June 6, 2003 -- The sounds of "Fore! Thwack! ...Ouch!" may be more common on golf courses than the gentle roll and swish of a hole in one. A new study shows that golf may be on par with other sports in terms of causing overuse injuries to the elbow, back, and shoulder that can keep players off the links for months at a time.
But before golfers start hanging up their clubs, the study also found that a good, 10-minute warm-up can do a lot to keep most golfers on the greens and in good health.
Researchers say golf is enjoying a major upswing in popularity across the globe with the emergence of young, exciting golfers like Tiger Woods. But despite the increasing number of adults participating in the sport, relatively little is known about the potential risks for golfing-related injuries.
Elbows, Backs, and Shoulders ... Oh My!
To find out where golfers hurt most, researchers surveyed 703 golfers (643 amateurs and 60 professionals) from 24 golf courses in Germany during two golfing seasons. Their findings appear in the current issue of the American Journal of Sports Medicine.
Researchers found more than 80% of the golf injuries reported were overuse injuries, and about 17% were isolated traumas like a head injury or sprained ankle. Golfer's elbow -- a form of tendinitis -- was the most commonly reported overuse injury among amateur golfers, followed by aching backs and shoulders.
Professional golfers injured themselves more often and suffered an average of three injuries a year compared with an average of two injuries per year among amateurs. Professional golfers were more often injured in the back, wrist, and shoulder.
The golfers' age, sex, or body mass index (BMI -- a measurement that indicates if someone is overweight) didn't affect their risk of injury. Nor did their playing level or handicap make much of a difference in terms of injury rates among amateur golfers.
But the amount of time golfers spent warming up before hitting the links did have a significant impact on their frequency of injury. Those who warmed up for 10 minutes or less beforehand reported an average of about one injury per player compared with only about 0.4 injuries reported per player who warmed up for more than 10 minutes.
In addition, the study found that golfers who carried their own bag suffered significantly more injuries to the lower back, shoulder, and ankle than those who used a cart or caddie.
Overall, golfers lost about four weeks of golfing time per injury, but a significant number of injuries kept golfers off the greens for up to six months.
"The seriousness of musculoskeletal problems in golf is underlined by the fact that almost one-fourth of reported injuries were major ones causing absence from the golf course for more than one month," write researcher Georg Gosheger, MD, of the University of Muenster in Muenster, Germany, and colleagues.
As expected, the study also found that the amount of time golfers spend swinging their clubs also increased their risk of injury. Researchers found golfers who played four or more rounds of golf per week or hit at least 200 range balls per week reported significantly more injuries than others.
"These numbers are without a doubt different for every golfer; still, they emphasize the fact that too much golf does result in more injuries," they write.
SOURCE: American Journal of Sports Medicine, Vol. 3, No. 3, 2003.