Do you know a golfer who is plagued by an injury that doesn’t seem to want to go away? I’m sure you do, it is very common. Knees, hips, backs, shoulders, necks, elbows, and wristas are all common areas of concern.
Why Do These Golf Injuries Occur?
Many of these issues are overuse in nature, and that’s what I will be writing about in this article. Of course some injuries are related to more significant trauma, and they are outside my realm (see a sports medicine professional).
Overuse injuries occur when an area is exposed to a stress it cannot tolerate, over a long period of time. Many of these injuries could have been avoided in the first place, are not particularly complicated, and can be simply rehabbed if some basic principles are applied consistently. Before getting into what I have found is a useful framework to follow for run of the mill aches & pains, let’s look at some reasons why these niggly golf injuries can hang around for longer than necessary.
Golf Injuries Aren’t Properly Managed
From my observations communicating with 1000’s of golfers there are a number of reasons why simple injuries are not well managed, which is hugely affecting the length and quality of recovery for the average case.
Not Getting Good Quality Advice
Who should you see if you have an overuse injury? That’s a good question, and it will likely depend on who you ask and awhat country you live in.
My advice is to make sure that you see a medical professional that is working regularly with sports injuries, and can accurately diagnose your issue. This should involve a thorough conversation about your activity history, the problem you are trying to solve, and your goals.
There is an important difference between getting back to normal daily activity and high level / intense activity (like sports) without issue. Not all medical professionals have the same expertise or experience to satisfy these differing needs. Do your research and choose wisely. If you are not satisfied with your experience, it can be worth getting a second opinion.
A doctor with specialisation in sports injuries or a physiotherapist is likely your best option, in my opinion. As mentioned earlier, this might be country dependent.
Ask them what they believe your return to full activity will look like. If you are simply written a prescription for pain killers, and told to ice and rest, I suggest looking elsewhere. These might be useful in the short term after an injury occurs for managing pain, but they are not sufficient for returning to your best.
Treating Symptoms Rather Than Improving the Situation
Anti inflammatories, ice, heat, many passive treatments, and avoidance of loading or stressing the area (often termed as rest) will likely help with short term relief, but are doing little to help prevent the issue from recurring when you resume to normal activity. To prevent the issue recurring when we return to activity we need to build a greater tolerance / conditioning level than was present when the injury originally reared its head.
The “I’m fragile” Mindset
“With my bad back I can’t lift that”
“I need to mind my knees”
“That looks like it’s a lof of stress on the _____________”
“I was told I can’t do that anymore”
“At my age………….”
When you have an injured area you have two choices.
Option 1: Gradually train the area and surrounding areas to improve function (mobility strength, power, endurance, etc)
Option 2: Avoid training the area, leading to it getting weaker, more deconditioned and losing function.
Which do you think is better for your long term outcome?
I hope you picked option 1. So often people choose to do just the opposite. An extremely common scenario I come across is somebody tells me their back or knee hurts during or after playing golf and it’s affecting their performance, enjoyment, or how regularly they can play or practice. I ask them what they’re doing to rectify the situation. They proceed to tell me the usual list of icing or heating, pain killers, wearing a brace / support, resting, and maybe some stretching or massage. The above can be useful for managing the symptoms, but are very unlikely to lead to successful rehabilitation as they do little to nothing for improving long term function.
Does This Cycle Of Event’s Sound Familiar?
Golfer’s explain the following cycle to me regularly. Let’s use the shoulder as an example.
Golfer develops pain in shoulder from golf (can substitute any activity).
Golfer takes pain killers and uses ice to numb pain.
Tries “sucking it up” and continues playing the same amount. Shoulder pain gets worse.
Golfer is forced to take a complete break from golf and decides shoulder needs to “rest”, so stops all activity that load the shoulder.
Shoulder pain seems to reduce and feels “OK”, golfer jumps straight back into the previous level of activity thinking / hoping shoulder is “fixed”
Shoulder pain returns.
The diagram below shows an illustration of this.
Cycle Of Recurring Golf Injuries
Why Don’t You Get Better?
A crucial error many people make when returning to golf after a lay off due to injury (this applies to any activity) is that they bring the previously injured and deconditioned body / body part immediately back to the exact same amount of practice and play that lead to the issue in the first place. This is completely nonsensical. If your tolerance to the stresses of practice and play was below the level needed for your amount of practice and play before the injury, how on earth do you expect the now weaker and more deconditioned area to tolerate the same demands imposed on it?
Although after your rest period the area is no longer sore, this by no means signifies it’s ready to return to your previous volume of practice and play.
You need a structured and progressive rehabilitation plan which improves the loading capacity your body can tolerate. In simple terms this means you probably need to improve your mobility, get stronger and more powerful, and improve your muscular endurance. This is infinitely more important and beneficial than ice, heat, pain killers, massage, cupping, acupuncture, adjustments, needling etc. (These may have some small place, but they’re not rehab).
A Better Approach:
An overuse injury is a sign that something needs to change. “Sucking it up” and popping pills is not the long term solution, especially if you care about your body and golf performance.
The first step is something that most golfers do not like to hear. You will need to reduce your practice and play to a level that you can tolerate. This doesn’t mean you have to stop playing golf completely (although it might for a period), but you will need to make some modifications. Exactly what those modifications are and how severe they need to be are impossible to say. This is where your medical professional comes in, and you will need to experiment. There’s many variables and individual nuance that come in to play. In simple terms we need to reduce the type and amount of stress (e.g hitting golf balls) that are the main aggravating factors. Some examples of how to do this include but are not limited to:
- Playing 9 holes rather than 18.
- Getting a small bucket of balls rather than large.
- Changing the surface you hit off when practicing. Doing 2 x 30 minute practice sessions with a couple of days between them, instead of 1 x 60 minute session at once.
- Working more on short game or less than full speed swings, as opposed to regular long game work.
- Switching up the types of shots we are hitting more frequently. Switch between full swings, pitches, putts, frequently rather than standing in place making the same movement over and over again.
If we go back to the common cycle I highlighted above, here is a better approach:↓↓↓↓
Golfer performs year round strength & conditioning which hugely reduces chance of picking up an injury. Something as little as 10-20 minutes 2-3 times per week can make a big difference. This can be planned in accordance with your playing amounts at different times of the year.
If a golfer develops a problem playing golf, they stop “picking the scab” and applying the same stress to the area that is causing aggravation.
They get the area assessed by somebody experienced in dealing with golf injuries, AND competent in creating a structured, progressive rehabilitation plan. A comprehensive plan should include exercises based on their assessment, and a discussion on how to GRADUALLY to return to golf. . Make sure they have experience dealing with sports related injuries. As your rehab progress it should less like therapy and more like regular training. A common mistake in rehab is a lack of progression. Yes, things should be conservative at first, but appropriate progression is essential.
As your symptoms and function improve the rehabilitation plan should gradually be progressed. It’s important not to rush in this stage. This stage is where many golfers get impatient and just pop some pain killers, get the ice pack, and return to their normal routine, and the same symptoms reappear. After a couple of rehab sessions and a short period of time they throw in the towel and declare “it’s not working”. What they don’t respect is that the issue was created over a long period of time, and it’s foolish to think improvements will be instant.
As the symptoms and function improve further, gradually build back towards normal practice and play volumes. DO NOT think you’re “fixed” and ditch your training exercises. It’s important to remember you need to build up to a level of conditioning that’s higher than the level you were at when the injury presented itself in the first place. Use aggravation as your guide. Some tenderness / soreness / symptoms are to be expected, but they should be mild. If you need to dial it back a little bit, do. Again, the key here is that you don’t revert to complete inactivity, but to the stage of rehab and practice / play that is your “sweet spot”. This is a level that is enough to stimulate recovery and enhancement, but not so much it causes backwards steps.
Eventually you should be back to better than what you previously considered ‘normal”, and able to withstand more practice and play than you previously would have without having issue.
I strongly encourage you perform basic year round strength & conditioning training to help prevent these issues arising in the first place. It also hugely improves general physical function and golf performance potential.
Many people don’t have this level of patience, but it’s what’s usually required. It’s a key difference I’ve seen in the attitude of high level athletes who respect their body, the recovery process and want to be better in the long term, versus those looking for a quick fix and masking of symptoms.
(PS If someone is promising a “quick fix” or not advocating progressive structured rehab, beware)
As Charlie Weingroff says “Training = Rehab, Rehab = Training”
A wise approach to this is to start a training program at an appropriate level, taking into account the current state of your injury, function and tolerance level, and level of overall conditioning. You can set a future goal performance level and gradually work towards there.
Many golfers see injuries as isolated issues. They have a sore elbow, back, or shoulder and don’t realise that a better overall level of conditioning will likely make a huge difference to their ability to play and practice without having to deal with these aches and pains.
It’s important for people who are dealing with long term niggles to understand that they are not broken, and it’s perfectly OK and critically important to load and train problematic areas. We are not as fragile as we think, and exposing the body to an appropriate level of stress is crucial to psychological and physiological improvements.
If you are an avid golfer who currently does not have injuries, it’s a good idea to take a proactive approach. Basic strength & conditioning principles go a long way to reducing the likelihood you have to spend time on the sidelines, or playing through pain. Of course there is also huge performance benefits. More mobile and powerful swings resulting in increased club head speed, and more energy during rounds being the most obvious.
If you are a golfer interested in a simple but comprehensive strength & conditioning program to help you improve your golf specific fitness you might be interested in the Fit For Golf App.
Over 8000 golfers have gone through programs on the app and one of the most positive areas of feedback I have received is how many players have cleared up nagging injuries! There is a program suitable for all ability levels and they can be followed from the gym or home.