Golf related knee injuries
Tiger Woods knows the importance of taking care of his knees. Just this past April, Tiger underwent his third knee surgery since 1994. He has since then spent a tremendous amount of time rehabbing the left knee in preparation of returning to golf, hoping to come back stronger and more accurate than ever in time to participate in tournaments late May or early June.
Tiger’s surgeries have been to the left knee, which is the more commonly injured knee for a right-handed golfer. Second to the low back, the knee is the most commonly injured joint in golf. Knee pain or injuries can significantly alter swing mechanics and, therefore, result in poor ball placement and higher scores.
There are numerous common knee injuries related to golf. Basic knowledge of knee anatomy is required to understand golf-related injuries. Below is a list and brief description of the main anatomical parts of the knee joint.
Bones – The knee is made up of three bones: the femur, which is the large thigh bone; the tibia, which is the shin bone; and the patella or kneecap.
Muscles – The muscles that run across the knee joint are extremely important in not only moving the knee but also in protecting it and absorbing shock. The main muscles include the quadriceps, or thigh muscle, which extends the knee forward; the hamstring, which sits behind the thigh and bends the knee; and the calf muscle, which pushes the foot down and works at the knee as the hamstring’s assistant to bending the knee. There are other small muscles that run from the back of the knee into the foot. These muscles work to rotate the knee at the end of straightening to help lock it in that position.
Ligaments – There are four main ligaments that support and prevent excess motion at the knee. The most famous (or notorious, especially in sports injuries) is the ACL, or the anterior cruciate ligament. Its counterpart is the PCL, or posterior cruciate ligament. These two ligaments run between the femur and tibia under the patella, and help prevent excess forward or backward movement of the knee. The MCL, or medial collateral ligament, is a wide ligament that runs on the inside of the knee connecting the femur and tibia. The forth ligament, the LCL (lateral collateral ligament), is on the outside of the knee joint. These ligaments are important in side-to-side movements.
Cartilage – In between the femur and tibia sit two C-shaped meniscus, or cartilage. This cartilage acts to distribute shock between the lower and upper leg and help guide the motion at the knee.
Now that we have a basic understanding of knee anatomy, let’s discuss common injuries or problems associated with the knee.
Osteoarthritis (OA) – OA is the most common knee problem and the second leading cause of disability in Americans over the age of 65. OA is the “wear and tear” of joints, and is often the result of poor mechanics. This can be due to tight and/or weak muscles, previous injuries to the joint, and overuse of the joint. Signs and symptoms of OA include stiffness and swelling that is worse in the morning or after resting, and improves slightly with activity.
Condromalacia (CM) – CM is “wear and tear” or softening of the undersurface of the kneecap. Similar to OA, CM can be a result of poor mechanics at the knee joint. Dull pain and/or grinding are often felt under the kneecap, and the pain is worsened with hills or stairs.
Torn Ligaments – Strains or tears (partial or full) are common with activities that involve sudden starts/stops and pivoting. Ligament injuries such as ACL tears are often seen in basketball, soccer, and football. With a ligament injury, a loud “pop” is often heard. There may or may not be pain associated with a full ligament tear.
Meniscal Injuries – The meniscus is often injured with twisting or pivot motions. Because the meniscus lacks good blood supply, they do not heal as most other tissue does. Meniscal injuries often cause clicking and catching sensations in the knee, especially with squatting or bending.
Tendonitis – Tendons often become inflamed and irritated due to overuse or improper use of muscles. Tendonitis is especially common in those just starting out in a new activity, or when changing form when not enough time for rest is allowed.
There are various causes of knee problems related to golf. Many of these problems are related to the amount of rotation throughout the body that is required during the backswing and follow-through. For a right-handed golfer, a significant amount of torque and valgus stress (stress to the inside of the knee) is generated at the left knee. The knees must stay flexed during the backswing to absorb some of the rotational stress of the swing. For the many golfers who have tight back muscles and joints, one of the ways to attempt to generate more turn in the backswing is to place more stress on the knee. This often leads to injuries to the medial (inside) meniscus. There are also many golfers with tight hip muscles, which changes the joint alignment at the knee. This again places more stress on the knee, making it more susceptible to injury. Another possible cause or contributor to knee pain is poor fitting or poor supporting shoes. Golf shoes that do not provide enough arch support can lead to a pronated foot position (flattened arch), which places the knee in a rotated position. Over the course of walking 18 holes, or up and down hills and through sand traps, this foot and knee position can lead to a significant amount of knee pain.
The knee is not designed well for the rotation and side-to-side movement required by the golf swing. Because of this, precautions should be taken to ensure that extra stress is not placed on the knees. One of the best measures to take is to ensure that the muscles in your hips, low and mid back are flexible. By allowing full rotation to occur through the hips and back, stress is evenly distributed about the knee, and will not cause any extra injury. It is also important to make sure that the three main muscles surrounding the knee joint are strong. By making certain that these three main muscles are strong and the hips and back are flexible, the knee joint is afforded maximal protection against injury. Your Physical Therapist or personal trainer can help you with flexibility and strengthening exercises to target these areas to decrease stress on your knees.
If you are recovering from a knee injury, there are some tips for your preliminary return to playing golf. I always advise my patients to practice at the driving range up to several weeks prior to playing 18 holes of golf. While first starting back to the range, I advise them to start with their wedges and shorter irons. I have them start with short swings, working up toward their full swing, and then eventually into their longer irons and driver.
I also advise my patients to wear spikeless shoes upon their first return. The shoes should have good arch support to prevent knee rotation. There are many specialty golf shoe and sneaker stores than can fit you with over-the-counter arch support for your sneakers and golf shoes if needed. In some cases, custom-made orthotics from your healthcare professional may be required to provide optimal foot positioning. Orthotics can potentially help the knee, but also decrease strain on the hips and back.
Many patients often ask me about knee bracing, either preventatively or after a knee injury. My advice is usually the same: Knee braces are good for providing temporary support after a mild injury, but should not be worn long-term. Any brace that is worn long-term may cause the body to rely on that extra support, and can actually weaken or suppress the structural support system.
As always, any injury that prevents you from playing or walking normally, or lasts longer than a few days needs to be examined by your healthcare professional. Playing through a knee injury can actually worsen the injury or lengthen the recovery time needed to get back on the course. Remember, strong knees and flexible back muscles help ensure smooth movement through the entire backswing and follow-through, helping to make your shots go straighter and longer.
Erin Hurley Booker, MPT, is a GFM Advisory Team Member and Clinic Director for Physiotherapy Associates, in Ocoee, Florida. For further information on Erin, log onto www.golffitnessmagazine.com/advisoryteam.
EDITORS NOTE: Golf Fitness Magazine is the only national consumer publication dedicated to golf-specific fitness, mental focus, and improving ability, performance and health among all golfers. Our priority is to maximize your potential, lower your scores, reduce your risk of injury, and extend your golfing years. Each issue has departments dedicated to men, women, seniors, and juniors along with tips, advice and simple exercise routines from GFM’s team of experts. If you want to improve your golf game, and hit the ball farther, click here for special offers on a subscription so you can have all this and more in-depth advice delivered right to you! Get cutting edge fitness & mental tips sent to your inbox each month with our FREE golf performance eNewsletter, Shape Your Game. To contact our Senior Editor, Publisher or Online Editor with questions or comments, please visit our web site golffitnessmagazine.com for more information.
Watch: Tiger highlights from Round 2 at Honda
Tiger Woods started at even par in Round 2 of the Honda Classic. Friday began with a bogey at the par-4 second, but Woods got that stroke back with a birdie at the par-4 fourth:
Following four consecutive pars, Woods birdied the par-4 ninth to turn in 1-under 34.
At 1 under for the tournament, Woods was tied for 10th place, three off the lead, when he began the back nine at PGA National. And the crowd is loving it.
Defending champ Fowler misses cut at Honda
PALM BEACH GARDENS, Fla. – The roles might be reversed this weekend for Rickie Fowler.
Last year, when he won at PGA National, Fowler was greeted behind the 18th green by Justin Thomas, one of his Jupiter neighbors. Thomas had missed the cut in his hometown event but drove back to the tournament to congratulate Fowler on his fourth PGA Tour title.
It’s Fowler who will be on the sidelines this weekend, after missing the Honda Classic cut following rounds of 71-76.
“I haven’t been swinging it great the last month and a half,” he said afterward. “Obviously playing in the wind, it will pick you apart even more.”
After a tie for fourth at Kapalua, Fowler has missed two of his last three cuts. In between, at the Phoenix Open, he coughed up the 54-hole lead and tied for 11th.
Fowler said he’s been struggling with commitment and trust on the course.
“It’s close,” he said. “Just a little bit off, and the wind is going to make it look like you’re a terrible weekend golfer.”
Asked if he’d return the favor for Thomas, if he were to go and win, Fowler smiled and said: “Of course.”
Tiger Tracker: Honda Classic
Tiger Woods is making his third start of the year at the Honda Classic. We're tracking him at PGA National in Palm Beach Gardens, Fla.
Tweets by GCTigerTracker
Cut Line: Woods still eyeing Ryder Cup dual role
In this week’s edition, Jack Nicklaus makes the argument, again, for an equipment rollback, Tiger Woods gets halfway to his Ryder Cup goal and Paul Lawrie laments slow play ... in Europe.
Captain’s corner. Last week Tiger Woods coyly figured he could do both, play and be a vice captain for this year’s U.S. Ryder Cup team. On Tuesday, he made it halfway to his goal.
U.S. captain Jim Furyk named Woods and Steve Stricker vice captains for this year’s matches, joining Davis Love III on the team golf cart.
Whether Woods will be able to pull off the double-header is now largely up to him and how his most recent comeback from injury progresses, but one way or another Furyk wanted Tiger in his team room.
“What Tiger really has brought to the table for our vice captains is a great knowledge of X's and O's,” Furyk said. “He's done a really good job of pairing players together in foursomes and fourball. When you look at our team room and you look at a lot of the youth that we have in that team room now with the younger players, a lot of them became golf professionals, fell in love with the game of golf because they wanted to emulate Tiger Woods.”
Woods is currently 104th on the U.S. points list, but the qualification process is designed for volatility, with this year’s majors worth twice as many points. With Tiger’s improved play it’s not out of the question that he gets both, a golf cart and a golf bag, for this year’s matches.
#MSDStrong. Every week on Tour players, officials and fans come together to support a charity of some sort, but this week’s Honda Classic has a more personal impact for Nicholas Thompson.
Thompson graduated from nearby Marjory Stoneman Douglas High School, and last week’s horrific shooting there inspired the former Tour member to work with tournament organizers and find a way to help the victims.
Officials handed out 1,600 maroon ribbons to volunteers to honor the victims; and Thompson and his wife, who is also a Stoneman Douglas graduate, donated another 500 with the letters “MSD” on them for players, wives and caddies.
Thompson also planned to donate 3,100 rubber bracelets in exchange for donations to help the victims and their families.
“I’m not much of a crier, but it was a very, very sad moment,” Thompson told PGATour.com. “To see on TV, the pictures of the school that I went through for four years and the area where it occurred was terrible.”
The Tour makes an impact on communities every week, but some tournaments are more emotional than others.
Made Cut-Did Not Finish (MDF)
Golden moment. Jack Nicklaus has never been shy about expressing his thoughts on modern equipment and how far today’s professionals are hitting the golf ball, but this week the Golden Bear revealed just how involved he may be in what is increasingly looking like an equipment rollback of some sort.
During a recent dinner with USGA CEO Mike Davis, Nicklaus discussed the distance debate.
“Mike said, ‘We’re getting there. We’re going to get there. I need your help when we get there.'” Nicklaus said. “I said, ‘That’s fine. I’m happy to help you. I’ve only been yelling at you for 40 years.’ 1977 is the first time I went to the USGA.”
The USGA and R&A are scheduled to release their annual distance report before the end of the month, but after the average driving distance jumped nearly 3 yards last year on Tour – and nearly 7 yards on the Web.com Tour – many within the equipment industry are already bracing for what could be the most profound rollback in decades.
Geographically undesirable. Although this will likely be the final year the Tour’s Florida swing is undercut by the WGC-Mexico Championship, which will be played next week, the event’s impact on this year’s fields is clear.
The tee sheet for this week’s Honda Classic, which had become one of the circuit’s deepest stops thanks to an influx of Europeans gearing up for the Masters, includes just three players from the top 10 in the Official World Golf Ranking, and none from top three. By comparison, only the Sony Open and CareerBuilder Challenge had fewer top players in 2018.
On Monday at a mandatory meeting, players were given a rough outline of the 2018-19 schedule, which features some dramatic changes including the PGA Championship moving to May and The Players shifting back to March, and numerous sources say the Mexico stop will move to the back end of the West Coast swing and be played after the Genesis Open.
That should help fields in the Sunshine State regain some luster, but it does nothing to change the fact that this year’s Florida swing is, well, flat.
West Coast woes. Of all the highlights from this year’s West Coast swing, a run that included overtime victories for Patton Kizzire (Sony Open), Jon Rahm (CareerBuilder Challenge), Jason Day (Farmers Insurance Open) and Gary Woodland (Waste Management Phoenix Open), it will be what regularly didn’t happen that Cut Line remembers.
J.B. Holmes endured the wrath of social media for taking an eternity - it was actually 4 minutes, 10 seconds - to hit his second shot on the 72nd hole at Torrey Pines, but in fairness to Holmes he’s only a small part of a larger problem.
Without any weather delays, Rounds 1 and 2 were not completed on schedule last week in Los Angeles because of pace of play, and the Tour is even considering a reduction in field size at the Shriners Hospitals for Children Open to avoid similar schedule issues.
But all this seems to miss the point. Smaller fields aren’t the answer; rules that recognize and penalize slow play are the only solution.
Tweet of the week: @PaulLawriegolf (Paul Lawrie) “Getting pretty fed up playing with guys who cheat the system by playing as slow as they want until referee comes then hit it on the run to make sure they don't get penalized. As soon as ref [is] gone it’s back to taking forever again. We need a better system.”
It turns out slow play isn’t a uniquely Tour/West Coast issue, as evidenced by the Scot’s tweet on Thursday from the Qatar Masters.