Health Letter

Golf provides some of us with moments of joy when hitting a great drive, sinking a long putt, or chipping in for a birdie. These emotional highs are mixed with crushing moments of frustration when other shots don’t meet our expectations.

We can even find great satisfaction from one great shot. Regardless of our scores, we push forward and embrace a lifetime of practice and fine-tuning that the game requires.

That is, until we suffer a golf injury.

Golf seems, on the surface, to be a gentle sport. But it can be easy to get hurt without good flexibility, strength, and proper technique.

We’ll look at common golf injuries and how to avoid them.

Common Golf Injuries

Many golf injuries can be traced back to an aspect of the swing, which involves balancing an explosive forward motion, violent muscle contractions, and the long lever arm effect created by the force of the golf club. Most golf injuries happen repetitively, over time, from taking many swings with incorrect form.

Common golf injuries include:

• Back injuries and strains
• Golfer’s elbow (medial epicondylitis)
• Tennis elbow (lateral epicondylitis)
• Rotator cuff injuries or shoulder pain
• Hip Injuries
• Knee injuries

We’ll look at each of these injuries in turn.

Back Injuries and Strains

During a round, a golfer spends shot after shot in a bent position while applying pressure to the spine and back muscles. This can strain muscles and result in pain. Lower lumbar spine injuries and disc herniation can also occur – or if these injuries pre-exist, they can be aggravated by golf swings.

Golfer’s Elbow

Golfer’s Elbow is caused by the excessive force used to bend the wrist toward the palm when swinging a golf club. It results in pain, soreness, and inflammation on the inner part of the elbow. The pain is caused by damage to the tendons that bend the wrist toward the palm. Tendons are tough cords of tissue that connect muscles to bones.

Tennis Elbow

While golfers don’t carry a tennis racket in their golf bags, they can also be susceptible to tennis elbow. Tennis elbow involves inflammation in the outer tendons of the elbow. Golfers will feel pain from this condition along the outside of the elbow when extending their arms during a golf swing.

Rotator Cuff Injuries or Shoulder Pain

Have you ever taken a shot off the fairway and hit a rock or a root during your swing? The force of that unexpected impact can cause a rotator cuff injury or pain in the shoulder. Improper swing technique can also lead to tendinitis, bursitis, shoulder separation, and shoulder impingement syndrome from repetitive swinging movements.

Hip Injuries

Most of the power in a golf swing comes from movement and rotation in the hips. Lack of hip flexibility can cause hip problems and lower back issues. One common hip injury and pain source for golfers is trochanteric bursitis, where the bursa on the outer part of the hip joint inflames and swells.

Knee Injuries

If a knee has weak muscles, the strain on it to stabilize the hip rotation at the beginning of the swing can cause severe knee pain. Extreme force applied to the knee can cause torn or sprained ligaments and kneecap injuries.

Partial meniscus tears in the knee can also be present without symptoms. A golf swing can further aggravate that existing tear to the point where pain and inflammation suddenly become apparent.

General Golf Injury Prevention

Maintaining fitness is an integral part of a healthy and competitive golf game. Those golfers who tend to stay healthy follow structured fitness and exercise programs outside of their time on the course.

If you live a sedentary lifestyle between your golf rounds, you are more likely to suffer injury when you do play.

Beyond being fit, the following recommendations are a good starting point for general golf injury prevention:

• Work with a golf professional to learn proper swing techniques. Good form and proper mechanics will reduce stress on the body and help improve flexibility and agility.
• Warm up and take practice swings before a round. Stretch and hit a few balls on the range to prepare your joints and muscles for play.
• Build up your tolerance for golf movements. Don’t overdo it with too many shots in a day or over a period of days without preparing your body for it.

If You Do Get Injured

If you do experience musculoskeletal pain during golf that continues after the round, see a doctor before getting out on the course again. You may be surprised by what can be done with proper diagnosis to get you back out again playing golf pain-free.

Sports medicine isn’t solely limited to procedures and treatments for athletes.

It does focus on preventing, diagnosing, treating, and rehabilitating sports-related injuries. But you don’t have to be a weekend, school, or professional athlete to take advantage of all it offers.

Sports medicine is also appropriate for those injured during physically demanding work activities, such as pulling a muscle while on a construction site. It has a place for those hurt while pursuing active lifestyles, such as throwing out your back while doing yard work. It provides services to those who injure themselves while doing recreational exercises, too.

In this article, we’ll help you better understand what sports medicine involves and determine if it might be a good treatment path for you.

Who Practices Sports Medicine?

Most sports medicine practitioners have a variety of backgrounds, ranging from physical medicine and rehabilitation to orthopedics, family medicine to internal medicine, pediatrics to emergency medicine, and other specialties. They all share one common goal: to get you back into the game and function at peak performance.

Sports medicine is also practiced with a team of supporting medical professionals. These may include:

• Physical Therapists
• Certified Athletic Trainers
• Exercise Physiologists
• Occupational Therapists
• Chiropractic Practitioners

Each of these professionals may play a role in your recovery, helping you return to full function sooner.

What Kinds of Injuries Does Sports Medicine Treat?

Sports Medicine covers various musculoskeletal conditions involving the bones, muscles, tendons, ligaments, and joints. These include:

• Ankle pain and injury
• Arthritis
• Concussions
• Elbow pain and injury, including bursitis, golfer’s elbow and tennis elbow
• Foot pain and injury
• Fractures and Dislocations
• Hip Pain and Injury
• Knee Pain and Injury, Including ACL Tears
• Shin Splints
• Shoulder Pain and Injury
• Sprains and Strains
• Sports-related Injuries
• Stress Fractures
• Tendonitis

There are two general categories within sports medicine care.

The first involves acute injuries. These kinds of conditions develop suddenly and usually last only a short period. Examples may range from a sprained ankle or an accidental fall to bone fractures, dislocated shoulders, or torn tendons.

The second category involves wear-and-tear disorders like arthritis that develop over time. These disorders can occur or get worse with sports or exercise, but they are more often a result of repetitive movement in our work or simple daily routines. This can lead to a loss in mobility, along with mild to severe pain from strain or stress on affected body parts.

How Are Sports Medicine Injuries Evaluated?

An initial sports medicine appointment will involve a full evaluation to fully understand a patient’s symptoms, medical history, daily activities, and goals. Most frequently, common musculoskeletal conditions can be successfully treated non-operatively.

Magnetic resonance imaging (MRI), X-rays, or ultrasound will be prescribed in appropriate cases to visualize and assess sports injuries.

X-rays provide valuable insights into fractures and bony abnormalities, while MRI and ultrasound offer detailed information about soft tissue structures, including muscles, tendons, ligaments, and cartilage. These imaging techniques help confirm diagnoses, assess the extent of injuries, and guide treatment decisions.

How Are Sports Medicine Injuries Treated?

Although a sports medicine doctor will take the lead in evaluating your injury, treatment plans often involve a team of supporting medical professionals.

Physical therapy and other types of rehabilitation are often integral components of sports medicine injury treatment.

Sports medicine professionals work closely with physical therapists to design individualized rehabilitation programs that focus on restoring strength, range of motion, and function. Rehabilitation may include exercises, manual therapy, specialized therapies, and functional training to aid recovery and prevent future injuries.

Medications and injections may be prescribed to manage pain, reduce inflammation, and facilitate healing. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate pain and inflammation associated with sports injuries.

In some cases, corticosteroid injections may be administered to target specific areas of inflammation and provide localized relief. These injections also reduce pain, allowing more effective physical therapy treatments.

When a sports injury is severe and non-surgical alternatives have been exhausted, a sports medicine doctor may suggest that surgical intervention be considered. Surgical treatments can involve fracture fixation, ligament reconstructions, cartilage repair, and other procedures to restore function and promote recovery.

How Can Sports Injuries Be Prevented?

There are ways that you can minimize the likelihood of sustaining sports injuries:

• Stretch and Cool Down: Warming up before a workout with an easy walk or jog will lessen muscle strain. After warming up, stretch to increase flexibility, and be sure to cool down afterward. This advice applies to preparing to participate in a sport, begin an exercise workout, or engage in any intense physical activity, such as construction or yard work.
• Learn and Use Proper Technique: Proper technique in your sport is vital for injury prevention. Seek guidance from experienced coaches or trainers to use the correct form and body mechanics during training and competition. This also includes using proper techniques in general activities, such as lifting heavy items.
• Develop Strength and Conditioning: Follow a fitness plan incorporating resistance training to target core stability and flexibility to support your body during sports and physical activities.
• Wear Protective Gear: Wearing appropriate protective gear, such as helmets, pads, and mouthguards, can significantly reduce the risk of severe injuries in contact sports. Wearing a helmet when biking, skiing, or participating in similar activities is essential. Use specialized equipment that is designed to protect you in everyday work situations.
• Wear the Right Shoes: Improperly fitting or inappropriate shoes can lead to conditions such as stress fractures, plantar fasciitis, Achilles tendonitis, and ankle sprains. Ensure you are using the right shoes for the activity you are participating in and that they are not worn beyond their useful life.
• Stay Hydrated: Drinking plenty of water before, during, and after exercise can help prevent muscle damage, fatigue, and other complications that can lead to injury.
• Pay attention to your body: Look for signs of fatigue, pain, or discomfort. If you experience pain while playing, exercising, or working, stop the activity. Pushing through injuries can worsen them and lead to longer recovery times.
• Adjust Your Routine in Hot Weather: Take extra precautions to prevent heat-related illnesses during hot weather. Wear lightweight, breathable clothing and schedule activities during cooler parts of the day.

When Should You See a Sports Medicine Practitioner?

When an injury still hurts after resting, or it feels better until you start to exercise again, you should make an appointment with a sports medicine physician or a specialist in musculoskeletal medicine, such as a physical medicine and rehabilitation doctor.

Those who periodically suffer from lower back pain know the reality. Staying active and using over-the-counter pain relievers may often be sufficient to restore the quality of your life. With this approach, lower back pain usually fades away with time.

However, for some, home remedies fail to relieve the angry pain that confronts them each day. At that point, it becomes time to work with a doctor to figure out an individualized path for pain relief. 

Lumbar epidural steroid injections are one of the standard treatment options doctors consider for many forms of lower back and leg pain. They have been used since the 1950s. For doctors who are Physical Medicine and Rehabilitation specialists, they are considered an integral part of the non-surgical management of lower back pain and sciatica.

What Is a Lumbar Epidural Steroid Injection?

An epidural steroid injection of an anti-inflammatory medication (also called corticosteroid) into the lower back to relieve pain in the legs or lower back. The medication is injected using fluoroscopic (X-ray) guidance into the epidural space, an area of fatty tissue surrounding the spinal nerves.

A lumbar epidural steroid injection can help reduce nerve inflammation and stabilize membranes. It can reduce swelling and pressure on irritated nerves in the lower back. Corticosteroids decrease the production of inflammatory chemicals and reduce nerve fibers’ sensitivity to pain.

What Are Corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone our body’s adrenal glands and brain produce naturally. Corticosteroids are often referred to as “steroids,” but it is different from the anabolic steroid compounds that some athletes use to build muscles.

Corticosteroids are used to help reduce pain and inflammation as well as treat a variety of painful conditions, including lumbar disc herniation.

The Goals of a Lumbar Epidural Steroid Injection

The goals of a lumbar epidural steroid injection are to:

• Relieve pain by reducing inflammation in and around nerve roots.
• Help a patient improve their mobility and lower back function.
• Improve leg mobility and function for sciatica sufferers.
• Enable a patient to participate and progress in a comprehensive physical therapy program.

Commonly, lumbar epidural steroid injections are only recommended when a series of other more conservative treatments have been tried without adequate results.

What to Expect from a Lumbar Epidural Steroid Injection

For many patients, a lumbar epidural steroid injection can provide relief for intense episodes of back and/or leg pain. 

These injections are normally administered in an outpatient setting, usually under twilight sedation. A local anesthetic is used at the injection site, and fluoroscopic (X-ray) guidance precisely targets the medication to nerve roots in the epidural space of the back. 

It generally takes a few days after an injection before the medication begins to take effect and lower back pain improves. Pain relief often lasts at least three months and may extend for years. 

For some patients, one lumbar epidural steroid injection is all they need to resolve their back pain issues. If more than one injection is required, there usually is a limit of three or four a year.

If back pain is present for over three months, it is considered chronic. It can come and go and vary in intensity.

If you suffer from it, you are not alone. Surveys estimate that more than 8 percent of U.S. adults are currently experiencing chronic back pain. It limits everyday activities as a result.

While spinal back surgery can benefit some causes of back pain, it’s important to note that it’s rarely necessary. Back pain often resolves itself over a few months, especially with the help of effective non-surgical treatments. 

We’ll take a look at nine options to try to relieve back pain without surgery.

1. Follow an Anti-Inflammatory Diet

Inflammation is a natural response of the body in response to illness or injury. It follows that when you are experiencing back pain, you may have some accompanying inflammation. Recent University of Pittsburgh Medical School research suggests that anti-inflammatory diets are better for back pain.

Anti-inflammatory diets include a variety of whole grains, fruits, and vegetables, a mix like the Mediterranean diet. Conversely, processed foods and foods high in sugar tend to increase inflammation. 

Omega-3 fatty acids, found naturally in fish, seafood, nuts, and seeds, are also beneficial for anti-inflammation.

2. Achieve a Healthy Weight

According to multiple studies, excess weight contributes to lower back pain and degenerative disk disease. Every extra pound of weight significantly increases the strain on the muscles and ligaments of the back. 

Excessive weight can pull the natural curves of the spine out of alignment. It can overload the shock-absorbing disks of the spine. And fat can secrete chemicals that contribute to chronic whole-body inflammation and pain disorders.

Achieving a healthy weight can reduce some of the continuing damage to your back, but it can’t reverse existing damage.

3. Regular Exercise

A sedentary lifestyle can result in weak core muscles, poor posture, and increased low back pain. Lifestyle changes are required to reverse that trend.

There are no guarantees that an exercise program will completely alleviate back pain. However, research shows it often relieves pain and improves overall fitness and mobility. Studies have also found that doing regular exercise can reduce the occurrences of back pain by almost half.

Even ramping up daily activity by a small amount can significantly improve back pain levels.

However, if you last exercised regularly a while ago, you should consult your doctor before starting a fitness program.

4. Physical Therapy

Doctors often refer patients to a physical therapist as one of the first treatment options for low back pain. Their recommendations usually include that a physical therapist provide guided therapeutic exercises to strengthen lower back muscles and condition spinal tissues and joints.

These physical therapy programs aim to decrease painful symptoms, improve low back function, increase spine flexibility, and set up a long-term program to prevent back pain recurrence.

5. Alternative Treatments

Some patients may benefit from alternative treatments for chronic low back pain. Acupuncture, massage, and biofeedback therapy are options worth exploring. The potential benefits of these therapies outweigh their risks.

6. Injection-Based Treatments

Doctors may use injection-based treatments, including lumbar epidural steroid injections, for specific causes of chronic lower back pain. Lumbar epidural steroid injections are often effective for relieving pain from herniated disks and spinal stenosis. They are usually precisely targeted using fluoroscopic (X-ray) guidance.

These injected steroids can reduce swelling and pressure on the nerves that are causing back pain. This procedure often leads to temporary pain relief lasting three months or longer.

7. Ablation Procedures

When other back pain relief methods have been unsuccessful, ablation procedures may be an appropriate alternative. 

One such procedure is radiofrequency ablation (RFA), also known as a radiofrequency neurotomy. Radiofrequency ablation uses radio waves to heat a small area of nerve tissue in the spine identified as a source of back pain. The heat destroys that nerve area, stopping it from sending pain signals to the brain. 

Another ablation procedure, called Intracept, targets the basivertebral nerve that causes chronic vertebrogenic low back pain. Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates from disc degeneration or simply wear and tear from everyday life.

8. Orthobiologic Therapies

Orthobiologic therapies use blood, tissue, or cells to boost the body’s natural healing processes. 

The VIA Disc procedure falls into this category. This minimally invasive therapy rehydrates and supports the cushioning function of degenerated discs, which can relieve back pain. VIA Disc is one of the first orthobiologic therapies covered under Medicare.

Platelet-rich plasma Injections (PRP) are another therapy in this category. It uses a patient’s blood to isolate and concentrate platelets injected into an injured back area. Although clinical results for this procedure seem promising, it is still considered an experimental treatment. The use of PRP for chronic back pain is generally not covered by medical insurance.

9. Neuromodulation Therapies

Spinal Cord Stimulation (SCS), Dorsal Root Ganglion Stimulation (DRG), and Peripheral Nerve Stimulation (PNS) are three neuromodulation therapies used to relieve back pain. These therapies use mild electrical stimulation targeted to specific neurological sites in the body to interrupt pain signals before they reach the brain.

These minimally invasive procedures may be appropriate when multiple other treatments have failed to provide adequate relief. They each have the significant potential to restore patients’ quality of life.

Summing It Up

Spine surgery may be ultimately appropriate for some patients for pain relief. However, it should only be considered after all other alternatives have been exhausted. 

Sciatica is a symptom of a medical problem that causes pain, numbness, tingling, or weakness in the leg. It is most commonly associated with two different conditions: a herniated disk or lumbar spinal stenosis. 

Sciatica pain occurs along the path of the sciatic nerve, which runs down the lower back and into the legs. This symptom can result from a herniated disk, where the disk ruptures and its gel center pressures the lumbar nerve roots.

Lumbar spinal stenosis can also cause sciatica pain or cramping in one or both legs. Lumbar (lower back) spinal stenosis is usually caused by osteoarthritis. This is a “wear and tear” condition resulting in bone overgrowth. This overgrowth can extend into the spinal canal, narrowing the space, which pinches and puts pressure on nerves within the spine.

The potential for misdiagnosis is understandable, given the similarities in the leg pain and sciatica symptoms between these two conditions. However, getting the diagnosis correct is critical, as the treatments for each differ.

In this article, we’ll take a deeper look at the causes and symptoms of each.

Herniated Disks and Sciatica

Disks sit between vertebrae bones that stack to make the spine. These disks act as rubbery cushions that allow you to bend and move easily.

Each spinal disk has a soft, gel-like center called a nucleus and a firmer outer layer known as the annulus. A herniated disk occurs when the annulus tears and some of the nucleus’s gel center pushes through the opening. It is also known as a ruptured disk or slipped disk.

Herniated disks usually occur in the lower back or neck. Since our discussion is on sciatica symptoms, this review is specifically on ruptured lower spine disks. Aging, excessive weight, repetitive motions, and sudden strain from improper lifting or twisting can all contribute to a disk rupture.

Often, people experience no symptoms from a herniated disk. But for some, the rupture creates pressure on one of the sciatic nerve’s nerve roots. With sciatica symptoms, this usually occurs in the last lumber nerve root (L5) or the first sacral nerve root (S1) as they exit the lower spinal column. 

Sciatica from a Herniated Disk Symptoms

Sciatica pain may be experienced anywhere along its nerve pathway. Frequently, it follows a path that radiates from the lower back down one side of the buttocks into the leg and sometimes the foot. The pain can vary from a mild ache to a sharp burning. 

Other symptoms may include:

• Lower back pain.
• Tingling or numbness in the legs and/or feet.
• Muscle weakness.
• Pain while sitting and rising from a sitting position.
• Worsening pain from prolonged standing.
• Pain when bending forward.
• Pain that improves throughout the day after rising.

Treating Sciatica from a Herniated Disk

In most cases, pain from a herniated disk can be treated at home. If the pain is severe, it is recommended that sciatica sufferers rest for one to three days but avoid long periods of laying down to prevent stiffness. You can also take an over-the-counter pain reliever, such as ibuprofen or acetaminophen, and apply heat or ice to the affected area.

However, you should see a doctor if the symptoms don’t improve after four to six weeks or get worse. You should also see your doctor if the pain interferes with your everyday life, you develop loss of bladder or bowel control, or you have trouble standing or walking.

Lumbar Spinal Stenosis and Sciatica

By age 50, degenerative changes begin to affect 95% of people. One of those changes is spinal stenosis, the narrowing of one or more spaces within the spinal canal. The spinal canal is the tunnel that runs through the vertebrae bones of the spine. It contains the spinal cord, which connects the brain to the lower back.

As the spinal canal narrows due to bone overgrowth from spinal stenosis, it can cramp the spinal cord and the nerve roots that branch off it. The tightened space can irritate, compress, or pinch the spinal cord and nerves, leading to back pain and other nerve issues like sciatica. 

Spinal stenosis usually develops slowly over time. Lumbar spinal stenosis is less commonly known as lower back spinal stenosis.

Sciatica from Lumbar Spinal Stenosis Symptoms

Sciatica pain from lumbar spinal stenosis begins in the buttocks, runs down the leg, and may continue into the foot. It may involve one or both legs. 

Other symptoms involve neurogenic claudication, including:

• Lower back pain.
• A heavy feeling in your legs, which may lead to cramping.
• Numbness or “pins and needles” tingling in the buttocks, legs, or feet.
• Pain worsens when standing for long periods, walking downhill, or bending backward.
• Pain that lessens when you lean forward, walk uphill, or sit.

Treating Sciatica from Lumbar Spinal Stenosis

The treatment for lumbar spinal stenosis varies depending on the severity of the symptoms.

For mild symptoms, at-home care may be appropriate. This may include:

• Over-the-counter pain relievers.
• Head and cold applied to the aching joints.

If at-home care is insufficient, your doctor may recommend nonsurgical treatment options, including:

• Physical therapy to strengthen spine-supporting muscles and improve flexibility and balance.
• Corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain, and irritation.

Surgery for spinal stenosis is only considered in rare cases where all other treatment options have failed to provide adequate relief.

Wrapping It Up

Sciatica may result from two different conditions: a Herniated Disk or Lumbar Spinal Stenosis. Knowing which condition is causing sciatica pain is essential to establish the appropriate course of treatment.

You should usually see your doctor to get an accurate diagnosis.