Knee Pain and the Elite Golfer
In most sports the knee joint ranks as the first or second most afflicted region. Due to this it’s injuries, their management and rehabilitation, be it invasive or conservative, have been extensively researched.
In golf the occasions of knee pain are a lot less. For sure osteoarthritis of the knee joint can limit the more elderly golfer, but this is predominantly not singularly caused by golf and also generally the walk (over undulating terrain, bunkers, carting a bag etc.) is more of an aggravating factor than the golf swing.
In the elite golfer studies tend to show that the knee joint is the affected joint in only about ~ 5-10% of injuries. Much less than the back, elbow, shoulder or wrist.
However the trouble that Tiger Woods sustained with his left knee certainly brought the knee into the spotlight and the maybe debilitating effects that the forces produced in our modern swing can cause.
The right knee experiences the largest of its compressive forces at the end of the backswing where-as the left knee maximal forces occur just before impact and into the follow-through. For both the left and right knee these maximal forces occur with tibial on femoral rotation.
With this can come injury to both the medial and lateral joint compartments, including the meniscus.
So how do we protect the knees from these injuries? At both positions of the swing we must ensure physically and technically that we are not putting more than the necessary forces through them and that these forces are received in the best positions possible.
For example; in the back-swing, if the player is lacking internal rotation of their right hip joint (<30 degrees) then to attain the adequate end of back-swing rotation the knee tends to extend (straighten) more.
Either this or they can weight-shift laterally and/or posteriorly which brings on more problems (particularly in the back!)
This knee extension, added with tibial rotation, increases the risk of injury. Similarly, the left knee extends with tibial rotation at impact and into follow-through.
Here the forces are about ~50% greater than the right knee experiences in the back-swing. So not surprisingly it is in the left knee, and at this point in the swing that more knee injuries occur.
Apart from compartmental and meniscal type injuries, the elite golfer can also suffer from patellofemoral joint syndrome, iliotibial band syndrome, bursal and fat pad impingements.
As always, if you suffer from knee pain get it firstly assessed and treated by your relevant medical professional. If caused by golf then once settled or controlled you will need to attack the cause, and probably both physically and technically.
Martin McInnes - Physiotherapist
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