control and/or reduce the magnitude of frontal bending, lateral bending, and torsion in the trunk, as well as the peak loads, while skiing.

Core stabilization exercise prescription, part 2: a systematic review of motor control and general (global) exercise rehabilitation approaches for patients with low back pain

Context

Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach.

Data Sources

PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain.

Study Selection

Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals.

Data Extraction

Included studies underwent appraisal for exercise intervention and outcomes.

Results

Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain.

Conclusion:

Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles.

Comprehensive strength training program for a recreational senior golfer 11-months after a rotator cuff repair

BACKGROUND AND PURPOSE

Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair.

CASE DESCRIPTION

The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises.

OUTCOMES

The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program.

DISCUSSION

The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery.

Incorporating kettlebells into a lower extremity sports rehabilitation program

The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.