Golf

For Patients

The Principle

If the top of a limb turns and the bottom cannot, the joints in between absorb the twist.

The knee is poor at absorbing twist, because it is built to bend rather than to rotate.

A small twist repeated for decades is a different kind of exposure from a large one once.

At the Knee

In a golf swing the feet stay planted while the hips and shoulders rotate through a large arc.

The front knee, the left knee in a right handed golfer, takes most of that rotation.

The forces are modest compared with running or jumping. The rotation is what is distinctive.

Walking the course adds several miles, often carrying or pushing a bag.

Clinical Relevance

Golf is played into old age, so golfers often have arthritic knees as well as golfing ones.

Lead knee pain in a golfer is usually about rotation rather than impact.

Spikeless shoes and a slightly open front foot both let the knee rotate less, which often helps.

No injury rates are given on this page, because no source was available to check them against.

For Medical Students

The Principle

Sporting exposure has three dimensions: magnitude, repetition and direction. Golf is low in the first, moderate in the second and unusual in the third.

Rotation with a fixed distal segment is the specific exposure, and the knee has the least capacity in that plane.

That is why a low force sport produces knee symptoms at all.

At the Knee

The downswing rotates the pelvis over a planted lead foot, producing internal rotation and valgus at the lead knee. 3.2.3 covers internal rotation.

Peak forces are a fraction of those in running, so the mechanism is rotational rather than compressive.

The lead knee's rotation is resisted by the anterolateral structures and by the menisci. 3.11.5 covers rotation control.

Trail knee loading is lower and more flexion dominated during the backswing.

Walking the course contributes a substantial cumulative walking load, which is often forgotten in the history. 3.14.1 covers walking.

What Changes It

Handedness, which determines which knee is the lead knee.

Foot position at address, since an open lead foot reduces the rotation demanded of the knee.

Shoe and surface traction, which determine whether the foot can pivot.

Swing style, since a more rotational hip action reduces knee rotation.

Age and existing degenerative change, which are common in this population. 6.71 covers osteoarthritis.

Clinical Relevance

Establish handedness, since it identifies the lead knee and therefore the expected side.

Ask about foot position and footwear, both of which are simple modifications.

Include the walking load in the history, which is substantial and routinely omitted.

Describe mechanism rather than rates, as this page does, because no source was available.

MRCS Level

The Principle

Golf is the sport in this chapter whose mechanical modifications are easiest to make and least often suggested.

Foot position and footwear change the knee's rotational demand immediately and cost nothing.

That matters more here than elsewhere because the population is older and the alternative is often stopping a sport they have played for decades.

At the Knee

Lead knee internal rotation torque peaks during the downswing and through impact, with the foot fixed by spikes and turf.

The medial compartment and the patellofemoral joint are the reported sites of symptoms, consistent with rotation in a slightly valgus position. 3.12.11 covers malalignment.

Opening the lead foot at address reduces the internal rotation the knee must produce, which is a direct mechanical intervention.

A more rotational pelvis and a less restricted lead hip both reduce knee rotation, which makes hip range a knee variable in this sport.

Golfers after knee arthroplasty return in large numbers, and the rotational demand on a replaced knee is a genuine consideration. 3.14.12 covers that gait.

What Changes It

Lead foot position at address and whether it is allowed to pivot through impact.

Shoe sole design, since spikeless designs permit rotation.

Lead hip internal rotation range, which if restricted transfers demand to the knee.

Swing coaching, which can redistribute rotation without losing distance.

Existing degenerative change and prior arthroplasty, which are common in this group.

How It Is Measured

Three dimensional swing analysis, which is widely available commercially and reports mostly to coaches rather than clinicians. 3.16.7 covers capture.

Pressure mats and force plates under the feet, which are standard in teaching facilities.

Modelled knee rotation torque, which is inferred from the kinematics. 3.16.4 covers modelling.

Clinical hip range measurement, which is the cheapest useful measurement here.

Golf has abundant swing measurement and very little of it is framed as a knee question, which is an opportunity rather than a gap in the data.

Clinical Relevance

Suggest opening the lead foot and a less aggressive sole before suggesting the patient stops playing.

Measure lead hip internal rotation, since restriction there transfers demand to the knee.

Expect medial and patellofemoral symptoms in the lead knee rather than instability.

Note that abundant swing measurement exists and is rarely framed as a knee question.

Weigh the player's age, physiology, comorbidities, knee demand, psychological state and their own ideas, concerns and expectations, because for many of these patients golf is the activity that keeps them walking.