Shoulder Injuries in Golf

 

Shoulder pain and injury is consistently cited as the third most common injury among golfers.  This statistic has lead many researchers to conduct studies and formulate correlations between shoulder injuries, physical characteristics of the golfer and swing faults. Furthermore, it is not within the scope of this post to review the anatomy and pathophysiology behind different medical diagnoses (ex. rotator cuff tear, sub-acromial impingement, etc.) in regards to shoulder pain.  However, it has been well documented that treatment should not performed with only the medical diagnosis in mind and that each individual should be evaluated. The following is a summary of different mechanisms that have been found to contribute to shoulder pain in golfers.

RANGE OF MOTION

• Shoulder Elevation: Optimal shoulder elevation is 170-180 degrees.
  • Many compensations will be viewed if this is less than optimal.  A basic screen is —> HERE.
  • Note: Do not let the name of the screen fool you.  If you are find a deficit in this test, it does not always because of tight lats.
• Shoulder Horizontal Adduction: Optimal shoulder horizontal adduction is 135 degrees.
  • A good demonstration of horizontal adduction is located —> HERE.  The elbow of the moving arm (left arm of the subject in the video) should be able to at least cross midline.  However, be aware of hyper-mobility and its implications with instability.
• Shoulder External Rotation: Optimal shoulder external rotation is 90 degrees.
  • Here is a great golf specific screen for shoulder rotation —> HERE.
• Trunk Rotation: Optimal trunk rotation is 50 degrees in each direction.  It is necessary to understand that optimal trunk mobility is important in shoulder health because of the intimate relationship between the trunk and the shoulder blade.
  • Want to test your own trunk rotation? Click —> HERE.

MUSCLE STRENGTH/ACTIVATION

No isolated tests have been researched that correlate to reduction of shoulder injuries in golf.  However, understanding muscle activity during the golf swing can serve as a basis for training and improvement of the swing mechanics, so that selective strengthening and rehabilitation of shoulder musculature can take place.  This is important not only to optimize function and protection of the joints, but to reduce imbalances from the repetitive nature of the golf swing.

• Rotator Cuff Muscles: FYI, several clinical studies have found that there is no difference in the activation of these muscles in men and women.  This is most likely due to the consistent nature and demands of the golf swing.
  • Supraspinatus and Infraspinatus of the Lead Shoulder: demonstrate low activity during the swing with peak activity occurring at take away and follow-through.  These muscles act as abductors and external rotators to help stabilize the shoulder joint.
  • Subscapularis: The most active of the rotator cuff muscles showing activity during most of the swing especially during the acceleration phase of the down-swing.

 

• Scapular Stabilizers: These muscles are also very important in the health of the shoulder in golfers.
  • Latissimus Dorsi and Pectoralis Major: Most active of all shoulder muscles, with the lat acting maximally in the down swing and acceleration phase.
  • Deltoid: Interestingly non-active except for the anterior deltoid during the follow through to help with shoulder flexion.
  • Trapezius: helped to retract the lead shoulder during the down-swing and acceleration phases, whereas it was active in the trailing arm during the back-swing.
  • Rhomboid and Levator Scapulae: were active for retraction during the backswing and control of protracting during the down swing (especially on the right).
  • Serratus Anterior: acted as a scapular protractor and demonstrated peak activity during the downswing and follow through phases of the trailing arm.  In the lead arm, it demonstrated low synchronized activity throughout the swing which may explain why it is susceptible to fatigue in some golfers.

The lead shoulder (left shoulder in right handed golfer) has been found to be injured 3x more than the trail shoulder, and more recently, it has been reported that more than 90% of shoulder problems in golfers occur on the lead side.  During the backswing, the lead shoulder undergoes internal rotation, flexion, and horizontal adduction which can exacerbate certain types of conditions.  Conversely, during the down swing it undergoes abduction and external rotation.  A thorough history, clinical evaluation and symptom response are of utmost importance for isolating the shoulder dysfunction that is causing pain.  However, in simple terms it is important to optimize mobility/ flexibility and stability/ strength to protect the shoulder and torso against such high demands of motion and force.

As discussed —> HERE, low back pain and range of motion deficits (especially on one side) correlate to improper function during the golf swing.  Similarly, shoulder range of motion and strength deficits may be found on one side of the body versus the other.  This is due to the repetitive one sided nature of the golf swing.  Furthermore, the above information (especially in terms of range of motion) would be optimal on both sides of the body; however, emphasis should be placed on one side versus the other depending on the handedness of the golfer.  Likewise, an understanding of the above information can facilitate the evaluation of muscle imbalances in golfers which may lead to decreased performance and even injuries.

 

 

 

 

 

Resources

Kao JT, Pink M, Jobe FW, Perry J. Electromyographic analysis of the scapular muscles during a golf swing. Am J Sports Med. 1995;23(1):19-23.

Kim, David H., Millett, Peter J., Jobe, Frank W. “Shoulder Injuries in Golf.” The American Journal of Sports Medicine 32.5 (2004): 1324-330. Web.