June 17, 2011
By Harvey B. Simon, M.D.
Harvard Medical School
Despite its popularity, golf is the most misunderstood of sports. In particular, many guys share two beliefs that are off the mark:
- Golf does not promote heart health because the pace is too leisurely.
- Injuries are rare because golf is gentlemanly.
As a dedicated runner and practicing doc, I helped perpetuate both myths. I told my patients that golf is a great way to ruin a 4-mile walk. But new research has brought me up to par. In fact, golf can be good for your health. And while injuries are common, you can prevent them by making golf part of a balanced fitness program.
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Walk the Walk
The aerobics revolution of the 1970s taught us that vigorous exercise is great for health. But over the past 10 years, researchers have learned that modestly paced exercise is also very beneficial, even if it's interrupted by periods of inactivity. Your goal should be to exercise at a moderate pace for at least 30 minutes almost every day.
When it comes to golf, the benefit won't come from swinging the club, no matter how high your score. It comes from walking.
The average course is about 6,000 yards. A round of golf can count as 4 miles of walking. If you walk 18 holes 3 to 5 times a week, you'll get a nice amount of endurance exercise for your heart. If you pull your clubs or carry them, you'll burn more calories per round and benefit even more. But if you play less often, or you live in a climate that imposes a lengthy off-season, you'll have to add other activities to get the best results.
Even if you walk for 54 to 90 holes a week, you should add exercises for flexibility and strength. This helps balance your fitness routine and helps prevent injury. And, it makes for a lower handicap (see below).
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How to Score
Finland is hardly the golf capital of the world. But scientists there conducted a study that shows golf really can promote fitness and health. (It was published in The American Journal of Medicine, August 2000.)
The subjects were 110 healthy but sedentary men between the ages of 48 and 64. During the trial, half the men played 18 holes of golf 2 to 3 times a week; they always walked the course. The other men didn't play golf, but they continued their normal routines, including gardening and household chores. All the men went through a series of tests before and after the 20-week experiment.
In just that short period of time, the golfers showed some impressive results. Compared with their non-golfing peers, the golfers:
- Lost weight
- Reduced their waist size and abdominal fat
- Improved their aerobic exercise capacity
- Increased their strength
- Boosted their HDL ("good") cholesterol levels
- Lowered their blood pressure
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Golf may look leisurely, even gentle, but it puts a lot of strain on your muscles and tendons. A golf swing involves your whole body. Any time you take a swing, you can be hurt. Just one "fat shot" (striking the ground with the club) can do it. But the muscles you use the most are at greatest risk of injury.
The likelihood of injury is greatest in older players and in people who play the most. That's why up to 50% of touring pros have gotten injured severely enough to stop playing for three weeks or more. Overuse is the leading cause of injury in pros and top-notch amateurs. Poor technique is more often to blame in "duffers." (In golf slang, that's a mediocre or poor player.)
Here's a quick rundown on common golf injuries and how to prevent them.
If you think that golf is for wimps, consider this: A golf swing puts a compressive load on the low back that is eight times your body weight. That's more than running (three times your body weight) or even rowing (seven times your body weight). That's why a single swing can lead to a herniated disc or even a compression fracture of one of the vertebral bodies. Although these injuries are extremely painful and can be quite serious, they are rare.
Muscle strains, however, are quite common because of the twisting needed for a good swing. The "modern" swing, with its inverted C follow-through, may make for longer drives than the "classic" swing, but it also produces more torque and more injuries.
Despite their many differences, golf and tennis have one thing in common: the elbow. In both sports, the tendons become inflammed as they attach to the epicondyle, the knoblike bony prominences of the elbow. In textbook cases, tennis elbow involves the outside knob (lateral epicondylitis), while golfer's elbow strikes the inner prominence (medial epicondylitis). Golfers, however, can develop pain and tenderness on either side. A golfer's leading elbow (his left if he has a right-handed swing) is at greatest risk.
Hand and wrist injuries
The head of a club can travel at 100 miles per hour when it strikes the ball. The wrist and hand absorb most of the impact. Add a tight grip and repetitive use and you have a recipe for tendinitis, the most common wrist injury. Other problems may include carpal tunnel syndrome, "trigger finger," and even fractures of the hamate, a small bone at the base of the wrist. Although they are much less painful, blisters on the hand or fingers can be serious enough to interfere with play. The leading hand tends to be the site of all these woes.
Simple overuse causes most shoulder problems. In particular, the top of the backswing and the end of the follow-through place stress on the four muscles of the rotator cuff; tears are infrequent, but rotator cuff tendinitis is common, especially in competitive golfers.
Lower body injuries
Golf is relatively easy on the lower body, but if you walk the course to help your heart and metabolism, you will increase the load on the lower half of your body. Carrying your clubs will increase circulation but may produce some pain in your lower body. Like other athletes (and couch potatoes, for that matter), golfers can develop strains, sprains and tendinitis of their knees, ankles and feet. Blisters and athlete's foot are less dramatic but can be quite annoying.
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How to Prevent Injuries
Golfing injuries are surprisingly common, but most are relatively mild and treatable. Even better, many can be prevented by following these suggestions.
- Get in shape. Before you count on golf to keep you fit, build up your endurance with walking. Also do exercises for flexibility and strength. Your health will improve, and so will your game.
- Stretch. Muscles get stronger when you use them. But they also become tighter and stiffer. Age, too, takes a toll on flexibility. Stretching will help reduce your risk of injury and help you develop a smoother stroke. It will also help prevent injury off the links. Stretch at least three times a week, paying particular attention to your back, shoulders and arms.
- Build strong muscles and bone. Men lose muscle mass and bone calcium as they age. Strength training will reverse this, especially if your diet has the right amount of protein, calcium and vitamin D. Weight training will also help you hit the ball farther.
- Warm up. Cold muscles and ligaments are vulnerable to injury; warming up will help and it will also improve your swing. A little walking and some gentle calisthenics will bring your circulation up to speed. Stretching will loosen up your muscles and joints. Spend 10 to 15 minutes warming up even before you start your practice swings. Join the 3% of golfers who warm up properly; it will suit you to a tee.
- Take lessons. Good technique is your best defense against both injuries and high scores.
- Use good equipment. Golfers pay lots of attention to their clubs, but many overlook the importance of their shoes, socks, gloves and clothing.
- Spot problems early and treat them aggressively. You can play through minor aches and pains, but remember to ice down aching tissues as soon as you get to the clubhouse. Use the PRICE (protection, rest, ice, compression and elevation) approach to treat more serious problems. Get help from a trainer, physical therapist or doctor if you don't improve promptly.
- Don't neglect the little things. Stay well hydrated, but don't eat a full meal before a game. Protect yourself from the sun (a wide-brimmed hat, long sleeves if it's not too hot, a sunscreen with an SPF of 15 or higher and sunglasses) and from insects (repellants containing DEET).
- Don't overdo the food or drink on the 19th hole.
Golf is a great game. It's a test of skill that can be challenging enough for the competitive athlete. It also provides an opportunity for companionship that men often lack. It can even be good for business ("client golf"). Above all, perhaps, golf can be good for your health. Just follow these simple guidelines that will keep you shouting "fore" instead of "sore."
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Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.