Golf – Enhancing Performance.

 

41% amateur golfers report injuries each year.

Despite golf being considered a low impact, recreational sport – the time spent on feet, repetitive nature of golf, high forces of the golf swing & incorrect technique leads to overuse injuries – ignored until they significantly impact performance.

Physiotherapists help enhance your performance with thorough assessment & diagnosis of your golf injury – providing rehabilitation for common golf injuries such as elbow, shoulder, hip, knee, foot & back pain. The positive effect on golf performance is achieved by assessing the contributing factors to your injury & creating injury prevention strategies.

Robust rehabilitation returns you not only to play, but to peak performance.

 

Knee Pain in Golf

Although the golf swing is considered unlikely to cause acute injury, because of the repetitive nature of golf and the significant forces through the knee in the swing, it does mean the knee is susceptible to joint wear or osteoarthritis, meniscal (cartilage) damage and overuse soft tissue injuries.

Research is evolving to suggest modifications to the golf swing to help manage those playing with degenerative changes in the knee.

Golf swing

• research consistently show that with forces, in many directions, both lead and trail knees face significant forces throughout the swing (Nelson et.al, 2022).

Ball Position

• “the distance length of one golf ball closer to the golfer” can reduce forces of the lead leg during the golf swing
• forces can be reduced by modifying the ball position at address without compromising clubhead speed (Kim, 2022)

Open Stance

• “biomechanics of the lead knee joint were significantly altered by externally rotating and using the open stance at address.”
• this can reduce rotation & compressive forces on the lead knee joint – which may be related to knee OA (Stokes et.al., 2023)

Golf Swing Tips with Golf Distillery

The golf swing is a powerful, complex movement requiring coordination through the whole body — from your hand & wrist to your feet.

 

Shoulder Pain in Golf

Shoulder pain is responsible for between 8–18% of golf injuries (McHardy et al., 2006) – the third most common injury behind the lower back and wrist.

Due to the repetitive nature of golf, these are related to overuse which unless addressed early can erode the structural integrity of the tendons & shoulder joint.

Rotator cuff – The rotator cuff is a group of four muscles that work together to help hold the top of the humerus centrally in the shallow shoulder socket – they coordinate to allow great mobility & range of motion around the shoulder.

Golfers who lack rotation range through the thoracic spine & hips during both backswing & follow-through, compensate using their shoulders or lumbar spines, causing excessive, repetitive forces through these structures.

This results in

• Rotator cuff tendinopathy
• Subacromial impingement
• AC joint irritation
• Labral injuries

 

Elbow & Wrist Pain in Golf

Elbow and wrist injuries together account for 25–35% of all golf-related injuries — making the upper limb the most common region affected after the lower back (Batt, 1992).

Medial Elbow Pain (“Golfer’s Elbow”)

• Pain on the inside of the elbow is commonly tendinopathy in the tendons of the wrist flexors. During the downswing & impact phase, golfers maintain a firm grip & a slightly flexed wrist to control clubface position.
• This places high loads through the wrist and muscles of the forearm. With repeated efforts, poor technique & over-gripping, this gradually overloads the tendons causing a breakdown in the tendon architecture.
• For right-handed golfers, the left (lead) arm absorbs significant forces at impact & follow-through, contributing to elbow tendon micro-trauma.

Lateral Elbow Pain (“Tennis Elbow”)

• Pain on the outside of the elbow due to overuse of the wrist extensor tendons at the elbow.
• Excessive wrist extension and over-gripping the club both cause wrist extensor muscle overuse.

 

Wrist Injury in Golf

> Triangular fibrocartilage complex (TFCC) tears cause pain on the outside of the wrist (little finger side of the wrist).

> These commonly occur with a “fat shot” – or a golf shot hit fat. This is where the club hits the ground before making contact with the ball rather than the clubhead making contact with the ball before the ground. (www.golfdistillery.com)

> Hook of Hamate Fractures: This fracture often occurs during swings when the golfer strikes the ground before hitting the ball. Pain is felt on the palm side of the hand near the wrist – on the same side as the little finger.

> Extensor Carpi Ulnaris (ECU) is a muscle on the outside of your forearm that controls the wrist. It is most active during the golf swing at impact and can present as a tendinopathy or can sublux (move out) of it’s groove at the wrist causing pain. It is most common in right handed golfers in their left wrist.

 

Back Pain in Golf

The thoracic spine plays an essential role in transferring forces from the hip, through the lower back to the arms and the club.

Research indicates that lumbar spine injuries account for approximately 55% of all injuries in professional golfers and 35% in amateurs, highlighting the prevalence and potential impact of such conditions on golfers’ performance & general health.

Upper Back – Why is thoracic stiffness a problem in the golf swing?

Thoracic Pain & Stiffness

> Poor mobility in the upper back (between the shoulder blades to the lower back) contributes to limited extension (standing straight, shoulders back) and rotation.

> During the backswing – the upper body needs to be able to rotate away from & significantly more than the lower body.

> As the backswing ends – hips begin to unwind & rotate towards the target before the upper body and arms – they separate.

> During the downswing – the delayed rotation of the upper body relative to the lower body – the “separation of the hips & shoulders” creates a stretch through the trunk that is then released through the downswing – creating power & speed.

> Stiffness and lack of thoracic mobility results in the golfer trying to generate the forces through other means – arms, elbows & wrists – which can lead to injuries.

Lower Back Pain

> Lack of mobility & strength in other areas often leaves the lumbar spine vulnerable to excessive forces & overuse.

> Poor hip range, a stiff thoracic spine & stiff ankle range combined with a lack of abdominal & trunk strength, lead to excessive forces through the lumbar spine. This inevitably leads to:

 

• soft tissue injury – muscle or ligament
• disc degeneration
• facet joint arthritis
• bone stress injuries

 

> Swing characteristics, such as Reverse Spine Angle and Early Extension, have been identified as having a high correlation with the onset of low back pain. These can create excessive rotational forces on the lumbar region, leading to increased stress on the discs and surrounding structures.

 

Hip Pain in Golf

Hip injuries are a common concern, often resulting from the repetitive nature of the sport and specific biomechanics involved in the golf swing.

The action of swinging a golf club involves significant hip rotation, particularly on the lead leg, which places stress on the hip joint and surrounding muscles.

Overuse Hip Joint Injuries

> The labrum of the hip is a ring of cartilage that attaches to the rim of the hip socket to deepen & maintain the lubrication of the hip joint by creating a seal. Repetitive wear on the labrum can cause degenerative tears which result in deep hip pain, clicking & grinding.

> Soft tissue overuse injuries around the hip include gluteal muscle tendinopathy & bursitis (inflammation of a small fluid filled sac that reduces friction between tendon and bone)

> Hip Impingement (femoroacetabular impingement) occurs when the femoral head (ball of the hip) pinches against the acetabulum (hip socket). Golfers report hip stiffness, pain & catching in the front of the hip.

 

Foot Pain in Golf – Plantarfasciitis

A key structure in the foot’s anatomy is the plantar fascia, a dense, wide band of connective tissue that stretches from the heel bone (calcaneus) to the toes, supporting the arch of the foot. The plantar fascia plays a crucial role in absorbing shock and supporting the foot’s structure during activities such as walking, running, and pivoting, which are common in golf.

What increases the risk of heel & foot pain in golf?

Usually a combination of factors linked to a prolonged physical activity results in higher stresses on the plantar fascia. These include:

• prolonged physical activity
• inappropriate shoes
• poor arch support for foot type
• flat feet (over pronation) or high arches
• people who are overweight
• long periods on uneven terrain
• repetitive stress of the golf swing

 

How Physiotherapy Can Help

Tendinopathy

Tendon injury of the shoulder, elbow, wrist, foot & hip does not heal overnight. The tendinopathy recovery process is slow and relies on consistent, progressive loading.

• Pain reduction can be seen within 6–8 weeks of guided rehabilitation & activity modification.
• Tendon remodeling takes around 12 weeks or longer for true physiological change.
• Full strength & load tolerance can take up to 16–20 weeks depending on the injury.

Early pain relief from rest or passive treatment is encouraging, but lasting improvement comes from rebuilding tendon strength and control through specific loading programs.

 

Strengthening is a process – no short cuts.

Isometric Contractions – These are where the muscle contracts without movement & can be used when you are in pain to reduce pain & restore tendon load capacity. They are unlikely to cause pain or aggravate the tendinopathy.

Controlled Strength Through Range – Build strength and control through range, progressing from lifting a weight but also lowering it with control.

Heavy Slow Resistance – this phase helps stimulate true tendon adaptation in preparation for introducing speed once the strength as been restored.

Plyometric Phase – this is important to work on the rate of force development in the muscle.

Sport Specific Phase – introduction of high-impact activities, individualised to each affected structure.

 

Returning to Golf After Joint Replacement Surgery

Approximately 80% of golfers will return to golf after joint replacement surgery (arthroplasty) in an average of 4.4 months (Robinson et.al., 2022).

90% return after a hip replacement

70% return after a knee replacement

80% return after a shoulder replacement

 

Restore Performance

Our physiotherapists use a combination of evidence-based treatments to manage pain + progress strength + improve mobility + restore performance.

• Manual therapy & soft tissue techniques to reduce pain and improve mobility.
• Shockwave therapy for stubborn tendon pain (heel, shoulder, wrist pain) to allow you to start your rehabilitation program.
• Individualised strength & flexibility programs to help restore the range & control you need to play golf safely and consistently.
• Join our Strong & Steady Class for guided & supervised strength classes in our physio gym.
• Load management advice to help you modify play & training safely while you rehabilitate your injury.

Whether you’re a weekend golfer or a competitive player, our team is here to help you return to pain-free golf with confidence – at the top of your performance..

 

 

Book an appointment – at The Sports Physio Clinic — and get back to playing the game you love.

 

Golf Injuries & How Physiotherapy Can Help You Get Back On Course.

Creighton A, Cheng J, Press J. Upper Body Injuries in Golfers. Curr Rev Musculoskelet Med. 2022 Dec;15(6):483-499.

Gladdines, S., von Gerhardt, A.L., Verhagen, E. et al. The effectiveness of a golf injury prevention program (GRIPP intervention) compared to the usual warm-up in Dutch golfers: protocol design of a randomized controlled trial. BMC Sports Sci Med Rehabil 14, 144 (2022).

Grimshaw P, Giles A, Tong R, Grimmer K. Lower back and elbow injuries in golf. Sports Med. 2002;32(10):655-66.

Kim SE. Reducing Knee Joint Load during a Golf Swing: The Effects of Ball Position Modification at Address. J Sports Sci Med. 2022 Sep 1;21(3):394-401

Murray AD, Daines L, Archibald D, et al. The relationships between golf and health: a scoping review. Br J Sports Med 2017; 51:12–9.

Nelson, Jessica A.; Richard M. Wardell; Dustin L. Richter; and Robert C. Schenck. “Knee Mechanics in the Golf Swing and the Potential Risk for Injury to the Anterior Cruciate Ligament and Other Structures: A Review.” Western Journal of Orthopaedics 11, 1 (2022).

Robinson PG, Clarsen B, Murray A, Junge A, Mountjoy ML, Drobny T, et al. A prospective study of injuries and illnesses among 910 amateur golfers during one season. BMJ Open Sport & Exercise Medicine. 2024;

Robinson PG, Williamson TR, Creighton AP, et al. Rate and Timing of Return to Golf After Hip, Knee, or Shoulder Arthroplasty: A Systematic Review and Meta-analysis. The American Journal of Sports Medicine. 2022;51(6):1644-1651

Stokes H, Escamilla R, Bellapianta J, Wang H, Beach T, Frost D, Zheng N. Open Foot Stance Reduces Lead Knee Joint Loading During Golf Swing. J Appl Biomech. 2023 Aug 16;39(6):395-402

Williamson TR, Kay RS, Robinson PG, et al. Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis British Journal of Sports Medicine 2024.

 

TPI – MyTPI.com