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Rebalance University & KingUniversity & King
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Toronto, ON M5H 3B7
Rebalance Sports Medicine - 155 University Avenue Suite #303

T: (416) 306-1111
F: 1-866-204-0961
E: [email protected]

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Treatment of Golf Injuries

Golf Injuries - Toronto Physiotherapy, Chiropractic and Massage Therapy TreatmentThe golf swing is a combination of complex movements. It is so complex that even professional golfers can appear to have regressed to their worst amateur days if they are injured or having an “off” day. When proper biomechanics occur during a swing, it can look smooth and effortless. The body’s ability to coordinate muscle groups in order to generate power to drive the golf ball with accuracy and great distance is impressive.

Like all sports, golf can come with an added risk of many different injuries due to its highly repetitive nature and rotational forces. If you start feeling pain or restrictions in your movement at some point in your golf swing, it’s helpful to understand what your body is doing. You can break down a golf swing into phases; this can help you identify when you feel your pain and what the demand on your body is. Your health care professional (ie. Physiotherapist, Chiropractor or Registered Massage Therapist) can help you identify this and better focus your treatment.  They will also prescribe exercises that would be best suited in addressing the motion(s) at which you feel your pain.

Phases of a Golf Swing

Phases of the Golf Swing
  • Back Swing: From the ball address to the back of the back swing.
  • Forward Swing: From the end of the back swing until the club is horizontal to the ground on the golfer’s trail side.
  • Acceleration: From the club being horizontal to the ground to the point of impact with the ball.
  • Early Follow Through: From ball contact to the club being horizontal to the golfer’s lead side
  • Late Follow Through: From the horizontal club position to the end of the motion.

If you’re an anatomy nerd, the following 2 tables below might interest you. It breaks down and identifies which muscles are recruited during the different phases of a golf swing. It further identifies which muscles are used at each phase, which side of the body is recruiting the muscles, and between upper and lower body muscles (Tables 3 and 4 respectively).

Table 3 - Summary of Most Active Upper Body Muscles During Different Phases of Golf Swing
Table 4 - Summary of Most Active Lower Body Muscles During Different Phases of Golf Swing
Not an anatomy nerd? Not to worry. The takeaway from these charts is that if you can point to your pain, and then your therapist will identify which phase of the golf swing you have the pain, it can help with diagnosis and optimal recovery.

Common Golf Injuries

Three common golf injuries include Medial Epicondylitis (a.k.a. Golfer’s Elbow), knee pain and back pain.

Medial Epicondylitis or “Golfer’s Elbow”

Medial Epicondylitis or Golfer’s elbow is pain felt close to the bony bump on the inside part of the elbow due to inflammation of the wrist tendons. The pain can travel down the inside part of the forearm and is often accompanied by muscle tightness along the inside of the arm.

Treatment for Golfer’s Elbow by a Physiotherapist, Chiropractor or Registered Massage Therapist

A Physiotherapist and or Chiropractor will help diagnose this condition and can help you throughout your recovery. Treatment may include manual therapy, modalities including Shockwave therapy or Acupuncture, bracing/taping techniques, therapeutic exercises and education to help speed healing time.

Massage therapy techniques will address the whole arm in general, where deep techniques will be applied to any tight muscles surrounding the shoulder, elbow, and especially the forearm. Pin and Stretch or Active Release Techniques to the inside part of the elbow at the muscle closest to the tendon can help to decrease the local pain, and promote tissue  mobility and health in the area. Dynamic cupping (sliding a silicone cup), along the inside part of the forearm,  where tension/tightness is present, can also compliment Massage and Pin and Stretch techniques. Since Massage Therapy is composed of numerous compressive techniques, cupping can offer up added therapeutic value since it decompresses the soft tissue and fascia mobilizing the area in a different direction (away from the bone.

Home Exercises for Golfer’s Elbow

Local contrast bath to control swelling/pain

If the injury is experienced within the last 24-48 hours, warm/cool contrast hydrotherapy can be helpful.

  1. Soak 2 separate face cloths 1 soaked in warm water and 1 in cold water
  2. Place warm face cloth over affected area (inside part of elbow at bony prominence), for 3 minutes
  3. Place cold face cloth over same area for 1 minute
  4. Repeat 3-4 times, can offer up pain relief and promote local circulation important for healing.

Stretch: Wrist Flexors

  1. Either standing over a bench/desk/table or kneeling on the floor place the palm of your hands on the flat surface, with your forearms facing out, away from you, and your fingertips facing towards you.
  2. Gently lean back, maintaining palms on the flat surface.
  3. Hold stretch for 30 seconds (up to 2 minutes if you have the time), repeat 2-3 times.

Strengthen: Wrist Curls (banded or weighted for flexors and extensors)

  1. Place back of forearm, palm up on bench/table or, while seated, on your thigh.
  2. Have your wrist and hand hanging off the end of the bench or your thigh.
  3. Raise and lower the weight using slow, controlled movements.
  4. Repeat with back of forearm and palm facing upwards.
  5. 2-3 sets, 8-15 reps each side.

Knee Pain from Golf

If you’ve followed the career of Tiger Woods, you may recall early on in his career he had a number of knee surgeries to remove cysts in his knees and arthroscopic surgery to repair his ACL (anterior cruciate ligament). Knee pain is quite common in golfers, and occurs for various reasons:

  • Sprains: Injury to ligaments ie. ACL
  • Torn or Injured Meniscus
  • Strains: Injury to a muscle
  • Tendinopathy: injury to a tendon
  • Osteoarthritis: degeneration to the cartilage of a joint presenting as pain, decreased mobility

Often, knee pain in golfers is felt on the inside of the knee and/or across the kneecap due to rotational forces.

Treatment for Knee Pain in Golfers by a Physiotherapist, Chiropractor or Registered Massage Therapist

A Physiotherapist and or Chiropractor will help diagnose what structures of your knee are causing pain condition and can help you throughout your recovery. They may refer you for more imaging if needed but they will start treatment right away. Treatment may include manual therapy, modalities including Shockwave therapy or Acupuncture/Dry needling, bracing/taping techniques, therapeutic exercises and education to help speed healing time.

Massage Therapy for knee pain will likely focus on structures around the knee in addition to above and below. Working on improving hip and ankle mobility will be important. When the hips are not mobile and strong, the knee works harder to stabilize the hip. Deep tissue techniques applied to the low back, gluteal, quadriceps, hamstrings and adductors (inside thigh muscles), can improve hip movement. Range of motion exercises for the hip and joint mobilizations to the low back and hips can help to improve mobility, making it easier on the knees.

Home Care/Exercises for Knee Pain

Strengthen: Adductors Squats

  1. Standing, put a pillow in between your thighs, just above the knee.
  2. Squeeze knees together
  3. With your feet hip distance apart perform a Squat while continuing to squeeze the pillow throughout the movement.
  4. Repeat 2-3 sets, 8-15 reps, hold squeezes for 2-3 seconds each.

Strengthen: Standing calf raise with heel squeeze

  1. Stand facing fairly close to a wall
  2. Squeeze a ball (i.e. lacrosse, rubber), between you heels
  3. Slow and controlled, raise both heels off ground without losing heel squeeze on ball
  4. Repeat 2-3 sets, 10-15 reps

Strengthen: Full lower leg chain, single leg stance on a unstable surface

  1. Place a pillow on the floor.
  2. Place on foot on the pillow and lift your other foot off of ground.
  3. Sustain single leg stance for 30-60 seconds.
  4. Repeat 2-3x. Use wall or chair if required for stability.

Back Pain from Golf

Back pain is the most common injury or complaint from golfers. Pain can be felt in the lower, middle, upper back. Often with back pain, golfers report a restricted range of motion at one or more phases of the golf swing. Common areas of back pain in golfers:

    1. Sacroiliac (SI) Joints – the area connecting our pelvis to our tailbone
    2. Thoracolumbar junction – the area where our rib cage ends (where thoracic spine becomes the lumbar spine)
    3. Inter-scapular area – area between our shoulder blades.

Treatment for Back Pain in Golfers by a Physiotherapist, Chiropractor or Registered Massage Therapist

A Physiotherapist and or Chiropractor will help diagnose this condition and can help you throughout your recovery. Treatment may include manual therapy, manipulation of the spine, modalities including Acupuncture or Dry needling, therapeutic exercises and education to help speed healing time.

Joint mobilizations for the sacroiliac joint will help assist with hip and low back mobility, which is important for generating torque through the pelvis, whereas joint mobilizations to the scapulae and shoulder joint will help maintain the backswing and follow-through phases of the swing.

A Massage therapist can apply deep tissue techniques on your back. It’s important to Massage the whole back, even if the pain is only presenting in one area of the back. This is to ensure tissue health surrounding the full spinal column is mobile. It is important to also address the chest and glut muscles and around the shoulder and hip as well to help ensure there are no restrictions in movement through the different phases of the golf swing.

Passive, assisted stretches to the quadratus lumborum (QL) muscles, and hip flexors will complement the hip and SI joint mobilizations, while passive, assisted stretches to the pectoral muscles are a good follow up to the deep tissue techniques.

Home Exercises for Back Pain

Mobility: Deep squat with thoracic rotation

      1. Move into a deep squat, with feet flat on the floor.
      2. Grab outside of left foot with left hand, but keep your arm on the inside part of your knee.
      3. With right arm extended, rotate behind you and reach as far back as comfortably possible.
      4. Reverse for other side.
      5. 2-3 sets, 10-15 reps per side.

Mobility: Thread the Needle

      1. On a yoga or Pilates mat, get in quadruped position (all 4’s)
      2. Outstretch your right arm to 90º and rotate back behind you as far as comfortably possible, and then bring it back down and “thread” it through the space under your chest and reach as far out as you can and tap the floor for a beat, repeat.
      3. Reverse for your other side.
      4. 2-3 sets, 10-15 reps per side.

Mobility with Stretch: Standing lunge, side bend stretches (for QL muscle)

      1. Take one step forward with the left foot in a partial lunge stance
      2. Standing tall in the partial lunge, raise both arms straight above your head.
      3. With your left hand, gently pull on your right wrist and side bend to the left.
      4. Hold for 30 seconds (up to 2 minutes if you have the time).
      5. Reverse for the other side.
      6. Repeat 2-3 times each side.

Proactive treatment which can include regular Massage therapy and is a great way to maintain or improve the quality of movement of your golf swing, allowing the potential to hit your peak distance on your drives! If you are interested in improving your game or have a nagging injury related to golf, our professionals are here to help!

Happy Golfing!

References:

  1. Silhouette description of the phases of the golf swing (Farber et al., 2009).
  2. British Journals of Sports Medicine: Muscle Activity of the Golf Swing on 21 October 2005.

Mark Dones, Registered Massage Therapist

Mark Dones is a registered massage therapist practicing at Rebalance Sports Medicine in downtown Toronto.

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YONGE & ADELAIDE
UNIVERSITY & KING
Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
E: [email protected]
University & KingRebalance Clinic University King
155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
E: [email protected]

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