Golf, long considered the athletic par of pulling weeds, actually contains a physical savagery producing injuries more associated with marathons and die-hard tennis.
Such as herniated discs. Bursitis. Synovitis. Tendinitis. Ripped or inflamed ligaments and muscles. And golfer's toe, a new and unwelcome addition to bowler's thumb, tennis elbow, surfer's knots, jogger's knee, skier's thumb and other pains of weekend, essentially over-the-hill jocks.
Further, states Glendale orthopedic surgeon Robert Brumfield, golf probably places more demands on the musculo-skeletal system than any other sport. It has to do, he says, with the spasmodic nature of the beastly frustration.
"The average golfer will spend between 4 and 4 1/2 hours on a course," explained Brumfield. He's a bogey golfer who says he played all high school sports in McComb, Miss., and excelled at none. "During those four hours, presuming it takes 1.5 seconds to swing and hit a ball, you will actually be hitting for only 200 seconds, or less than 3 1/2 minutes.
"Each shot, however, is interrupted by five- or 10-minute intervals." Muscles cool down. There's no further preparation between drive and chip. Wrists, elbows, shoulders, backs (and toes) go from half asleep to full thrash in an instant. The average car engine receives more consideration than that.
"Golf is an extremely demanding sport on your muscles for a very short period of time. Imagine playing tennis that way, where you were only allowed to hit one serve. Then you are not allowed to hit another ball for three minutes. That is why golf is so demanding on the musculo-skeletal system."
And thereby, at least to the inveterate hacker, looms a handicap larger than fog on the back nine.
For once pain and suffering sets in, continued Brumfield, a golfer will favor the affected joint. The injury might even impair certain movements. Either situation will drastically alter the geometry of the player's swing.
"If they (players) have a painful hip or back, when they come back with the club they are not going to turn," said Brumfield. "So there's a breakdown of the backswing leading to excessive elbow flexion and subsequent overuse of the shoulders in hitting across the ball.
"If there's inflammation in the shoulders, you'll bend your elbows (in compensation) when you come back. So you won't get the torque into the ball. Those are only two movements . . . and Gary Player once said that there are 123 aspects of hitting a golf ball."
Survey of Injuries
Brumfield, an associate professor of orthopedic surgery at USC, cannot quantify his theory. A survey of 226 professional golfers has showed that 23.7% suffer from lower back pain, 23.9% have wrist pain, and 7.1% experience hand pains.
But there are no injury statistics for the nation's estimated 16 million recreational golfers, more participants than for any other outdoor activity.
Brumfield, 53, recently made a computer search for medical literature pertaining to golf injuries and could find only four references. So he is writing his own paper, conducting his own polls (with fellow members of La Canada Flintridge Country Club as convenient subjects) and researching his own orthopedic experiences.
During his 25 years in orthopedics, Brumfield estimates he has logged close to 100,000 patient visits. More than 25% of their musculo-skeletal ailments, he said, stemmed from athletics.
"Yet only in recent years have I seen increasing numbers of golfers with musculo-skeletal problems," he continued. "I think this is due to several reasons--an aging population with increasing leisure time and a national emphasis on physical fitness, even though golf is not necessarily considered an aerobic sport."
Further, he said, the recreational golfer generally is more sedentary than the average jogger and racquetball player. They are more inclined to being overweight, drinking and smoking. Few golfers perform stretching exercises before that first drive, therefore golfers are more prone to strains and sprains.
"The most frequently seen problem is an inflammation in the left shoulder in right-handed golfers and right shoulder inflammation in left-handed golfers," he said. "Often this is associated with or related to inflammation in the hip and stiffness in the back."
Whether the exertion be softball or fly fishing, jogging or hand ball, believes Brumfield, the ailments almost exclusively attack synovial joints and their attachments. That's the lining of the joint (the capsule), the small sacs (bursi) allowing tendon and muscle movements outside the joint, the synovial membrane, the ligaments . . . and with inflammation that could involve several of these tissues.
Repetitive microtrauma is the clinical term. Overuse is the more understandable diagnosis. Either means swelling, redness, warmth and pain. The degree of severity can range from short-term irritation to extended impairment and that, again, is common to many pastimes.
Golf Cart as Culprit
Yet, believes Brumfield, there's one culprit of the fairway agonies that is as peculiar to the sport as the monogrammed ball. It's the golf cart. Without it, players would walk. With it, they slouch and jounce, flop and jolt, until the spine becomes a casualty.
As golfing ailments are far from unique to the game, neither is their treatment. After X-rays and an examination for neurovascular problems, care of the affected joint may require only rest, ice, compression and elevation.
"Depending on how severe the involvement, medication could be aspirin, maybe as many as 12 a day, or any non-steroidal, anti-inflammatory drugs," said Brumfield.
He recommends "judicious" use of cortisone, liberal employment of prophylactic exercises such as stretching and strengthening ("five to 10 minutes of slow, easy stretching . . . 15 to 20 minutes of ice packs after activity"), the use of orthodic devices and (especially for those golf-cart slaloms) personal weight control.
He does not dismiss acupuncture.
"No one knows scientifically how acupuncture works . . . but it does seem to work," he said. "I say, try it."
Brumfield can even quieten the dreaded golfer's toe.
And he has been its victim.
"I shoot right around 90 and have a very good swing," he said. "But there's too much follow through in my swing, the weight goes on the big toe on the dominant side, and there's inflammation in the toe joint, golfer's toe."
"I did one of the things I tell my patients. I didn't hit a golf ball for a month. I hiked and rode a bike. And when I came back, I was hitting better than before."
A classic, quite obviously, of a physician healing thyself.