Anatomical structure may contribute to predisposition to wrist pain in golfers. Individuals who are excessively mobile should be careful to consider many of the issues raised in this article. If your wrist flexion and extension is greater than ninety degrees (see Fig 1 - 4), marked changes in playing or practice hours should be avoided or progressed by a golf trained health professional or your PGA professional. Basic assessment of wrist strength may highlight marked differences between right and left sides and individual muscle groups in the forearm.
Many fitness professionals incorrectly prescribe wrist flexion and extension exercises in golf training programmes. During the golf swing there should be very little through range wrist movement except in ulnar and radial deviation (thumb up to thumb down with a stable forearm). All programmes should aim to provide symmetry in radial and ulnar deviation, grip strength and left versus right. However this is attained without active flexion and extension strengthening. If no assessment has been done and your programme includes these exercises seek advice from a golf trained physiotherapist or strength and conditioning coach.
Your PGA professional aims to have all players swing the club without major technical faults. One of the by-products of this process is that ideal technique does not involve excessive bowing of the wrist in takeaway, a higher than ideal hand position through impact or excessive wrist flexion and extension movement through impact ("flapping of the hands"). Review by your PGA professional will highlight if you are predisposed to wrist injury.
Biomechanical evaluation of the optimal sequencing of body parts shows that many individual golfers dissipate forces created as the body rotates back toward impact. Our best ball strikers are able to efficiently transfer body forces into the arms. One reason this occurs is because they display very good ability to stabilise or "connect" their arms to their trunk. Many of the golf swings that appear to be arm dominate may be in the "at risk" group. Many female amateurs with excessive mobility and poor trunk strength may also fit into this "at risk" category.
Any golfer with a past injury to the wrist or forearm should be seen as extremely likely to suffer a recurrence of wrist pain. This group requires physical assessment, technical review and specific exercise intervention to ensure that predisposition to recurrence is decreased. Accurate diagnosis is extremely important. This will ensure that effective treatment is instituted and that the ideal timeframe to allow for healing and recovery is adhered to. As an indicator almost all wrist injuries will require significant time in either a resting or active splint. Many of the structures that are damaged in wrist injuries, are not seen with a plain x-ray. They will often require more involved imaging, for example, magnetic resonance imaging (MRI).
Practice habits contribute significantly. The onset of club championships or a new year's resolution to improve your game may increase your predisposition. In the northern hemisphere, our compulsive golfer may spend up to four months hitting off mats. The incidence of wrist pain is significantly higher in northern hemisphere studies compared with that seen in Australia where we are able to practice on grass all year round. If you do not break up your long game practice or train excessively on unforgiving surfaces or hit out of the rough or buried lies or make contact with immovable structures (tree roots and rocks), you will increase your likelihood of wrist pain.
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