Symptomatic and asymptomatic overuse injuries in recreational golf players

Golf is classified as a physical activity of low-to-moderate intensity with a metabolic cost ranging from 2.5 to 6 METs, thus suitable for most people. However, as many other sports, and particularly those whose fundamentals need asymmetric movements - such as the 'swing' - golf leads to a high incidence of overuse injuries of the muscle-skeletal system in middle and high-level players. Although this injuries may be clinically significant, sometimes they are asymptomatic, thus leading to a probable 'hidden' worsening of the clinical picture. Among golf players, this is particularly true for what concern hand injuries. In order to evaluate the incidence of symptomatic and asymptomatic overuse injuries, 60 male adults (53.2±12.1y) recreational golf players underwent a face-to-face questionnaire and a sonographic assessment. The questionnaire was concerned about both golf practice/training - how many years, average weekly frequency, and single session duration - and injuries status - symptoms, pain localization (by means of the Pain Drawing) and intensity (by means of the Visual Analog Scale, VAS). Acute injuries and those clearly not related with golf practice were not retained for later descriptive analysis. Sonographies of the elbow, wrist, and hand of both arms of each player were made by means of a portable ecocolor power-doppler sonographer with 12 to 18 MHz linear transducers. Results were classified in 3 categories of years of practice (0 to 5, 6 to 10, >10 yrs) and monthly training hours (no training, <8, ≥8 h/mo). Pain drawing results evidenced that only 38% of the recreational golf players did not report any pain symptom, whereas the remaining symptomatic 62% suffered from low back pain (34%) and felt pain in the elbow (12%), shoulder (8%), hand (3%), and 'other' (5%) regions (hip, lower limb, knee, foot). VAS results, on average, evidenced values ranging from 4.1±1.6 (shoulder) to 5.3±1.4 (elbow). Sonographies confirmed both wrist and elbow synovial expansions in all the symptomatic players reporting pain in those regions. Sonographies of the asymptomatic players revealed that about 50% were actually not injured, whereas, of the remaining players, 46% suffered from synovial thickening and palm fibrosis (hand), 18% from tendon cysts and fluid films (wrist), and 36% from synovial thickening, epitrocleitis and epicondylitis (elbow). On average, as long as of golf practice years increase, elbow and low back pain occurrences rose, while shoulder and 'no pain' occurrences decreased. As for training monthly time, average pain occurrences rose in elbow, shoulder, and low back regions, as well as 'no pain' reports. Average VAS results seemed to be not affected neither by golf practice years nor by training monthly time. In conclusion, recreational golf players may be at risk of symptomatic and asymptomatic overuse injuries, particularly in the low back, elbow and hand areas, and years of practice may increase the incidence of those overuse injuries.