All posts by Ashleigh Franklin

Golf Injuries!

golf

Golf requires much more athletic ability than many imagine

Golf is a sport with many health and wellbeing benefits. A reported 60 million people of all ages play golf across the world, sometimes into their 80s and 90s.

The health benefits have been widely reported in recent years with an 18 hole round amounting to 6-8 km of walking, requiring over 8,000-12,000 steps and a calorie burn of 1,500.

However, golf can be very demanding; requiring strength, endurance, explosive power, flexibility and athletic ability to perform a movement that produces some of the fastest club head and ball speeds of any sport.

The effect of these repeated large forces on the body can lead to many different types of injuries, which are often specific to certain areas and sides of the body in golfers, depending on their lead side.

Much research has been done on the types and likelihood of injuries experienced by golfers with the main areas of the body prone to injury being the lower back, shoulder, elbow, wrist and hips.

Below, European Tour consultant physiotherapist Nigel Tilley explains some of the common golfing injuries and how physiotherapy can help get you back on the green.

Wrist injuries – Extensor Carpi Ulnaris (ECU) injury

There are a large range of common wrist injuries in golf – we will concentrate on one main area of problem: Extensor Carpi Ulnaris (ECU) injury.

What is it?

The ECU is a skeletal muscle that extends and adducts the wrist. It has to work very hard during the golf swing and is highly prone to injury, which can be caused by high force trauma (hitting a tree root or thick grass), rapid increase in loading, continued excessive loading and technique faults.

How does physiotherapy treat this type of injury?

This type of injury will often require ‘load modification’ with more traumatic sudden onset injuries requiring immediate removal of load and PRICE protocol (protection, rest, ice, compression and elevation) or POLICE (protection, optimal loading, ice, compression, elevation). The aim here is to reduce the bleeding and swelling from the injury site if severe tissue disruption, such as a partial or full rupture, has occurred.

Lower back injuries – Non-specific low back pain (NSLBP)

What is it?

Lower back injuries account for roughly 30% of all golfing injuries, with poor technique and lack of flexibility in the mid spine and hips possible causes. Often it presents as an aching and discomfort on moving into certain positions and doing certain activities. However, the soreness and stiffness that people often present with is called ‘non specific’ as it is not usually clear which structure is causing the problem/pain.

How does physiotherapy treat this type of condition?

Trying to remain active and avoiding extended periods of rest is important in people with NSLBP. Whilst it may be a good idea in the very initial stages of the problem to reduce or avoid significant movements or activities that aggravate the symptoms, it is a good idea to keep mobile and try to do stretches and exercises that relieve the symptoms and promote normal movement. These are often specific to each individual and your physio will discuss the best options for you. Often in the initial phases the use of heat through hot packs and baths can help as well as manual therapy treatments, soft tissue massage, TENS and advice on the best ways to lift, bend, sit and move in out of the car and bed.

Elbow injuries – Tennis elbow (lateral epicondylitis)

What is it?

Tennis elbow is common in golfers, who are more likely to suffer from injuries to the outside of the elbow region, rather than ‘golfer’s elbow’ which affects the inside. In general the tendons do not show signs of inflammation but rather angiofibroblastic degeneration, collagen disarray and hypoxic tendon degeneration. This often occurs due to rapid increase in loading and or continued excessive loading due to training or technique faults that the tissues are unable to adapt to.

How does physiotherapy treat this type of condition?

The type of physiotherapy management will depend on the stage of the problem and your individual presentation. Often this type of injury will require ‘load modification’ with more sudden onset injuries requiring immediate removal of load and PRICE protocol (protection, rest, ice, compression and elevation) or POLICE (protection, optimal loading, ice, compression, elevation).

Increasing the ability of the tissue to tolerate loads and re-model can be achieved through structured exercises, which your physiotherapist will be able to advise on, depending on the stage and severity of your presentation.

Other treatment techniques include the use of manual therapy to the elbow and associated tissues and structures as well as devices called epicondylitis clasps and taping techniques that can help to offload the injured area to help it recover.

Shoulder injury – Rotator cuff injury

The shoulder is a complex joint and there is a large range of injuries that can occur within it and its structures. We will concentrate on the rotator cuff.

What is it?

The rotator cuff is a group of 4 muscles in the shoulder that are involved in movements and control of the shoulder joint. There are two main causes of injury to this structure, acute trauma and degeneration. The amount of stress needed to cause an injury to the rotator cuff tendon will often depend on factors such as the person’s age, general health and underlying condition of the tendon prior to the stress elicited on the tissue. Tears can occur from injuries such as a fall onto the arm, sudden lifting or rapid movement of the arm (such as in the golf swing) or deceleration of the club head suddenly when unexpected (hitting a tree root or getting the club head stuck in thick rough). Repetitive movements of the golf swing combined with poor technique and/or flexibility and control issues can lead to injuries to the shoulder and rotator cuff.

How does physiotherapy treat this type of condition?

The type of injury, its severity and stage will affect the physiotherapy management of the condition and the time of recovery. TENS, manual therapy and acupuncture are techniques that can help with pain relief. The aim of physiotherapy will be to return optimum function and control to the shoulder complex through structured exercises rehabilitation. Physiotherapists often use taping techniques to also help in the treatment of shoulder injuries. Advice on ergonomics, activity and lifestyle can help identify ways to reduce positions and aggravating factors that may slow the recovery or worsen the injury.

Conclusion

To conclude, golf requires much more athletic ability than many imagine and the consequences of this mean many people suffer injuries through poor general conditioning, lack of warm up, poor technique and practice and playing habits.

But with regular conditioning, improvement in technique, warm ups and structured practice the improvements in a golfer’s performance and reduction in injuries can be significant. Your physiotherapist can help you with this as well as provide you with effective treatment should you suffer with any injuries.

 

Physio Team-Works, we can help with your football injuries!

With the help of expert physios, players including Steven Gerrard and Theo Walcott regularly recover from injuries to hamstrings, quadriceps and ligaments. Find the facts and famous examples on this page

 

Dislocated shoulder – How does physiotherapy treat a dislocated shoulder?

The shoulder will be reduced and depending on the severity of the dislocation, can be surgically stabilised. Intensive physiotherapy treatment will follow, working on flexibility, muscle strengthening and confidence, to ensure the shoulder does not dislocate again.

Dislocated shoulder: famous football examples

England winger Theo Walcott suffered a series of dislocations earlier in his career, and Chelsea keeper Petr Cech dislocated his shoulder in a Champion’s League semi-final this year.

 

Groin strain – How does physiotherapy treat groin strain?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation).  The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.

For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.

Groin strain: famous football examples

England captain Steven Gerrard recovered from a mild groin injury leading into the World Cup.

 

Hamstring strain – How does physiotherapy treat hamstring strain?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation).  The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.

For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.

Hamstring strain: famous football examples

Michael Owen suffered multiple severe hamstring injuries throughout his career, while Spain’s Diego Costa recovered from a strain in time to play in the World Cup.

 

Thigh (quadriceps) strain – How does physiotherapy treat thigh (quad) strain?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation).  The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.

For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.

Thigh (quadriceps) strain: famous football examples

Man United’s Robin Van Persie and Man City’s Vincent Kompany both missed a number of games this season with this injury.

 

Meniscus injury – How does physiotherapy treat meniscus injury?

Dependent on the severity of the tear, it can irritate or cause the knee joint to lock. Sometimes following the initial swelling symptoms resolve, and other times surgery is required. In this case, the meniscus is either repaired or trimmed.

Following surgery, the player will have intensive physiotherapy in order to control swelling, pain and increase muscle activation. This may include hydrotherapy and anti-gravity treadmill training initially, before starting football specific drills.

It is important that the rehabilitation is supervised by a chartered physiotherapist to reduce the risk of re-injury.

Meniscus injury: famous football examples

Liverpool’s Uruguayan striker Luis Suarez underwent intensive physiotherapy to get fit in time for the World Cup. Other players to suffer the injury in recent times include Fernando Torres, John Terry and Phil Jones.

 

Anterior cruciate ligament (ACL) injury – How does physiotherapy treat anterior cruciate ligament injury?

Rehabilitation following ACL injury is long and intensive. It is a staged process to ensure the repair (graft) does not fail from early stressors. Initial treatment will include electrical muscle stimulation, hydrotherapy, anti-gravity treadmill work and exercises for flexibility.

Football specific drills will be introduced later, starting with straight line running. Pivoting and quick turns will be introduced towards the latter stages of rehab, as these put the newly repaired ligament under the most stress. It is crucial that the player’s rehabilitation is closely monitored and progressed by a chartered physiotherapist to reduce the risk of re-injury.

Anterior cruciate ligament injury: famous football examples

Two England internationals have been struck down by ACL injuries in the run up to the world cup. The luckless Theo Walcott suffered his injury against Spurs in January, followed by Southampton striker Jay Rodriguez later in April.

 

Medial collateral ligament (MCL) sprain – How does physiotherapy treat medial collateral ligament sprain?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation).  The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

As the ligaments start to heal, the player will be encouraged to put more weight through the ankle joint. The physio will then work with the player on their balance, co-ordination and muscle strength to get them back to match fitness and football specific drills.

They may use bracing techniques to support the joint during rehabilitation. It is important that the rehabilitation is guided by a chartered physiotherapist to reduce risk of re-injury.

Medial collateral ligament sprain: famous football examples

Alex Oxlade-Chamberlain experienced a mild MCL sprain following a collision with a player in a World Cup warm-up against Ecuador.

 

Calf strain – How does physiotherapy treat calf strain?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation).  The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

Following this, the rehabilitation period will include gentle stretching, soft tissue work and muscle strengthening. Once properly healed, the player can start football specific drills, including jumping, running and sprinting.

For safety and to reduce the risk of re-injury, players should complete rehabilitation under the guidance of a chartered physiotherapist.

Calf strain: famous football examples

Holland’s former Spurs star Rafael van der Vaart will miss the World Cup with a calf strain.

 

Sprained ankle – How do physiotherapists treat sprained ankle?

Immediate treatment will involve the ‘PRICE’ protocol (protection, rest, ice, compression and elevation). The aim here is to reduce the bleeding and swelling from the injury site. This will also help with pain and can last for around three days.

As the ligaments start to heal, the player will be encouraged to put more weight through the ankle joint.  The physio will then work with the player on their balance, co-ordination and muscle strength to get them back to match fitness and football specific drills.

It is important that the rehabilitation is guided by a chartered physiotherapist to reduce risk of re-injury.

Sprained ankle: famous football examples

Spurs winger Andros Townsend’s chances of making England’s World Cup squad were ended by an ankle ligament injury.

 

Broken metatarsal – How does physiotherapy treat a broken metatarsal?

Initially the player will be encouraged to take weight off the foot by wearing an aircast boot. Once the medical team are happy that the bone has healed sufficiently, the player will gradually return to play.

The physiotherapist will specifically work on maintaining fitness, muscle strength/length, balance and co-ordination.

Broken metatarsal: famous football examples

David Beckham and Wayne Rooney suffered high-profile metatarsal injuries before major tournaments for England, although both went on to play in the 2002 and 2006 World Cups respectively.

Rooney has suffered the injury on three occasions

football

Occupational Health – Physio Team Works CAN help!

Good work – that is, work within the capability of the person doing it – is linked to health.

Work can bring both mental and physical health benefits, and so being in work is a key determinant of health. Most people need to work and socioeconomic success is also a factor in life expectancy.

The UK population is living longer and there is an associated rise in the government pension age. As we age, most people will develop long-term health conditions that they will need to manage whilst working. The workplace now needs to support people so that their ability to contribute is sustainable.

Size of the task

  • Sickness absence from work currently costs the UK £14.3 billion
  • 40% of all UK sickness absence is due to work-related MSDs
  • Working days lost due to work-related MSDs = 5 million
  • Working days lost due to work-related stress = 9 million

The UK challenge:

health, work and austerity

At a time when the NHS is serving a growing and ageing population, the UK government estimates the need for £22 billion in NHS savings by 2020/21(3). Yet public expectation remains that access to ever improving treatment should be available to all. So the drive to reduce the welfare bill and to have people in

productive work remains a government priority.(4) There is clearly a pressing need for best value and productivity in healthcare.

Musculoskeletal disorders (MSDs), from short term back pain to complex, long term conditions such as rheumatoid arthritis, are the main reason for people being off work. These conditions can also link to mental health conditions such as anxiety and depression, which are associated with stress and are responsible for the most working days lost in the UK. Psychosocial factors such as workplace culture can in turn impact on the development of MSDs.(5)

Benefits of early referral to physiotherapy for work

  • Economic savings to the UK
  • Prevention of MSDs and work-related exacerbation of other conditions
  • Clinical effectiveness in the treatment of MSDs and other conditions affecting workers
  • High levels of staff satisfaction
  • Healthy conversations‘ that support behaviour change

 

Early access to physiotherapy enables people to work;

Physiotherapy can help. It is a regulated, clinically and economically cost-effective profession.

Physiotherapists are autonomous practitioners, with the skills to accept referrals directly.

They assess, diagnose, advise and treat people in many clinical and non-clinical settings, both inside and outside of the NHS. They are experts in the prevention and treatment of MSDs and of other conditions affecting people of working age, such as cancer, cardiac, respiratory and neurological conditions.

According to Macmillan, there are currently over 750,000 people of working age living with cancer and it is predicted that there will be 17million people living with arthritis and 3 million with cancer by 2030.

Work advice from physiotherapists

All physiotherapists can give advice to help people to prevent problems related to their work. They advise employees, enabling conversations with line managers, and liaise with other health care professionals, family and carers as needed. Where a problem or health condition already exists they work with people to achieve optimal function and mobility – with work an important treatment outcome.

Physiotherapists add further value in supporting the public’s overall health. For instance, they can give specific advice about physical activity levels based on an individual’s clinical physiotherapy assessment. This can help people address concerns such as obesity, leading them to better overall health and promoting self-management of their condition.

Within the workplace, physiotherapists specialising in occupational health and ergonomics can provide targeted support in response to the needs of staff and their roles, as well as the business needs of employers. They liaise with line managers and others to promote workplace health and minimise sickness absence.

The NHS itself, the UK’s largest employer, has a high rate of sickness absence due to MSDs, costing around £400m per year. Early access to physiotherapy is now included in government measures. For instance, as part of the work generated by the Five Year Forward View aimed at reducing sickness absence in NHS workers.

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