Lower back and elbow injuries in golf

Abstract

Golf injuries to the lower back and elbow are common problems in both the professional and amateur player, and any information regarding the successful treatment of these injuries has important implications for the medical practitioner. This paper presents the successful management and outcome of two case studies associated with low back pain and lateral epicondylitis in golf. Exercise therapy and conditioning has been shown to be an effective treatment modality for these two types of injury. In particular, a dynamic exercise programme which incorporates golf functional rehabilitation, is a modern and accepted method by both the patient and the clinician. Effective programmes need to be golf-specific to maintain the interest of the participant and yet at the same time they need to be able to accommodate other factors such as age, gender and the level of the golfer. Furthermore, it is critical that the clinical practitioner has a fundamental knowledge of normal swing mechanics and a working knowledge of the musculoskeletal requirements needed to swing a golf club. In the case of the lower back injury, evaluation was based on detailed computer tomography and centred on the conditioning of the transversus abdominis muscle. Although this muscle is not considered to be paraspinal, it has particularly important implications in the maintenance of spinal stability so that other more specific golf functioning exercises and rehabilitation can be performed. For the case study of lateral epicondylitis detailed evaluation and consideration of neuropathy was an important factor in the diagnostic process. In part, it was necessary to deviate from conventional treatment to produce an effective outcome. A comprehensive resistance-strength-training programme and golf functional 'hitting' programme was used to treat the problem. The conformity by the patient to complete the exercise regimen has been an issue of concern for clinicians managing and treating golf-related problems. Many golfers are 'fanatical' and unless they can see that by continuing the programme their injury will be overcome, it is difficult trying to restrict their time on the golf course. The two case studies described in this article highlight how an extensive and dynamic golf functional programme could be used as an effective method for managing and preventing golf injuries.