Andrew McHardy

Golf injuries : a review of the literature

Golf is one of a few activities that people of all ages and skill level can play. Injury as with all sports can occur. The low back is the most common injury sustained whilst playing golf, and the dynamic action of the golf swing is a major contributing factor to injury. The golf swing is a complex movement that utilises the whole body in a coordinated fashion and when repeated frequently can result in injury. Injury can be overuse or traumatic in nature. Overuse injuries predominate in the professional golfer, and amateur golfer injury tends to occur secondary to an incorrect golf swing. Upper limb injuries are also common due to their role in linking the fast moving golf club with the power-generating torso. Fortunately, injury from a club or ball strike is rare. More common are the overuse injuries associated with the back, neck and shoulder. Most golf injury data have been collected retrospectively and further epidemiological study of a prospective nature is required to determine injury incidence and factor relating to the onset of injury.

One-Year Follow-up Study on Golf Injuries in Australian Amateur Golfers

Background Considering its popularity, little epidemiologic literature exists on golf injuries. Hypothesis The low back is the most common injury location for golf-related injury. Most golf injuries occur as a result of the golf swing, and occur mostly at impact. The variables age, handicap, practice habits, and warm-up habits are associated with injury. Methods A prospective survey over 1 year was used to study golf injuries among 588 golfers at 8 Australian golf clubs. Information collected included golfers’ injuries sustained during the year, location of injury, onset, mechanism of injury, and whether injury occurred during the golf swing or at another time. Additional information was sought on the type of treatment received after injury. Logistic regression was used to examine the epidemiologic patterns of golf-related injury and any possible risk factors for the injury. Results The overall 1-year incidence rate of golf injury was 15.8 injuries per 100 golfers, which equates to a range of 0.36 to 0.60 injuries/1000 hours/person. Recurrent injuries were most common, while injuries were more likely to occur over time as opposed to an acute onset. The lower back was the most common injury site (18.3%), closely followed by the elbow/forearm (17.2%), foot/ankle (12.9%), and shoulder/upper arm (11.8%). A total of 46.2% of all injuries were reportedly sustained during the golf swing, and injury was most likely to occur at the point of ball impact (23.7%), followed by the follow-through (21.5%). Multivariate analysis revealed that the amount of game play (odds ratio [OR] = 3.73, 95% confidence interval [CI] 1.29-10.75) and the last time clubs were changed (OR = 0.32, 95% CI 0.12-0.86) were significantly associated with the risk of golf injury (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significantly associated with golf injury. Conclusions Nearly 16% of Australian amateur golfers may expect to sustain a golf-related injury per year. The injuries in golf are most likely sustained in the lower back region as a result of the golf swing. Based on statistical analysis, only game play and a changing of clubs seem to be significantly associated with risk of injury after adjusting for other risk factors (P < .05). Other factors such as age, gender, handicap, practice habits, and warm-up habits were not significant.

Chiropractic Treatment of Upper Extremity Conditions: A Systematic Review

OBJECTIVE This study investigates the scope, type, and quality of chiropractic research conducted on the management of upper limb peripheral conditions. METHOD A literature search regarding upper limb and chiropractic treatment was performed on CINAHL, MEDLINE, and MANTIS databases. Search terms included chiropractic, shoulder, elbow, wrist, hand, forearm, and arm, with MeSH terms for each region. For articles to be considered relevant, there had to be a peripheral diagnosis and chiropractic intervention. Papers were excluded if pain was referred from spinal sites. Duplicates, articles published in non-peer-reviewed literature, conference proceedings, grand rounds, and discussion papers where no treatment was actually rendered were also removed. The articles were then reviewed and assessed for quality using the Physiology Evidence Database (PEDro) scale. RESULTS There was a total of 64 articles found. There were 36 case reports for the shoulder, 8 case reports for the elbow, 14 case reports for the wrist/hand, and 6 clinical trials (3 shoulder, 1 elbow 2 wrist). For the PEDro score, 58 case reports scored 0, 1 clinical trial scored 7, 2 clinical trials scored 6, 2 clinical trials scored 4, and 1 clinical trial scored 0. CONCLUSION There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence). Most treatments are multimodal in nature, which address both spinal and peripheral structures, with joint and soft tissue methods. There is a need for future research to be directed at higher-level evidence, in particular, randomized controlled trials for the chiropractic treatment of upper limb conditions.

Low back pain status in elite and semi-elite Australian football codes: a cross-sectional survey of football (soccer), Australian rules, rugby league, rugby union and non-athletic controls

Background: Our understanding of the effects of football code participation on low back pain (LBP) is limited. It is unclear whether LBP is more prevalent in athletic populations or differs between levels of competition. Thus it was the aim of this study to document and compare the prevalence, intensity, quality and frequency of LBP between elite and semi-elite male Australian football code participants and a non-athletic group. Methods: A cross-sectional survey of elite and semi-elite male Australian football code participants and a non-athletic group was performed. Participants completed a self-reported questionnaire incorporating the Quadruple Visual Analogue Scale (QVAS) and McGill Pain Questionnaire (short form) (MPQ-SF), along with additional questions adapted from an Australian epidemiological study. Respondents were 271 elite players (mean age 23.3, range 17–39), 360 semielite players (mean age 23.8, range 16–46) and 148 non-athletic controls (mean age 23.9, range 18– 39). Results: Groups were matched for age (p = 0.42) and experienced the same age of first onset LBP (p = 0.40). A significant linear increase in LBP from the non-athletic group, to the semi-elite and elite groups for the QVAS and the MPQ-SF was evident (p < 0.001). Elite subjects were more likely to experience more frequent (daily or weekly OR 1.77, 95% CI 1.29–2.42) and severe LBP (discomforting and greater OR 1.75, 95% CI 1.29–2.38). Conclusion: Foolers in Australia have significantly more severe and frequent LBP than a nonathletic group and this escalates with level of competition. Published: 17 April 2009 BMC Musculoskeletal Disorders 2009, 10:38 doi:10.1186/1471-2474-10-38 Received: 14 October 2008 Accepted: 17 April 2009 This article is available from: http://www.biomedcentral.com/1471-2474/10/38

Golf and upper limb injuries: a summary and review of the literature

BackgroundGolf is a popular past time that provides exercise with social interaction. However, as with all sports and activities, injury may occur. Many golf-related injuries occur in the upper limb, yet little research on the potential mechanisms of these injuries has been conducted.ObjectiveTo review the current literature on golf-related upper limb injuries and report on potential causes of injury as it relates to the golf swing.DiscussionAn overview of the golf swing is described in terms of its potential to cause the frequently noted injuries. Most injuries occur at impact when the golf club hits the ball. This paper concludes that more research into golf-related upper limb injuries is required to develop a thorough understanding of how injuries occur. Types of research include epidemiology studies, kinematic swing analysis and electromyographic studies of the upper limb during golf. By conducting such research, preventative measures maybe developed to reduce golf related injury.

Golf-related lower back injuries: an epidemiological survey

OBJECTIVE This study describes the playing characteristics of golfers who had an injury to their lower back in the course of play or practice in the previous year (12 months). METHODS A retrospective survey was mailed to members of randomly selected golf clubs across Australia. Statistical methods used included 2-sample t test to compare means of 2 independent populations and the chi(2) test to examine the association between categorical variables/factors in the study. RESULTS Of 1634 Australian amateur golfers surveyed, 17.6% of golfers sustained at least 1 injury in the previous year. The lower back accounted for 25% of all golf-related injuries in the previous year, making the lower back the most common site of injury. The golfer with a golf-related lower back injury was likely to have a previous history of lower back injury, while the injury had a progressive onset compared with an acute single onset. The follow-through phase of the golf swing was reported to be associated with the greatest likelihood of injury compared with other phases of the swing. Most of the injured golfers received treatment of their injury with a general practitioner (69%), a physiotherapist (49%), or a chiropractor (40%). CONCLUSION Practitioners treating golfers with a history of lower back injury should evaluate the golf swing follow-through to identify potential causes of aggravation to the lower back. Targeted measures such as spinal manipulative therapy, soft tissue and back exercise, and conditioning programs to assist the strength and mobility of the golfer could then be implemented.

Low back pain in junior Australian Rules football: a cross-sectional survey of elite juniors, non-elite juniors and non-football playing controls

BackgroundLow back pain in junior Australian Rules footballers has not been investigated despite findings that back pain is more prevalent, severe and frequent in senior footballers than non-athletic controls and findings that adolescent back pain is a strong predictor for adult back pain. The aim of this study was to determine the prevalence, intensity, quality and frequency of low back pain in junior Australian Rules footballers and a control group and to compare this data between groups.MethodsA cross-sectional survey of male non-elite junior (n = 60) and elite junior players (n = 102) was conducted along with a convenience sample of non-footballers (school children) (n = 100). Subjects completed a self-reported questionnaire on low back pain incorporating the Quadruple Visual Analogue Scale and McGill Pain Questionnaire (short form), along with additional questions adapted from an Australian epidemiological study. Linear Mixed Model (Residual Maximum Likelihood) methods were used to compare differences between groups. Log-linear models were used in the analysis of contingency tables.ResultsFor current, average and best low back pain levels, elite junior players had higher pain levels (p < 0.001), with no difference noted between non-elite juniors and controls for average and best low back pain. For low back pain at worst, there were significant differences in the mean pain scores. The difference between elite juniors and non-elite juniors (p = 0.040) and between elite juniors and controls (p < 0.001) was significant, but not between non-elite juniors and controls. The chance of suffering low back pain increases from 45% for controls, through 55% for non-elite juniors to 66.7% for elite juniors. The chance that a pain sufferer experiences chronic pain is 16% for controls and 41% for non-elite junior and elite junior players. Elite junior players experienced low back pain more frequently (p = 0.002), with no difference in frequency noted between non-elite juniors and controls. Over 25% of elite junior and non-elite junior players reported that back pain impacted their performance some of the time or greater.ConclusionsThis study demonstrated that when compared with non-elite junior players and non-footballers of a similar age, elite junior players experience back pain more severely and frequently and have higher prevalence and chronicity rates.