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.