Golf and shoulder pain: Know your treatment options
Recently I have had an influx of shoulder based injuries suffered by golfers. Now, not all injuries have been a result of their golf swing. Many patients have actually been recovering from other injuries and even surgery, simply wanting to return to the game that they love. I thought this would be a good opportunity to discuss the main causes of golf related injuries and what you can do to prevent them.
The most common shoulder injuries for golfers:
Rotator cuff tear or inflammation
Impingement (soft tissue swelling)
I feel sorry for the shoulder, especially for golfers' shoulders. It's often not the shoulders' fault that someone is experiencing debilitating pain. After screening these golfers, it’s pretty easy to see that the problem is often coming from somewhere else.
Golfers have a thirst for information, be it the latest technology, the recent PGA results, or simply an analysis of their own game. Most will know what a good golf swing looks like. It’s reproducing that swing ourselves that provides the challenge. We all know that movement should follow this basic sequence:
Torso (thoracic spine)
Professional golfers from Rory McIlroy to Jim Furyk maintain this same sequence, despite looking drastically different. When we fall foul of this sequence, problems occur. These problems may include:
Repetitive strain on joints and muscles
Loss of distance
Poor ball striking
Unreliable distance control and accuracy
The shoulder is a common site of injury for golfers
It is the main structure that transmits the force and power from the torso to the arms and club. Too often I see people in my clinic who use ‘too much arms’. This refers to an excessive reliance on the arms for power and distance. These people always have one (if not all) of the following results on a physical screen:
Poor hip rotation trail leg
Reduced torso rotation to the right (backswing)
Poor core and glutes strength
This is often matched with:
Poor shoulder and back flexibility
Weak back/shoulder blade muscles
These issues create unnecessary loading and stress on structures in the shoulder joint. If the hips and back are not moving the way they should, then how on earth will the shoulder ever cope?
How to fix shoulder pain
Screening is the priority. Knowing exactly what your body is unable to do is paramount to finding a fix. I see patterns as I have mentioned above, but everyone presents a slightly different case. By knowing exactly what a golfer needs to work on, I can eliminate the unnecessary exercises and focus on the most important.
Hip and back stretching will be a great start. Here are two excellent stretches to get started on better hip and back mobility:
Thoracic rotation stretch with club
Dynamic hip rotations
The next aim will be to control and transfer energy with a stronger core and glutes. Here are two exercises to begin to improve core and glute strength:
Bridge with leg extension
Of course the shoulder needs special attention as well. Despite causes potentially coming from other areas of the body, the shoulder isn’t always so innocent. Here are two exercises to help the shoulder become more reliable in the golf swing:
Pec stretch/external rotation stretch
Rotator cuff strength and shoulder blade control (theraband row with ER in abdn)
These exercises are a great start. Of course, once you achieve a more efficient body, good coaching is paramount to improving skill. This is where good coaching can take your game to the next level - not only when it comes to injury management, but also to lower that handicap.
As a 12 handicapper, I feel I can play some good shots mixed in with some OK shots, all rounded out with some shockers. My body is getting better at controlling my golf swing, so I can be more consistent and less injury prone. However, at this stage I am one of the lucky ones. I don’t feel any pain during or after a game of golf.
As a physio who treats many golfers, I am staggered by how many people simply put up with pain. Maybe it’s male bravado combined with that great Aussie attitude of ‘I’ll be alright’. It simply doesn’t make sense. The easiest time to fix something is now. It only gets harder as we get older.
30% of golfers feel back pain during or after every round of golf. This is crazy. This tells me two things:
1. Golfers are willing to put up with pain to do something they love – very admirable (however silly in my eyes)
2. 30% of all golfers are hitting way too many shots every round (some may see that as value for money golfing)
There is a strong relationship between pain in the body and poor ball striking. Pain is a fascinating thing. Nerves rightly or wrongly send an extremely strong message to the brain that interprets this information in a split second, causing varying levels of emotional response. What also happens is a subconscious change to the operating system that controls our muscles, joints and our movements. This means that like it or not, we move differently as a response to pain.
If we feel pain during our golf swing, we will compensate accordingly. I have never seen a golf swing that has changed for the better. No one has felt pain and hit the ball further. This is why I find it staggering that people will put up with pain and not do anything about it. It may be as simple as having good warm ups and great stretching, or slightly changing your weekly exercise routines to help reduce these major roadblocks to better golf.
I screen many people and find numerous things that their bodies could do better. This may be the result of sitting in an office for 8 hours a day. It may be a history of serious injury. Whichever it is, it is never too late to change. See a golf specialist physio and you may just surprise yourself. You may start beating your mates.
It’s the desire of every golfer. We all want to get extra distance off the tee. Regardless of our age or ability, hitting the ball further opens up the options on the golf course and makes us a better player.
In my opinion, as a physiotherapist, players look to radical changes in their swing, equipment and set-up well before they are prepared to look at their own body. Simply going to the driving range and pounding more balls at a million miles per hour will not help either. If your hip or back simply cannot move like Rory McIlroy’s, how do you expect to hit it like him? We need to start looking at the physical capabilities of our own body, to better understand why we can’t hit it like we want.
The reason why your body can’t produce a repetitively powerful swing? It’s not capable. Yet.
Pain and previous injury are obvious candidates for changing the way we move. But too often I see people with a poor understanding of why the ‘ache’ in their back is taking 20 meters off their drive. Often that ‘ache’ is ‘just part of life’. But this ‘ache’ is a clear sign of movement dysfunction. And movement dysfunction is the crux of a poor golf swing.
The 3 main causes of movement dysfunction that affects drive distance are:
Weak stabilizing muscles (core)
Weak power generating muscles (glutes)
Tight/restricted joints (hip/spine)
These 3 factors need to be trained in a golf-specific manner. This means a strong focus to rotation, balance and long flexible movements. To swing a golf club effectively takes a tremendous amount of golf specific strength, flexibility, coordination, balance and stability. None of this happens without improving your golf specific fitness.
To improve your driving distance you have to be prepared to work on your body off the course. It is as simple as that.
Not only will this approach improve your golf driving distance, but it will help eliminate low back pain and injury. Lower back pain is the most common complaint among golfers.
Golf Injuries & Prevention – Top Tips For Enthusiastic Golf Players
Golf is one of the most popular games in the world, with over 55 million people playing each year. Did you know that nearly 30% of those will experience back pain after every round? Not to mention other ailments in the knee, hip, shoulder and wrist. Often we simply deal with the pain and continue on, but for most of us, this leads to further injury and often time away from the golf course. Nothing could be more frustrating.
Most amateur golfers will present to medical professionals with injury caused by a number of common swing faults that are actually a result of physical limitations with our body. If certain key parts of the body are lacking in either mobility (movement) or stability (strength), incorrect/altered movement patterns will arise. As a result, we can overstress different structures, ultimately leading to injury, pain and frustration.
Common lower back injuries can include:
Muscle strain or ligament sprain
Dysfunctional movement patterns
Other common injuries experienced by golfers include:
Shoulder pain – rotator cuff impingement
Meniscus injury in the knee
On the flip side to these damning injury rates, is our performance. How far I drive the ball? How accurate my long irons are. How my concentration levels change through my round (rushing putts and misreading conditions)? These are all key components to our overall performance. Unfortunately, I have not met any golfers that perform better when injured.
With professional golfers, almost 80% of the injuries come from overuse simply due to the time they spend on the golf course or at the driving range. Injuries in amateur golfers can be caused by overuse, but in most cases, they occur due to swing patterns developed around physical limitations.
With the advent of very precise golf screening techniques, we can now assess the body for these physical limitations. This gives us an amazing insight into what areas in the body will need to improve, in order to not only enhance performance, but help prevent injury. It is also a very useful tool to help injured golfers return to play quicker, as we can isolate the causes behind the injury.
Take this for an example: whilst in a sitting position, keep your knees and feet together whilst crossing your arms. Then turn your shoulders to the right. If you cannot turn past the 45 degrees from the starting position, you are likely to develop swing characteristics that cause an early loss of posture in the golf swing. This will lead to a loss of power and driving distance, and ultimately excessive stress on your lower back and shoulders (note: the PGA player average for this test is 58-60 degrees). This stress on the back can cause disc bulges, muscle and ligament strain or facet joint arthritis.
People who are appropriate for the physical screen and swing analysis are those who want to:
Prevent future injury
Understand and solve current injury
Improve fitness and golf related strength
Find ways to improve their game
What do we do with the results?
Education – help you understand what is happening
Devise a plan – addressing the key areas to improve
Work with your golf coach – correcting swing faults
This post has been written by PhysioActive physiotherapist Joel Bates B.Sc - Physiotherapist, Manual Therapist, Sports Therapist, Golf Therapist
Joel is a Titleist Performance Institute Certified Professional. He leads the PhysioActive Performance Golf Program, applying this training to helping golfers of all ages and standards. Screening and swing analysis can be performed in the clinic or at your golf course/range.
The Titleist Performance Institute (TPI) is the world’s leading educational organization and research facility dedicated to the study of how the human body functions in relation to the golf swing. TPI has screened and analyzed thousands of professional and amateur golfers.