Pinched nerve in the neck

I write about pain in the neck in my last month. I have many readers ask me about pinched nerve. Pinched nerve or radiculopathy means that the nerve from the neck is being irritated or compressed by the slipped disc or bone spur. Nerves are extensions from the brain that reach out into the arms or legs to go to the muscles or skin. Nerves are actually bundles of millions of nerve fibers that leave the spinal cord and branch out to each muscle to make them move or go to the skin to provide feeling.

Slipped disc, disc degeneration, osteoarthritis of the neck joint and nerve injuries are interrelated to each other. Many golfers who have neck and arm pain due to a pre-existing neck injury that is aggravated by active golfing.

Disc injury are divided into two main groups of acute disc prolapsed and degenerative disc disease. Majority of disc or nerve injury is more likely to recur and often takes months to settle or never fully recovered.

Symptoms of disc and nerve injury are:

1. Numbness.
2. Shooting pain to the arm, neck, shoulder, upper back and arm.
3. Deep ache.
4. Weakness in arm and shoulder.
5. Tingling, burning and pin & needle sensation in the neck, upper back and arm.
6. Muscles cramp and spasm.
7. Pulling sensation in neck and arm.
8. Muscles wasting.

Causes of nerve injury:

• Injury from fall and swing.
• Overuse.
• Old age.
• Too much, too fast and too quickly in golf.
• Wrong technique.

Causes of pinched nerve:

• Disc prolapsed or slipped disc.
• Degeneration or osteoarthritis of cervical spine.
• Degenerated disc.
• Osteoarthritis of facet joint.

The twisting stresses of the golf swing can place considerable stress on the neck, the disc, ligaments and muscles. And knowing the types of strain sports place on the neck, helps prevent aggravating a neck injury. Some golfers also participate in other sports as part of cross training to maintain fitness and health; like running, swimming and gym workouts.

Factors that increase the risk of injury

• Time spent playing. The more often and longer hours of play, the higher the risk of injury.
• Incorrect technique. Examples of this are a poor swing style and hitting the ground instead of the ball.
• Failure to warm up and cool down.
• Previous neck injury - golf can aggravate existing injuries.
• Degenerative disc and spondylitis (osteoarthritis) of neck.

Treatment of nerve injury

• Rest. It is generally not advisable to further irritate the nerves by continuing to play with pain. Taking time off shortly from golf up to three months allow the nerve and disc to heal.
• Apply ice to the neck for 15 minutes one to two times a day while the neck and arm pain is there.
• Medication like anti-inflammatory drugs that can help decrease inflammation, swelling and pain. Consult your doctor before self-medication.
• Neck stretching exercises to relax the tight and stiff muscles.
• Neck strengthening exercise after initial sevre pain has settle.
• Alternative low impact exercise while waiting to return to golf to maintain your fitness. Return to slow walking or cycling for 30 minutes every other day after the neck pain has recovered.
• Consult your doctor early.

Simple neck injury prevention tips

• Golf lessons for beginners.
• Correct swing technique.
• Neck and back flexibility through stretching before and after golf.
• Slow and gradually increase in your golf game or driving range.
• Avoid too many games.
• Proper warm-up and cool down.
• Consider using a buggy to transport your clubs, or carry clubs using a supportive carry brace.
• Avoid too many balls and daily at driving range.

Achilles pain in golfers

Achilles pain is common in sports that involved long walking, long duration of standing or running. Achilles pain can cause by more common injury like Achilles tendonitis, Achilles tendinosis, Achilles bursitis or Achilles tendon tear.

Achilles Tendonitis

Achilles tendonitis is the inflammation of the Achilles tendon and is characterize by slow and gradual onset of pain in the Achilles region. The pain will worsen with active sports and physical activities such as golf. Golfers who play the walking course are more prone to develop the Achilles injury. Achilles tendonitis is more common in older golfers whose tendon has become stiffer and less flexible with aging.

Common symptoms of Achilles tendonitis are:

• Swelling.
• Stiffness, especially in the morning.
• Pain will tend to be worse in the morning.
• Pain after golf.
• Pain worse with increased sports activities.
• Pain may decrease with rest and icing.
• Tight calf.
• Thickening of the Achilles tendon.
• Redness or warmth over the skin.
• Feel of creaking sound or sensation on the tendon when the foot is move.

Achilles Bursitis

The Achilles bursa is a fluid filled sack that helps the Achilles tendon move smoothly on the calcaneum bone underneath during movement. It can become inflamed with repetitive movement as in long walking, brisk walk or running. Achilles bursitis also commonly occurs with Achilles tendonitis. The symptoms are quite similar. To find which condition is actually causing pain is difficult for a golfer. Your doctor can tell you from your symptoms and examination.

Achilles Tendinosis.

It is a painful overuse tendon conditions which have a non-inflammatory pathology. The cause is an underlying degeneration of the Achilles tendon collagen fibers in response to repetitive overuse. Light microscopy of patients operated on for this type of Achilles tendon pain revealed collagen fibers disruption and classical inflammatory cells are usually absent. The symptoms are similar to tendonitis. Anti-inflammatory medication only provided short term pain relief.

Achilles Tendon Tear

Achilles tendon tear or rupture is less common. Immediate medical attention is usually required in the case of completed tendon ruptured. Minor small partial tear may have similar symptoms to Achilles tendonitis or tendinosis. In sports medicine, Achilles tendonitis has been described as microscopic tears with inflammation. Ultrasound scan or MRI scan can identify the big tear accurately.

Symptoms of Achilles tendon tear include:

• Sudden onset of pain in the Achilles region.
• A snap or pop sound.
• Sudden weakness in calf muscle.
• Leg suddenly giveway.
• Swelling.
• Bruising will be apparent after one to two days later.
• Limping and difficulty walking.

Risk factor for Achilles injury:

• Repeated overuse
• Bad or worn out shoes
• Over weight
• Aging
• Incorrect shoes over long period of time (over six months)
• Flat foot.
• Tight or weak calf muscles.
• Ankle joint stiffness.
• Ankle instability or not balance after lower leg injury.
• No routine warm up and stretching exercise for the leg before and after golf.

Self help tips:

• Temporary rest
• Use buggy instead of walking
• Reduce other sports or physical activities.
• Ice regularly
• Ice massage
• Stretching exercise for calf, hamstring and ankle
• Calf strengthening exercise
• Check your golf shoes
• Orthosis for flat foot

Achilles tendon has poor blood supply and healing often take longer time. If pain is persistent and unresponsive to simple self help tips, consult your doctor. Your doctor can arrange further investigations and a rehabilitation program.Do not continue to play and expect the pain to go away of its own accord. Taking pain killer to play golf may aggravate the injury and delayed healing.

Corn and calluses in golfer feet

A competitive golfer will know that problems with the feet, even a minor painful corn or callus, can impede timing and balance to the point where it affects the scorecard at the end of the day.

Many golfers like the walking course as part of their exercise. A full round of golf adds up to a seven km workout that can reduce stress and improve cardiovascular health. It is common to have some aches and pain in golfer feet along the way especially if there are slope and uneven ground.

Most common cause of corn and callus foot problem is related:

• Bio-mechanical abnormality like flat foot, broad feet or high arch foot
• Improperly fitted shoes
• Worn out shoes
• Wearing wrong type of shoes for the sports involved
• Overuse

Corns and callus are one of the most common feet problems found in golfer. It is cause by repetitive rubbing of the skin around the toes, sole or bony prominence of the foot against the shoes. Tight shoes can cause the toe to rub against another toe. Skin around bunion is also prone to develop into callus.

Common sites of corn and callus formation are the ball of the foot, under the big toe, the tips and the tops of toes. ‘Soft’ corns may develop between the toes, where the skin is moist from sweat or inadequate drying. Sometimes, the pressure of the corn or callus may produce inflammation, which can result in discomfort, acute pain, swelling and redness.

Self help tips:

• Check your golf shoes
• Applying pads around the corn area
• Wearing larger shoes to comfortably fit your foot without rubbing
• Use buggy temporarily
• Topical medication to soften the corn
• See a doctor for oral non-steroidal anti-inflammatory medication to help reduce the pain and swelling
• Painful calluses can be removed surgically
• Use padded insoles or orthosis for flat footer to improve the bio-mechanics and reduce friction
• Good and thick socks can reduce friction between the feet and shoes

Tips to select the most appropriate golf shoes:

• Shop for shoes in the afternoon or evening
• Buy golf shoe with a half size or one size bigger then your dress shoes
• Try them on with the same socks, insole or orthosis that you would wear on the course
• Tie both left and right shoes tightly and walk around the store for a few minutes before making a decision

When there is pain and inflammation, you should treated and reduce your golf games for daily golfer. When the pain eased, your return should be gradual. As much as you may want to get back to your game, take it slowly.

Golfer's Shoulder

I received an email from a golfer asking me about his shoulder pain. Mr. Kong has been a weekend golfer for many years. He has been playing three or four times a week after he retired four months ago. Unfortunately, his game is getting worse because of a nagging pain in his shoulder for last two months.

Mr. Kong is suffering from what's I called "Golfer's Shoulder" which is often referred to as a rotator cuff injury. This is a relatively common injury among aging golfers. It results from a strain or tears in a group of muscles and tendons (tissues that attach muscles to bones) that surround the shoulder. The incidence of rotator cuff tears increases greatly after age 50. The overuse injuries are frequently seen in the lead arm even both shoulders participate equally in the golf swing.

Causes of shoulder injury in golfers are overuse combined with the following factors:

• Lack of flexibility.
• Muscles weakness.
• Poor swing technique.
• Too much too fast too quickly.
• Poor posture.
• Trauma like fall, hit tree root and hard ground.
• Chronic wear and tear.
• Past history of fall or collision to shoulder.

There is also the referred shoulder pain that arising from cervical spondylosis (arthritis), cervical disc disease and myocardial ischaemia. Symptoms may include pain in the front, side, back or deep inside the shoulder especially with back swing movements. Putting on a bra, shirt or coat may be painful. Others symptoms are pain at night, pain lying on injured shoulder, weakness, stiffness, restriction of shoulder movement above and behind the shoulder, pain after golf game or swing.

Golfers often feel the pain below the shoulder joint around the deltoids (the large shoulder muscle) area. Study showed that the deltoids are virtually inactive during the swing, while the rotator cuff muscles work throughout the swing. Most golfers assumed their pain resulted from deltoid muscle tear which is where the pain is felt.

Common types of shoulder injury in golfers:

• Rotator cuff tear.
• Rotator cuff tendonitis.
• Acromioclavicular joint arthritis and injury.
• Shoulder instability.
• Subacromial bursitis.
• Impingement syndrome.
• Shoulder joint osteoarthritis.

Younger golfers (less than 35 years old) are more likely to have problems with inflammation (tendonitis) and strains, while older golfers may experience complete tears of the rotator cuff and degenerative changes in the joint, such as bone spur formation in osteoarthritis.

When you have shoulder injury, you should have your shoulder checked by your doctor to determine the exact cause of your pain. When there is injury, your golf game, stretching and strengthening exercises must be prescribed by your doctor or sports therapist. Consider swimming, cycling or walking exercises to help maintain your fitness while you are recovering from injury.

A delay in diagnosis and treatment can lead to further damage, more scar tissue and frozen shoulder. A delay could keep you off playing for a while, and that's something golfer wants to avoid.

When these muscle and tendon tears heal the new tissue is called scar tissue. There are five problems with scar tissue in the shoulder:

• It is weaker.
• It is less elastic (flexible)
• Healed tendon and muscle fiber is disorganised, not along the lines of the original muscle and load.
• Painful scar from small new nerve endings grow into the area.
• Increase risk of recurrence injury.

Tips that help prevent "Golfer's Shoulder":

• Stretch your shoulder before and after.
• Proper warm up and cool down.
• Avoid hitting more then 100 balls at driving range per session.
• Avoid consecutive day play.
• Shoulder strengthening exercise with a weight training program in the gym.
• Swing checked every so often by a golf pro.
• Massage is to reduce the build-up of ‘trigger points’ – areas in the muscle that literally seize up due to excessive loading.
• Strengthening work for the shoulder and muscles attached to shoulder and scapula bone.

One way to reduce the stress on the shoulder and acromioclavicular joint of the leading shoulder without sacrificing club-head speed is to shorten the swing by ending the back-swing with the club head at a 1 o’clock instead of a 3 o’clock position. 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.

Golfers who are not injured, should take note that a shoulder injury can take six months or more to rehabilitate. In every case, prevention is so much better than cure. Warm up; stretch your muscles well before and after you tee off, particularly those around the shoulder joint.

It is Golfer’s Elbow?

GOLFER’S elbow is a common affliction and is characterised by the pain on the medial (inner) side of the elbow. It is also known as Medial Epicondylitis. Golf and racquet sports are prone to this condition. When the elbow pain is on the outer side (lateral) of the elbow joint then the condition is often refer to as Tennis elbow.

After a 15-year of inactivity, Mr. Lee is advised by his doctor to exercise in order to keep his hypertension in check. So he took up golf again. “I met one of my friends who have been playing golf when I made a visit to the driving range recently. So I got back into the game” said the 45-year-old project manager.

Mr. Lee started playing golf, regularly two to three times a week at the local club and two times at the driving range. From an initial 100 to 150 balls per session, he quickly increased to 300 balls at each session. After three months, Mr Lee felt a twinge around his elbow but ignored it. He took some pain killer and continued playing golf. The pain increased until a stage when he couldn’t even pick up the club. By this time, his blood pressure had been brought under control and his weight had gone down. But he had suffered an elbow injury.

Golfer’s elbow is more common among people between the ages of 35 and 50. The muscles and tendons of younger people are more flexible and less prone to this type of injury. Golfer elbow’s is an inflammation of the muscle and tendons in the forearm attachment to the elbow bone. The elbow injury can be caused by physical work or sports activities. Other then golf and racquet sports, activities that require prolonged gripping such as hammering, driving screws, weight lifting, playing certain musical instruments and gardening can cause this condition too. Golfer who worked with free weights and resistance machines are also at increase risk of this injury.

In the case of Mr Lee, small tears to the tendons can occur as a result of overuse and the condition may persist for months. However, not all elbow pains are caused by tendonitis as there could be a tear in tendon and muscle when you hit the carpet, on the ground or tree root. The tendon may not be able to heal, or may heal very slowly over many months. The slow process of healing may have to do with poor circulation, but also because the area is stretched and twisted by normal movement of the elbow, making it hard for irritated areas to rest.

The symptoms of golfer’s elbow

• Pain after or during playing golf.
• Pain on the inner area of the elbow.
• Elbow pain may radiate up and down the arm.
• Weakness in the wrist and arm when carrying heavy thing.
• Pain caused by touch over the inner part of elbow.
• Swelling on the side of the elbow.
• Pain exacerbated by gripping activities like holding the handle of the club.
• Pain when turning a door handles or water tape.
• Pain when fully flexing the elbow.

Golfer with elbow pain should immediately stop whatever activity they are doing which is painful. In some golfers, temporarily resting the arm is enough to allow the elbow injury to recover after one to two months. However, sometimes this pain can almost recur immediately when they resume their golf. To get a more permanent cure, I would recommend a total layoff temporary followed by treatment and rehabilitation.

Proper treatment begins with the early detection of the injury. Left untreated, golfer’s elbow can last six months or longer. When treated early, sufferers enjoy a better chance to return to their golf and sports activities early.

Early treatment begins with treatment with ice and active rest. Non-steroidal anti-inflammatory drugs may be taken to help reduce the swelling and inflammation that accompanies this injury during the early phase. Active rest is vital to aid the recovery process. Elbow brace and band provided temporarily relief of pain.

Active rest involves avoiding the exercises or movements that exacerbate the pain. Keep fit with alternative exercise like running, swimming, cycling on stationary bicycles, brisk walking or aerobic class.

Do specific exercises designed to improve the flexibility and strength to the wrist and elbow when the pain subsides. A combine rehabilitation program will improves and speeds up recovery. Last, but not least, return to golf slowly and gradually increase your play.

Tips for golfer:

• Stretch your elbow before and after.
• Proper warm up and cool down.
• Avoid hitting more then 100 balls at driving range per session.
• Avoid consecutive day play.

Wrist Problems in Golfers

Wrist Problems in Golfers

Golf has historically been viewed as a low impacted sport with a low injury rate. Despite the perceived safety of golf, golfers do injure their wrists. A study of 225 professional golfers showed a 34% incidence of wrist and hand injuries. Wrist injuries can occur not only in the average golfer but also in the high-level professional.

Golf induced wrist injury can be devastating as the hand and wrist are so integral to the game. The majority of golf induced overuse injury can successfully treated non-operatively. Some may require restriction from golf for an extended period of time of three to six months.

Wrist injuries can be either traumatic or overuse. Examples of traumatic injury are fall from a golf cart, direct impact to the wrists from hitting the hard ground or carpet and break a fall with the hands. Traumatic wrist injuries are usually caused by accidents and are hard to prevent. They include broken bones, dislocations, and sprains.

The majority of golf injuries are overuse injuries of the wrist flexor or extensor tendons. The left wrist in a right-handed golfer more likely to have an injury. Golfer with more flexible wrist joint is also more prone to injury. Excessive extension and abduction of the wrist joint increase the stress on the joint itself.

Tendinitis ( inflammation of the tendon ) is the most common injury around the wrist and hand in golfers. This overuse injury is caused by a tight grip of the club and repeated ulnar deviation during the golf swing. Most common symptoms of wrist tendonitis include pain in the front, side, back or deep inside the wrist joint. Pain can occurred after golf or during initial golf game which disappear and recur again after golf. Others symptoms are swelling, clicking noise, pain at night, morning pain or stiffness, weakness, stiffness and restriction of wrist movement.

The triangular fibrocartilage complex is a structure on the ulnar side ( outside ) of the wrist. With the increased motion of the wrist that occurs in golf swing, this structure of soft cartilage and ligaments is prone to tearing.

Golfers can break their hamate bone in the wrist. This uncommon bony injury of the wrist is fracture of the hook of the hamate. The fracture is result from a bad shot when the club strikes the hard ground or carpet and the force is transmitted to the bone. Diagnosis is usually made by physical examination and confirmed with x-rays. This injury is a source of chronic lateral side wrist pain in the golfer and is often diagnosed late or left undiagnosed.

Types of wrist injury in golfers:

• Wrist tendonitis.
• Wrist ligament sprain.
• Triangular fibrocartilage complex injury.
• Fracture hamate bone of the wrist.
• Carpal tunnel syndrome.
• Wrist joint osteoarthritis.
• Wrist dislocation and fracture.

Factors that increase the risk of wrist injury in golfers are:

• Lack of flexibility.
• Muscles weakness.
• Poor technique likes

# wrong grip ( too strong grip or over gripping )

# poor swing

• Too much too fast too quickly.
• Trauma like fall, hit tree root, carpet and hard ground.
• Wrong grip.
• Advancing age.
• Previous injury.
• Anatomic abnormalities.

Treatment for wrist injury in golfers :

• Short rest.
• Ice.
• Wrist splint or brace.
• Nonsteroidal anti-inflammatory drugs.
• Avoidance physical or sports activities that cause pain.
• Injections.
• Physiotherapy.

Prevention of wrist injury in golfers :

• Taking it easy to avoid overuse injuries.
• Proper warming up and cool down.
• Improve your flexibility.
• Strengthening wrist muscles.
• Golf lessons.
• Use of proper equipment.
• Proper technique.

Common injuries that plague golfers

Common injuries that plague golfers

IF I say more and more people are getting injured as a result of golf, not many people will believe the fact despite the number of golf clubs that are sprouting up in Malaysia.

But, do you know how many of the world’s top 20 male golfers made it through the past year without any injury? The answer is: None. Even the world’s best golfer, Tiger Woods, had to squat in order to stick a tee into the ground because he injured his back while, of all things, trying to improve his fitness. It’s a real eye-opener.

The fact is more and more people are playing golf and more and more people are getting injured. Even youngsters and women are taking up the game. I have client who are teenager, play and train in golf daily instead of going to school. Their parents have high hope they will become the next Tiger Wood from Asia.

Although the overall risk of injury appears to be low compared to many other sports, golf, despite being a non-contact sport, do provide more than its fair share of injuries.

Last year, I conducted a study on 50 golfers who visited my sports clinic over a period of three months. These golfers, most of them men in their 40s and 50s, live in the Klang Valley. As we get older, our muscle, tendon, ligament and joint became stiffer and more prone to injury. Other reason older golfers have more injuries and pain is the ability to self healed is slower.

Most of them sought treatment for back and neck pain. Tennis elbow, golfer’s elbow and shoulder pain are the other common injuries suffered by golfers.

The average time it takes them to seek treatment is three months. Most players ignored initial presentation of their injury or pain and continue to play. This aggravated their injury and delayed healing. Based on their feedbacks, it was found that accidents and overuse was one of the main causes of golf injuries. You get players hurting their shoulders from falls or spraining their ankles while walking down a slippery slope.

The latest craze about getting fit is partly responsible for golf injuries. More and more golfers are heading to gymnasiums and fitness centres to build up muscles. Some golfer’s injury actually occurred in weight training.

Some are spending hours on driving ranges performing hundreds of twisting motions to improve their golf swings. Golf has become a power game. As a result, players are swinging harder in their bids to make the ball go further. This is the so call overuse injury. Judging by the way they’re pushing themselves, their bodies are bound to break down and they are bound to get injured. Listed below are some of the main causes of golf injuries.

Causes of golf injuries

1. Too much golf.
2. Hit too many balls at driving range.
3. Poor swing techniques.
4. Too much twisting during swings.
5. Hitting the ground.
6. Aggravating old injuries.
7. No warm-up or cool-down exercises.
8. Lack of stretching exercises.
9. Wrong equipment being used.

Swing technique

The golf swing is a rotational motion that rotates the whole body at very high speed. The force that is generated is transferred from the foot, leg, back, shoulder, elbow and wrist.

It places a lot of stress on the body. Injuries to the back, shoulder, wrist and elbow are the most common.

Most of these injuries occur at impact or just before impact during the golf swing.

The right-handed golfer will generally develop “tennis elbow” in his left arm which is used to pull the club. Players suffer from “golfers elbow” in their right arm as a result of their club hitting the ground or the ball. Beware of hard ground in some golf courses when playing in foreign country.

Golfers are also prone to rotator cuff (shoulder muscles) tendonitis, or muscle tears in their shoulders. Pain usually occurs at the top of their backswing. Poor swing technique is one of the major contributing factors to golf injuries. My advice is to take golf lessons and practise your swing first under a qualified coach before rushing to the golf course.

Developing the correct technique can prevent injury. Professionals usually do not sustain as many injuries as amateur golfers simply because they play with better form and technique.