Dr. Alan Cheung, Consultant Orthopaedic Surgeon and founder of the International Orthopaedic Clinic (IOC), on improving your swing and avoiding golf-related injuries

While most would view golf as a low-impact sport that results in hardly any injuries, is this a misconception? 

This is a misconception. While golf is not a contact sport, golfers can still pick up many different types of injuries. The typical yearly injury rate in amateur golfers is as high as 40%, and up to 90% in professional golfers, in certain studies. 

Take a look at Tiger Woods, one of the game’s most famous players. Car accidents aside, over the years, Woods has experienced injuries like knee anterior cruciate ligament (ACL) and medial collateral ligament (MCL) tears, cartilage damage, as well as tibial stress fractures, achilles tendon injury, lumbar ‘slipped discs’, and spine problems requiring major surgery, which have kept him out of the game for years. Granted not everyone plays like Tiger Woods, but you get the idea.

The problem with golf lies in the swing, a highly complex skill with several segments involving the coordination of multiple body parts. It involves a chain of movement initiated from the legs and hips, followed by the trunk and shoulders, and finally the hands and wrists. This creates an explosive force with which to propel the ball. Typically, a player will use 30lbs of muscle to generate four horsepower during a golf swing. This applies around 900kg of force to the golf ball in a millisecond. 

This action is repeated multiple times in a round of golf and range practice. This can take its toll over weeks to months, particularly if the swing is poorly executed or performed with excessive force. 

How do these injuries typically come about? Is it because the player did not stretch or prepare enough? Poor posture? Or a combination of several things? 

Many different factors have been associated with golf injury. These include:

• Overuse. E.g. playing more than four rounds of golf a week and/or hitting more than 200 balls a week in practice in one study
• Poor technique and swing mechanics, especially when the club hits the ground unintentionally
• Lack of warm up – failure to stretch for 10 minutes before a game can double your risk of injury
• Poor physical conditioning with lack of strength and flexibility

Zooming in on more specific injuries, can you tell us the most common causes and signs for the following:

a.) Spine injury

The spine experiences a great deal of rotational load during the swing. Poor swing mechanics and weak core muscle stability can make this worse, causing lower back injury. Carrying a bag of clubs for several rounds a week can also worsen back injury. Common golfing back problems I see are painful ‘slipped discs’ and inflammation of the facet joints in the spine. 

b.) Elbow injury

Pain on the outside of the elbow (lateral epicondylitis) and inside of the elbow (medial epicondylitis) are common in golf. This can be caused by a poor swing, overuse injury, gripping the club too tight, and striking the club into the ground. 

c) Shoulder injury

Common shoulder problems in golf involve rotator cuff tears, subacromial impingement. and acromioclavicular joint pain. 

Typically most of these injuries are treated with rest, medications, joint injections, and physiotherapy. If left untreated or if particularly severe, surgery may be required. 

Can you share with us ways to avoid such injuries and what preparation should be done by the player in the future? 

• Learn golf from a licensed professional to perfect your swing and technique
• Warm up and stretch for at least 10 minutes before hitting a ball
• Give yourself enough time to recover between rounds. Don’t play more than four rounds of golf or hit more than 200 practice balls in the range per week
• Undertake an exercise program with a strength and conditioning trainer or physiotherapist, to improve your hip, back, and core strength
• Don’t ignore injuries. See an Orthopaedic specialist or Sports Medicine Doctor when you have pain

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