An Evening for Golfers – Q&A Session

Watch this video of the Q&A session at UPMC Sports Surgery Clinic’s Evening for Golfers.

At this event, Ms Ann-Maria Byrne, Consultant Orthopaedic Surgeon presented on wrist injuries in golfers and how they can be prevented and Luke Hart Fitness Lead at SSC Sports Medicine presented and demonstrated exercises for increased mobility, flexibility & injury prevention.

This video is suitable for anyone interested in keeping strong, flexible and active as they get older and for anyone with hand wrist or elbow injuries.

Answered by Ms Ann-Maria Byrne

I suggest that people try a period of rest, then obviously attend to a physiotherapist. I often get referrals from physiotherapists for people who are failing an eccentric program and a loading program for the tendon, and then I’ll see them. I usually would give them between three and six months of physiotherapy and then I will want to assess them, check an MRI to make sure there’s no other pathology going on or any nerve issues because they’re so close by the common area of the inside of the elbow is associated with that – so anything between three and six months.

Answered by Ms Ann-Maria Byrne.

No, I recommend to use it as a counterforce. So as the force is moving up through the forearm, it stops the forces going up to the delicate tendon around the elbow.

So you wear it while you’re playing golf, or when you’re chopping vegetables when you’re bringing out the rubbish- when you are active, that’s when you do it so it’s not just about the golf, it’s the other things in your life as well that bring on these problems and symptoms.

Golf is just one part of the things that cause all these issues.

Answered by Luke Hart.

Yeah, that’s a great question. I think the first thing is that we’ll find a lot of people have MRIs with similar findings. So, 30% of people over 30 will have the same findings and when we get to 60 years old 90% of people have some sort of findings on their MRI.

So if you’re not in pain and you haven’t got any issues currently I wouldn’t worry too much about what the MRI is saying, in terms of a lot of people have those findings, but absolutely some of the exercises we’ve gone through today, especially glute bridges and hip thrusts they’re excellent for anyone with lower back pain, especially as a warm-up.

Obviously, it’s hard to do those at the course so you do them before you go to the course, and then, obviously, head over to the course.

And then a good warm-up is essential really to establish normal movement, especially if you’ve had to drive to the course.

So I think, warm-up is imperative if you have any kind of back pain but also during the glute bridges and the banded rotations are really important and will help anyone with kind of back pain to kind of get a little bit stronger through that region.

Answered by Luke Hart.

Yeah, so we’ve actually given you that those warm-up exercises to do, and you can get them on the website, you can have a look at the videos.

Obviously, we’re really good at going there for the competitions on Saturdays and Sundays, but it’s making sure you do the little things before you go out and play nine holes or 18 holes on a Friday that is important.

Using those video clips is really important, but also getting there early, making sure that you go on to the practice green if you can or into the net and having a few swings beforehand is really important. I think the biggest issue we see is it just going straight on to the first tee, and not doing anything at all, so just gradually building up as you go before you go out and hit your first shots is probably the most important part, but also the exercises we’ve gone through in the warm-up series which you’ll be able to get on the website.

Answered by Ms Ann-Maria Byrne.

Trigger thumb- I’m seeing so much of it during lockdown from everything that everybody’s doing between knitting and crochet and sports and DIY and of course golf as well can cause it.

It is tendinitis of the tendons going to the fingers that cause them to lock or get stuck and sometimes people find they have to open them up.

There is treatment with an anti-inflammatory gel to start off with resting from whatever activity is making it worse. And then obviously there are other treatments like injections and then obviously surgery, but pretty much anything can give it to you actually not just golf but that might exasperate it.


Answered by Ms Ann-Maria Byrne.

I would have to check with the MRI scan of that. The commonest place that you get arthritis in the thumb is the base of the thumb particularly in women because we have small hands and our hands work very hard and obviously this cause extra pressure on it.

There are plenty of operations out there, there is a period of recovery because you have to think of it as being like a joint replacement, but people do get back to playing golf after these operations but of course, you’d have to obviously assess them and their suitability for any type of surgery because there are different types of operations that are required so certainly there are options out there but it’s very individualized to the patient’s needs.

A lot of people will get a pain in their feet after walking 18 holes and there’s a couple of reasons that it could be.

I suppose the first one is, if we’re not doing much walking during the week and then we’ll go and do nearly 16,000 steps on the golf course on the weekend- there is a big mix-match between what we do in the week and what we do on the weekend. So we get a massive overload once a week, and that is what can cause a lot of those issues.

So generally, we should try and keep a higher step count throughout the week to make sure that we’ve got a steady amount of load going through our feet so we’re not getting any really big spikes.

Secondly, a lot of this can be kind of mitigated by doing a few heel raises so double leg heel raises and single-leg heel raises and really help our Achilles, can really help our plantar facia.

Also using a little bit of external load on there as well, because when we’re on the golf course we load up each foot by quite a considerable amount of our body weight when we walk around the course- so just doing a set of 10 heel raises probably isn’t quite enough for someone who’s walking 16,000 steps on the course.

So yeah, I think making sure you’re not overloading yourself just once a week, getting a bit more load through there throughout the week and then obviously doing a little bit of strength work for the back of the legs, the calves could also help with that as well.

Q: I suppose especially, people haven’t been playing golf now for a couple of months – when they go back it is going to be important for exercises?

Luke: We see so many overload injuries due to that kind of overuse. People going on holiday usually is the big one- where people play three or four times a week when they usually only play once a week.  Actually, after lockdown, we’re seeing a lot of people coming in with overload injuries because they’re playing for sometimes up to three months with no golf, and can’t even get down to the range and then playing a lot straight away as soon as they come out of lockdown.

Answered by Luke Hart.

I think, again, this comes back to how much people play so maybe it’s not so much just skill but also how much people play.

So, we see a lot of a certain type of injury in people who change the amount they play through the season so if you play a lot in the summer and don’t play at all in the winter, that’s very common.

And then people with higher skill levels or maybe faster swing speeds, we might see more kind of explosive injuries and we might see people who swing their club very fast and very hard have slightly different injuries to others. But generally, the same injuries do come across the board so we see the same injuries.

The reasons for those injuries might be different, but the same injuries still persist which is mainly in the lower back, in the wrists, elbows, and sometimes in the knees as well.

Answered by Ms Ann-Maria Byrne.

These are difficult ones. The reason that I mentioned them in the talk is that they’re rare injuries but they’re classics with golf, and I see a lot of them, but they wouldn’t be seen in general fracture clinics or emergency departments, and they are difficult to diagnose because they’re not picked up.

I really wanted people to be aware of them just so that they knew that there was a possibility there was a fracture there.

Some of them will go on to heal. Some of them will cause problems with the fourth and fifth finger when you’re stretching them out- where you’ll get irritation of the tendons in that region.

Some will go on to non-healing and with those a lot of people, they’ll be fine, they can live perfectly well with it, and the pain will settle down over a period of months. Others will need to have surgery to excise that little piece of bone that’s left behind that is just not healing and obviously, that’s another issue so it very much depends on what you see on up to date scans- to see has it healed, or has it not healed.

So it varies from person to person.

They’re awkward injuries because of where they are and it’s a tiny, tiny piece of bone but it can cause a whole lot of problems.

Answered by Ms Ann-Maria Byrne.

You can’t really say that – golf doesn’t cause any problems for it – it may exacerbate some of the symptoms just by the position of the hands or if you have a shoulder injury or a back injury that you may be using your hands or wrists in an inappropriate way.

But, you know, I think its life that causes arthritis in the fingers.

There is definitely a genetic component. There’s maybe old other fractures or injuries but you can’t really blame golf per se- it may exacerbate the symptoms but it doesn’t cause them.

Answered by Luke Hart.

Yeah, absolutely. I think first of all is get a little bit stronger in the upper back, so I think exercises such as some form of weighted rows, some form of banded rows can be great to help that.

The second part would be to do some rotation work before you play so again in the warm-up series we’ve got some rotation work in there to help just establish normal function, and also the banded rotations that we’ve got in the strength session will also help with that as well so it’s really important that we warm-up rotation before we play, we get a little bit stronger in our core for the front of the body but also strengthen the back of the body, as well, so they’re probably the key three areas that I would be focusing on.

Answered by Ann-Maria Byrne.

I have not really found that but I do think that there are some times if people are wearing very tight trackers they can get a bit of de Quervain’s, the tendon running up the wrist into the thumb but it’s again not specific.

Luke Hart.

I haven’t heard of anybody having problems with activity trackers at all.

Answered by Luke Hart.

Carrying the bag is, again, it’s just making sure you don’t overload yourself too much-so carrying the bag for nine holes for most people is fine, carrying the bag for 18 holes for some people is a little bit too much.

There is an increased energy expenditure by carrying the bag so you will burn more calories essentially because you are carrying that extra 5 to 10 kilos on your back.

In terms of your score, it’s definitely not advantageous. There have been some studies that show you actually lose up to two or three shots when you carry a bag versus a buggy or a trolley.

The only one thing I would say is that, if we’re carrying a bag, make sure you use both straps, not one strap. That has been shown to cause a kind of maybe an increased risk of injury, but it’s kind of inconclusive in the research at the moment. So I think it’s just what’s appropriate for you and for your level of strength so for maybe the younger players, it should be absolutely fine. Again, if you’ve got ongoing issues then probably it’s maybe not the best but there’s no real link between any kind of injury and back pain and carrying your bag, so it’s just individually as appropriate really.

I think we had 30% of people in our questionnaire said they have pain just walking the course.

I think a lot of this comes due to overload. So, strengthening the muscles in and around the feet, in the lower calf as well is really important. A lot of people with plantar fascia- they’ll roll it out, they’ll do a lot of stretching for it but we have to strengthen the region, it’s an overload problem, so you are giving that region to the foot too much work to do. We need to distribute the load further up the chain.

So some strength conditioning of the glutes, hamstrings and the quads, some form of calf strengthening, such as heel raises and some foot strengthening as well is absolutely necessary for the plantar fascia. And if it’s ongoing for a long period of time that’s when you might come in and see one of our sports doctors and we do see some positive results off the back of shockwave therapy.

Answered by Ms Ann-Maria Byrne.

There are different types of TFCC tears. Just like with the meniscus in the knee there are areas at the outside that are well perfused with blood vessels and they do well with primary repair in acute injuries and then there are the ones that are more central or degenerative tears that may be due to slightly longer Ulnas- that’s just the way the person is made, and that predisposes them to injury to that side, and they may be more a candidate for debridement of that region.

I do find that people go back- I certainly see a lot of the younger elite athletes with overuse injuries that do very well with local anaesthetic and steroid injections and then working with their trainers and their coaches on their technique. A lot of it is technique issues certainly at that age.

So a lot of it is looking at the age of the patient, looking at their demands and how their technique is working, and then obviously, correlating their examination with the MRI scan, but certainly, I have had good results with dealing with TFCC tears in patients of all levels.

Answered by Luke Hart

So first off for the teenage golfers I think a good strength conditioning plan is vital.

So making yourself a little bit stronger is going to really help you, especially around that age, there’s a lot of people who say ‘should young athletes be doing strength and conditioning?’ There is a resounding amount of literature saying it is very beneficial for young athletes to start a strength and conditioning program.

There are nearly in the hundreds of papers now kind of advocating for young athletes to be doing strength and conditioning, and actually, it’s the perfect age for them to start some form of it.

So I think that’s something that we do here and it’s really successful with a lot of our young golfers.

Swing speed sticks can be a nice way to improve your swing speed, but that really does need to be used in combination with maybe your coach really, especially at that age.

But generally, increasing the swing speed is a combination of being able to produce more force which is getting stronger, and then transferring that into your swing via something like a swing speed stick or having dedicated time down the range where you’re trying to swing the club, as fast as you can maybe not looking at the performance of the golf ball as much, but that should only be probably about 10% of your training down the range.

So for most people, that’s less than five to ten balls down the range where you should be focusing on that.

So they’re kind of the three key components to improve your swing speed, strength conditioning for the youth athlete, and for most people is a key way of improving swing speed.

Answered by Luke Hart

Yes, absolutely – so again the glute bridges are really important as are the hip thrusts. Some of the squatting variations we’ve got there as well will be very important, making sure that you do a good warmup – we have mentioned that a couple of times now but it is vital to making sure you don’t have pain after golf.

Making sure that region is a little bit stronger is a pretty foolproof way of protecting the region, enabling the muscles around there to deal with a bit more force. Like I said in the presentation the golf swing is a very high force activity so protecting yourself from that is never a bad route to follow.

Date: 2nd February 2021
Location: Online
This event is free of charge