Physiotherapy and Golf Injuries – Part 2 – The Shoulder
In the second of a series of articles on injuries common in golfers of all abilities, ETPI.com’s Nigel Tilley – a Consultant Physiotherapist on The European Tour – examines potential shoulder problems and recovery routes.
Golf is a sport played by millions of people across the world everyday. It is thought of by many non-golfers as an ‘easy’ sport and they are unsure how injuries can occur when playing.
While it has been shown to have huge health benefits and can be played by people of all ages, the physical demands required of the body to execute one of the most complex athletic skills in sport are enormous. For a number of biomechanical reasons, the anatomy is poorly suited to perform the high-torque rotational movement of the golf swing, which involves creating and resisting many high forces.
The modern swing uses a large shoulder turn but restricts the hip turn to build torque in the muscles of the lower back and shoulders. This places larger stresses and requirements on the muscles and structures of the shoulder complex and leaves it susceptible to injury.
However, with regular conditioning, improvement in technique, warm ups and structured practice the improvements in golfers’ performance and reduction in injuries can be significant. Your physiotherapist can help you with this as well as provide you with effective treatment should you suffer with any injuries.
The shoulder is a complex joint and there is a varied range of injuries and pathologies that can occur within it and its associated structures. Certain injuries are more prevalent at different ages and in golf are often specific to each shoulder depending on the lead side of the swing (as with wrist injuries).
The lead shoulder is often susceptible to posterior laxity, labral and Acromioclavicular joint pathologies and sub-acromial pain syndrome. The non-lead shoulder is often more likely to suffer with anterior laxity and rotator cuff pathology / tendinopathies. In this article we will concentrate on one area and that is the rotator cuff.
Rotator cuff injury
What is it?
The shoulder joint gains its large amount of mobility at the loss of structural stability. Other less mobile joints like the knee and hip are inherently more stable than the shoulder. It is, therefore, much more reliant on the efficient & complex control and stability that it receives from the muscles of the shoulder.
The rotator cuff is a group of four muscles in the shoulder called the Suspraspinatus, Infraspinatus, Subscapularis and Teres Minor that are involved in movements and control of the glenohumeral (shoulder) joint. The tendons of the muscles are more commonly involved in pathologies with the Supraspinatus the most frequently involved of the four muscles.
There are two main causes of injury to this structure -acute trauma and degeneration (chronic and cumulative). The amount of stress needed to cause a pathology to the rotator cuff tendon will often depend on factors such as the persons’ age, general health and underlying condition of the tendon prior to the stress elicited on the tissue.
Muscle/tendon tears can occur from injuries such as a fall onto the arm, sudden lifting, rapid movement of the arm (such as in the golf swing) or sudden and unexpected deceleration of the club head (i.e. hitting a tree root or getting the club head stuck in thick rough). Repetitive movements of the golf swing combined with poor technique and/or flexibility & control issues can lead to injuries to the shoulder and rotator cuff.
Often, rapid increases in load placed through tissues that cannot adapt in time lead to pathology and injury.
How does physiotherapy treat this type of condition?
The type of injury, its severity and stage will affect the physiotherapy management of the condition and the time of recovery. Exercise, TENS, manual therapy, and acupuncture are techniques that can help with pain relief.
The aim of physiotherapy will be to return optimum function and control of the shoulder. Exercises that are specific to each type of injury are designed to increase range of movement and provide loading to the muscle, tendon and tissues. Performed in a structured way, this can aid cellular adaption and tissue repair (i.e isometric, eccentric and concentric exercise for specific muscles in isolation as well as exercises that target groups of muscles that control and stabilise the gleno-humeral joint and shoulder girdle).
Your physio will use a variety of techniques and equipment to perform these techniques and help you progress these exercises appropriately through your treatment so that you can eventually return to full recovery, pain-free activity.
Physiotherapists often use taping techniques to also help in the treatment of these type of shoulder injuries. Advice on ergonomics, activity and lifestyle can help identify ways to reduce positions and aggravating factors that may slow the recovery or worsen the injury.
As with most injuries in golf and in amateur golfers, especially insidious onset injuries (no one specific incident, but that comes on slowly over time), it is vital that the cause of the problem is effectively identified as resolving that is often key to helping treat the injury as well as preventing a repeat.
A golfer’s swing should be checked with a professional golf coach and/or by a golf specific physiotherapist to ensure that the technique is not poor and does not lead to overload on the shoulder and rotator cuff structures (as well as other areas of the body).
Similarly, a screening of the golfer’s hips/pelvis, spine and upper limbs and they way they function together can help identify areas of the body that may benefit from exercises and treatment to improve range of movement, flexibility, co-ordination, control, separation and strength.
For safety, optimum treatment and to reduce the risk of re-injury, players and patients should visit and complete a full assessment of all injuries and receive treatment and rehabilitation under the guidance of a chartered physiotherapist.
Work on your golf fitness on-line with the European Tour Performance Institute and Road to Health at Tour fit for Golf (TFFG) www.tourfitforgolf.com
The European Tour Performance Institutes in Terre Blanche, France and at the Jumeirah Golf Estates in Dubai have highly qualified and expert physiotherapists, osteopaths, medical staff, biomechanists and support staff that are able to help you with your injury assessment, diagnosis, treatment and improve your golf performance. To arrange a visit or book an appointment with them email:
Terre Blanche – Email: [email protected]
Jumeirah Golf Estates – Email: [email protected]