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The running and sports injury clinic was developed to provide a diagnostic service to injured runners and other athletes. In order to understand the cause of running injuries sophisticated and precise biomechanical analysis must be conducted. This type of evaluation includes a computerized gait analysis that utilizes a state of the art motion analysis laboratory. The motion analysis laboratory includes: specialized treadmill, 3D video analysis system with special software, surface electromyography system and ground reaction force plate.

Golfer Waiting to Tee off

Golf Injury Treatment

One of the most popular sports among both young and old in today’s society, golf is a low-intensity activity which many enjoy. Although it may appear rather tranquil, presenting little possibility of an injury, the figures show that approximately 15-20% of golfers injure themselves every year, with over 50% of professional golfers having had to quit the sport altogether due to injury. Some of the most common complaints include chronic back pain due to the hunched-over putting position, shoulder pain, wrist and elbow pain, which are looked at in detail below. The causes for this vary greatly, from poor swing mechanics to not warming-up properly before the game.

Golfer’s elbow

Elbow pain is often attributed to the sport is a similar condition to what many tennis players experience, due to similar high level of force applied during the swing of the golf-club. This condition is generally known as the ‘golfer’s elbow’, medically referred to as ‘the medial epicondylitis’, which is a repetitive strain injury caused by overuse and poor swing mechanics, among other factors such as age, equipment used, and etc. The golfer’s elbow is different to the tennis elbow only in a sense that the inner tendon in the elbow is put under stress, particularly if the player’s lower body doesn’t follow the motion of the swing over the shoulder with a neutral grip, and deviates from what is known as the ‘natural swing concept’. Elbow pain may appear in either elbow, regardless of what the dominant hand of the player is. For example, a right-handed player might experience medial elbow pain (caused by inflammation in the inner tendon) in their dominant arm, or lateral elbow pain in their left arm (caused by the inflammation of the outer tendon). Due to the large force involved in such movements as the backswing, overusing the elbow causes the fibres in the tendons to become inflamed and cause acute pain. While this is an acute injury and easy to treat with manual therapy and rest (and a few golf lessons to perhaps improve technique), in the instance when the elbow pain evolves from acute to chronic, you should immediately seek a specialist, due to potential calcification occurring in the tendon, which generally requires surgery to fix.

Wrist Pain

Hand and wrist strains are extremely common among golfers. Extensive gripping of the golf club and pain occurring in the left wrist during the back-swing usually signals one of two common repetitive strain injuries in golfers – either the carpal tunnel syndrome or the DeQuervain’s tendinitis. Both injuries have similar symptoms which include a swollen wrist, pain and tenderness, particularly extending from the wrist to the base of the thumb. Although below there are two simple manual tests demonstrated, which would help determine the condition, it is worth visiting the doctor to determine the extent of the injury, and of course, rest the wrist and refrain from using it as much as possible.

DeQuervain’s tendinitis, sometimes also known as the ‘washerwoman’s sprain’ is a an inflammation of the tendon which stretches from the muscle in the forearm to the thumb, making any grasping motions incredibly painful. A type of a repetitive strain injury, where the tendons inflame and cause micro tears on cellular level in the tendon which stretches through a tunnel in the wrist starts causing friction from repetitive movements of the thumb, worsening the pain and the trauma itself. Preceding conditions such as rheumatoid arthritis increases the likelihood of DeQuervain’s disease occurring.

A similar condition, with nearly exact same symptoms is a carpal tunnel syndrome, which is commonly associated with those who spend a lot of time typing. This injury causes pain in the wrist due to inflammation of the flexor tendons which pass through the carpal tunnel, located in the wrist.

As previously mentioned, both conditions display very similar symptoms. It is best to see a physical therapist in determining the type and the extent of the damage inflicted on the tendons in the wrist. In order to distinguish the two conditions, a Finkelstein test is performed, where the person has to make a fist with the thumb inside and bend the hand down. This particular motion directly utilises the tendon pertaining to the DeQuervain’s tendinitis, thus making it a rather painful test for anyone who suffers from it.

For carpal tunnel syndrome, generally a Tinel Sign test is performed, where the patient extends the arm and the physician taps on the inside part of the wrist, where the median nerve passes. If the person feels tingling, mild pain, or a slight electrical shock sensation, this indicates that the median nerve is inflamed.

 

Shoulder pain

Shoulder Pain is another common complaint among golfers. When playing golf, certain tear and wear of the shoulder joints may occur, however, jolt motions such as the back swing cause the majority of shoulder injuries for golfers. Here, each shoulder plays a different role, and therefore each shoulder may suffer a different injury. The two most common shoulder injuries relating to the shoulder are discussed below – the rotator cuff tendinitis and the rotator cuff tear. It should be noted that in case of tears, this is a serious injury which should be attended to as soon as possible.

Rotator cuff tendinitis is an inflammation found in the tendons and muscles connecting 3 bones together (the scapula, clavicle, and the humerus), which in turn allows the arm and shoulder to move and rotate. Wear and tear of the overhead activities causes the rotator cuff to become inflamed, which is the tendinitis condition itself. The symptoms felt include discomfort or even pain when moving or rotating the arm, with the pain originating from the shoulder spreading throughout the arm. Other symptoms might include a popping or cracking felt in the shoulder. If left untreated, as the rotator cuff deteriorates, the pain levels increase and can lead to complications.

Rotator cuff tears, among golfers, are generally classified into two categories: anterior instability rotator cuff tear (in the dominant arm) and posterior instability rotator cuff tear (in the shoulder of the leading/nondominant arm).

Rotator cuff tear is a more serious injury, generally happening when doing a swing and resulting in a tear in one or more of the tendons which connect the shoulder to the upper arm. The symptoms experience are somewhat similar to that of the rotator cuff tendinitis, but with the pain sensation more extreme, and at times, being unable to lift the arm.

Back pain

Many golfers complain of back pain, with it accounting for over 20% of all golf-related injuries. The general cause for it is the hunched over putting position, however it may also be due to poor technique, back ligament and back muscle sprains, and longer practice hours. In worse cases, it may be down to a degenerative disc disease, which requires serious treatment.

In most circumstances, the causes behind acute pain (for example occurring during the swing) can be attributed to either back ligament sprains or back muscle sprains. These generally occur during a brisk movement. Therefore it is always important stretch before any exercise and employ proper mechanical technique.

Degenerative disc disease is another common culprit behind back pain. It can be summarized as chronic back pain caused by wear and tear of the intervertebral discs. The pain begins gradually as the discs begin to deteriorate, which can be characterized by tingling feeling in the affected region of the spine, or feeling pain when bending, lifting, twisting, and sitting for longer periods of time. The pain diminishes during active state of the body, such as running or walking

The picture on the right vividly demonstrates the number of possibilities of spinal conditions causing chronic back pain a person might experience. A further, precise diagnosis must be established by a certified professional before the pain can be tackled and eliminated.

Treatment at our clinic

The general rule for any acute pain is to follow the R.I.C.E. guidelines, which stands for Rest, put Ice on the affected body part, apply Compression, and elevate the injured part. This specifically applies to acute shoulder pain, wrist injuries and golfer’s elbow conditions. In any case, it is wise seeing a specialist in order to acquire a professional diagnosis. Some injuries may exhibit similar symptoms, for example shoulder tendinitis and rotator cuff tear, but the treatment options for either differ radically.

At the NYCSPT clinic, we can offer not only traditional treatment methods, such as manual and physical therapy, but also innovative approaches to treating injuries. These treatments may be used as the means to relieve the pain, but also address the core issue, which is eliminating the injury altogether.

In cases where doctors recommend an invasive approach such as surgery, we have alternative methods of treatment available, such as dynamic neuromuscular stabilization (DNS), extracorporeal shockwave therapy (ESWT), and rehabilitation through computer assisted rehabilitation environment (CAREN), among others. For example, ESWT has had great results in substituting surgical invasive treatment in such cases as tendinitis, tendon and rotator cuff tears, where shockwaves are sent to the affected area and thus prompting an increase in blood supply to the tendon, which significantly speeds up the healing process. Meanwhile, CAREN greatly improved core stability and enhanced performance. We place a lot of emphasis on surgery being the last resort solution, and guarantee rehabilitation with our unique treatment methods and state of the art technology.