Many golf injuries occur due to repetitive movements
Golf is one of the oldest and most traditional sports in the world. Its origin can be dated back to 15th-century Scotland, although some historians believe a form of it started as early as 1st century BC with the Romans. Most people consider golf a mild sporting activity unlike football, basketball and soccer in which there is constant physical contact with other participants. But in golf, there are significant forces acting through one's body to produce the power and accuracy required for success. In fact, many golf injuries occur due to the repetition of bending, twisting, squatting, walking, sitting and standing for 4-5 hours at a time. And that is just playing the game. There are also hundreds of hours of practicing around competition that just adds to the stress on the body's tissues, leading to golf-related injuries.
It has been documented that almost one-third of touring professionals play with an injury at any given time and that two-thirds of all amateur golfers will sustain an injury. The repetitive use of poor swing mechanics is widely viewed as a mechanism leading to a variety of golf-related injuries..1 Dr. Larry Foster, an orthopedic surgeon who trained at Columbia University and the Hospital for Joint Diseases in New York City, reports that most golfers will sustain an injury in their lifetime and 60% of those will be a major injury. Poor swing mechanics increase the likelihood of an injury, but even with proper mechanics, the repetitive nature of the movement can lead to overstressing tissues regardless.2
Rotating, pivoting and twisting motions make golfers susceptible
Hip injuries are not as common in golf as injuries to the shoulder, back and wrists, however golf can still take its toll on the hips. Golfers are susceptible to hip problems because of the repeated rotating, pivoting and twisting motions in weight bearing that occur through the hips. Some of the most common and more easily managed golf-related hip injuries are a variety of what we call extra-articular (outside the hip joint) conditions including tendinitis and bursitis. Examples of these include Greater Trochanteric Bursitis, Iliopectineal Bursitis, Iliotibial Band Friction Syndromes, Gluteal Tendinitis and irritation of the deep hip rotators including the Piriformis. In addition, when muscles like the Piriformis become hypertonic, guarded or irritated, this can also lead to entrapment and irritation of the sciatic nerve causing the ever-painful sciatica. Muscle strains can also occur at the groin or adductor and hip flexor muscle groups. The likelihood of these types of injuries do increase with poor and less consistent mechanics. However, even though professional golfers are much more consistent in their swings, they too are susceptible to these types of injuries. These golf injuries are relatively easily managed conservatively with physical therapy and rarely lead to any type of surgical intervention. Sometimes, unfortunately, these types of injuries can be related to more serious underlying pathology of the hip which we will discuss next.
Intra-articular pathologies can be exposed and irritated
More serious pathology at the hip that can be exposed or irritated during golf is categorized as Intra-articular Pathology which means they occur within and through the hip joint itself. Examples of these include Acetabular Labral Tears, Osteoarthritis (OA), Loose Bodies, Femoral Acetabular Impingement (FAI), synovitis, Ligamentum Teres tears and chondral defects to name a few. Before we discuss these conditions, let's have a quick anatomy lesson. The Acetabular Labrum is a type of soft tissue cartilage that surrounds the acetabulum (socket) that helps to deepen it and contribute to stability of the joint (Figure 1).
FAI is a type of condition that many people develop congenitally or acquire over time. There are two main types: CAM and Pincer although many athletes have a combination of both. These exist when the socket is overgrown or overlaps quite a bit (Pincer) or when there is extra bony growth on part of the femur (CAM). When someone has FAI, their range of motion can be greatly limited by bones hitting other bones or cartilage (Figure 2). OA or arthritis is a degenerative process that occurs naturally over time and leads to a breakdown of the joint. The space in the joint lessens, tissue becomes tight and inflamed and mobility begins to become greatly restricted (Figure 3)
Repetitive movements in golf can exacerbate OA, FAI
Golf by itself does not cause hip OA or FAI. However, when these pathologies are already present in the hip joint, the repetitive nature of twisting and rotating during golf can greatly irritate the tissues of the hip. The golfer begins to slam bone against bone with cartilage caught in between. It begins with a slight ache or discomfort in the hip joint, then progresses to more intense and searing pain that eventually leads to inability to play golf at all. If continued, this repetitive stress can lead to labral tears, bone bruising and eventually the possibility of surgery. These intra-articular pathologies can and should be treated initially with conservative management in physical therapy. However, if severe enough, they can require either arthroscopic surgery to repair the labrum and shave the extra bone down, or a total hip replacement.
Physical therapy, home manual therapy, offer non-invasive treatment
Conservative management with physical therapy consists of manual therapy, such as long axis traction, to improve the mobility around the joint and unload pressure, therapeutic and corrective exercise to improve the strength and biomechanics of the lower extremity and of great importance is the education in proper swing mechanics to unload any unnecessary stress to the hip in the first place. There are also a series of home manual therapy techniques that many golfers, including PGA tour players, utilize to prevent the limitations of their hips in the first place, but also to employ if they begin to feel the irritation occur. SuperBands are thick, strong bands that golfers use to "stretch" and mobilize their hip joints to ensure optimal range of motion. These techniques are termed Self-Mobilization with Movement. Another tool that many golfers use is a portable device called HipTrac that provides traction to the hip joint which can provide relief to an irritated hip joint as well as proactively work on maintaining optimal range of motion and spacing of the hip joints.
You can find examples of the Self Mobilization techniques here, and of HipTrac here.
Upcoming articles will discuss hip issues common to other sports as well as some of the mobility exercises, dynamic warm ups and biomechanical strengthening that all athletes, and especially golfers, should be performing to prevent some of these injuries, and improve performance during competition.