The following excerpt is from our new book: Pain Free Golf: Solutions for Golfers Over 50
Chapter 1. Osteoarthritis and Golf
Osteoarthritis is the irritation of joints due to the breakdown of cartilage that covers the bones that make up those joints. Osteoarthritis is one of the most common diseases in the United States, and is especially prevalent in people over 50 years old.
The most troublesome joints that most commonly cause pain in golfers are the knees, hips, lower back, and wrist/hands. Typically, symptoms are aggravated by too much activity, too little activity, and/or cold. If not addressed, we find that most people respond to this pain by resting or staying off their feet. However, this option results in weak muscles and decreased stability in the joint.
Decreased stability means more pain and increased joint damage, not to mention decreased coordination, flexibility, and poor posture. So the obvious advice is too stay active but don’t push it.
Only your doctor can diagnose you with osteoarthritis. A diagnosis occurs after taking a medical history, ruling out traumatic causes, and usually and X-ray.
Before we discuss conservative measures that we use in physical therapy to treat osteoarthritis, you should also be aware of several issues to discuss with your physician.
If you have been diagnosed with osteoarthritis, the primary goal of treatment is reduce pain and preserve function. Having a knee replacement is a good option, but it should be considered the last option.
Rehabilitation from a knee replacement surgery is difficult and lasts between 3-6 months on average. In addition, having an artificial knee usually means the end of impact related sports such as running, basketball, volleyball, and sometimes snow skiing.
Our Newest Book!!
Learn How To Combat Arthritis And Play Golf: Pain Free Golf
Safe And effective Ways To Treat Arthritis
NSAIDS and Golf
First, your physician and pharmacist can discuss the risks and benefits of prescribed medications. The primary role of medication treatment is control pain, which will allow you to maintain your level of activity and exercise to keep muscles strong and joints stabile. However, no drugs as of yet have been proven to re-grow or heal damaged cartilage.
The most commonly prescribed or recommended drug for treating osteoarthritis are non-steroidal anti-inflammatory drugs, also known as NSAIDs. These drugs do have side effects, so it is very important to discuss use and dosage with your physician.
Pain Relief Injection Options and Golf
Second, corticosteroid injections are commonly used by physicians to reduce pain and inflammation. Many patients lament that corticosteroid injections just make it feel better but after the injection wears off they will be right back where they started….so what is the point?
This is only partially true because one of the primary damaging effects of arthritis is inflammation. Prolonged inflammation can definitely exacerbate arthritis and cause more damage, so it sometimes is valuable to have a corticosteroid injection to reduce inflammation and, thus, reduce damage to the joint. However, like most medications, corticosteroids have side-effects if given in too high a dose or with prolonged use, so it is important to understand the risks and communicate with your doctor if you incur any physical or mental abnormalities.
Next, a fairly new and effective treatment in the battle against osteoarthritis of the knee is called Synvisc. Synvisc is a viscosupplement that is administered by a physician as a series of 3 shots given over 3 weeks.
It is purported to cushion and lubricate your knee joint to relieve friction and provide increased motion and decreased pain for 6 months.
In my experience as a physical therapist, patients who have received Synvisc injections from their physician have faired very well and have been able to return to their previous level of activities with minimal to no discomfort. Side effects are reported to be mild and rare. If other efforts have failed to bring you relief, and you are considering a knee replacement, I encourage you to talk to your doctor about Synvisc and visit www.synvisc.com.
Finally, the last resort is a complete knee replacement (TKA). If you are a VERY active person, it may we worth your while to talk to your surgeon about the possibility of having a high tibial osteotomy or a distal femoral osteotomy.
Other contraindications, or reasons not to have a knee replacement include: active knee infection, if your knees are naturally hyper-extended (bent backwards), severe obesity, if you are planning to return to high impact sports, and/or arterial insufficiency (blood supply problems to the legs) which can be caused by severe diabetes, etc.
After you have decided that a total knee replacement may be right for you, it is wise to consult with several surgeons as well as ask for referrals from your physician.
Physical therapists can also help advise you on which surgeons have the best reputation and results. Choosing the right surgeon can improve your outcome dramatically and is sometimes the most important factor determining your success in rehabilitation.
Countless studies have proven the effectiveness and importance of seeing a physical therapist BEFORE you have your surgery. Your physical therapist can prescribe an exercise program to help stabilize and strengthen around your joints that will decrease the time needed for post-surgical rehabilitation.
I have found that the patients that participated in a pre-surgery exercise program faired much better by far, than those who did not participate.
After you have the surgery, little explanation is necessary here because all the guidance and care you need, will be given to you by your physician and physical therapist. Like I mentioned earlier, rehabilitation can take up to 3-6 months depending on your current level of health, fitness, your age, and your ability to exercise independently.
If possible, schedule your surgery sometime between the end of September and the beginning of November so that you will be ready to tee it up again when the golf season begins.
If you and your physician have decided that other, more conservative measures would be better, physical therapy can play a large role in the treatment and management of osteoarthritis.
Conservative treatment is focused on managing the disease and preserving or increasing function.
Conservative Measures to Treat/Manage Osteoarthritis and Golf
- I. Weight Management
- II. Heat vs. Cold Treatment
- III. Exercise
- IV. Transcutaneous Electrical Nerve Stimulation (TENS)
- V. The Joint Friendly Golf Swing
I. Weight Management, Arthritis, and Golf
Weight management is one of the easiest answers to controlling arthritis, but may be the most difficult to carry out. As mentioned earlier, osteoarthritis occurs when the protective cartilage covering the ends of bone is worn away. So when two bones interact together in a joint, say your knee joint, the bones grind against one another instead of gliding smoothly.
As a result, the heavier you are, the more pressure you will place on the weight bearing joints of the body, such as the hips, knees and ankles. You are pressing the irritated bones closer together which makes it even more difficult for them to move, creates more grinding, more inflammation, more damage, and more pain.
The great thing about losing weight to decrease your joint pain is that any amount of weight that you are able to lose helps. You don’t have to lose 100 pounds before you get any relief, if you lose 5 lbs it will make a difference!
Age Defying Golf Rx is not a weight loss program per se, but many people who do the program as it is intended, do lose weight.
This program is for you IF….
- You are a golfer between 50-70 years old.
- Carry between an 8 – 36 handicap
- You want to improve flexibility, injury prevention, golf performance
- You are willing to spend 15 minutes, 3 times per week to play your best golf ever.
If you believe that you need help to lose weight, I strongly recommend that you seek out a personal trainer. 90% or more of people who need to lose weight fail, so do not feel bad if you have tried before. I personally believe the key to success is seeking out help. Find a personal trainer, dietitian, workout partner….whatever it takes.
Don’t set yourself up for failure by having too high of expectations. Weight loss and being healthy is a complete lifestyle change, so be patient. Having a background in personal training and physical therapy, I feel that the primary reasons that people fail to stick to a lifestyle change is that they try to do it on their own, their expectations are too high, and they push it too hard in the beginning.
Being healthy and exercising on your own only works if you have already created a habit of being healthy and exercising. DON’T GO IT ALONE, seek out help and find a partner as dedicated as you are!
To read a previous article on our easy method to sticking to an exercise program, Click Here: Tips to Sticking With a Golf Exercise Program.
II. Heat VS Cold Treatment for Arthritis and Golf
I am always surprised at the confusion of when to use cold treatments versus hot treatments for pain and injury.
Here is your basic advice (there are a few exceptions):
Use a cold pack or ice if you have a recent injury, inflammation, and/or redness and swelling. Use heat for tight or sore muscles, after the initial phase of the injury has passed (14 to 21 days past injury depending on severity), and for arthritic joints most of the time.
I say ‘most of the time’ because whether to use heat or cold on arthritic joints depends on the current state of the joint. If your joint is in an irritated state, such as occurs after exercise, or after a round of golf, or if you “tweak” the joint, etc., this is the time to use ice. All other times use heat! Heat increases blood flow to the joint and reduces stiffness.
Elasto-Gel Hot/Cold Knee Wrap with Elasto Gel. In our clinic, we use gel cold packs that you can tightly wrap around joints and secure with a Velcro wrap that is attached to the cold pack.
For use, place a cloth or paper towel between your skin and the cold pack to prevent burning your skin. Elevate your leg on a footrest or the arm of your couch and apply the ice for 10-20 minutes. If you would like to ice your joint again, make sure to wait at least 2 hours first. Applying ice for too long or applying it too frequently can sometimes cause tissue injury.
Heat can be administered in a number of ways. If you have osteoarthritis, you are probably the stiffest and in the most discomfort first thing in the morning. You have spent the last 6-8 hours in relatively the same position and your joints have stiffened up. Your first line of defense is an electric blanket or a heating pad in your bed. Turn it on before getting out of bed to heat up the joint.
You can start moving the joint through its range of motion as it warms up. Next, get in a warm shower or bath. If you have OA, you may have already figured out how helpful and pain relieving warm water can be. To finish of your morning ritual, place your clothes in the dryer for a few minutes before you put them on. Now you are ready to face the day, and conquer the 1st tee.
Heat is also an excellent choice before you exercise or partake in any physical activity. Use it directly on the joint or on sore muscles. Finally, use a heat pack or heating pad when you get into bed before you go to sleep. This will help calm achy joints or muscles so you can rest.
*Make sure to turn off the heat before you go to sleep or you might end up with a nasty little burn.*
Other instructions for heat application include: use a towel between your skin and the source of heat, never use a heating pad for longer than 25 minutes, if the heating pad feels too hot it probably is and you are at risk for a burn, and if you have compromised sensations (such as with diabetes) check your skin every 5 minutes for excessive redness.
NEVER, EVER LAY OR SIT ON A HEATING PAD.
The combination of heat and pressure will cause a burn.
You need to be aware that it is very easy to burn your skin with a hot pack. Since the pack heats up gradually, you will not feel the pain from a burn until the next day, so always be cautious.
III. Exercise, Arthritis, and Golf
If you want to avoid a total joint replacement, exercising in some form daily is a requirement. Exercise will help you maintain your flexibility, stabilize and further protect your joints, maintain an active lifestyle, and keep your body strong.
An exercise program designed for a person with osteoarthritis can be very different than your standard exercise program. It should be a well- balanced exercise program with a variety of exercises focused on range of motion 1st, endurance 2nd, and strengthening 3rd.
It is important to note that if your arthritis is flared up (joint is warm and swollen), you should only perform gentle range of motion exercises until the joint calms down. In this situation, strengthening will only increase inflammation and could further damage your joints.
1. Range of Motion
Range of motion is the normal range that you can move your bones about a joint. For example, your knee should be able to bend approximately 135 degrees and should fully straighten to 0 degrees. Thus the normal range of motion for the knee joint is 0 – 135 degrees. You should move all of your joints through their full, available range of motion daily. This will help you maintain your flexibility and movement, which is very important for golf and maintaining your current lifestyle and independence.
It will also increase the natural fluid in the joints that helps the bones glide more freely across each others surfaces. Remember, “motion is lotion” for your joints, so keep them moving…every day and even if it is somewhat painful. (Daily activities such as house or yard work DO NOT move your joints through their FULL range of motion).
…or conditioning is also very important for maintaining the condition of your muscles and increasing the blood flow and warmth to your joints. This can be difficult because weight-bearing exercises (such as hiking, jogging and sometimes walking) can be painful and damaging to your joints.
Instead, ride a bicycle or do exercises in the pool to reduce the compression and grinding of the joint. Walking is an excellent exercise if it does not bother your joints too much. Generally speaking, you should participate in some form of endurance exercises 3-5 times per week and work up to 20-30 minutes per session.
Take note! The first month of performing endurance exercises can difficult because your body is not used to them. However, after the first month or two, you will begin to enjoy more energy and good feelings following your workouts. You are going to feel better and enjoy golf much more. Stick to it.
Strengthening is important to stabilize and reduce the stress on arthritic joints. The intensity of exercise that is best for you is dependent on the level of pain and damage to your joint, your tolerance for weight bearing, and whether or not your arthritis is in a state of exacerbation (flared up).
I strongly encourage you to consult your physical therapist to develop a plan that will provide you with the most benefit without increasing joint damage.
Without evaluating you myself, the best recommendation that I can give you is:
- 1) try to perform exercises that cause minimal to no pain
- 2) do not exercise if your joints are warm and swollen
- 3) the best exercises for arthritis of the hips, knees, and ankles are performed in the pool.
IV. TENS (transcutaneous electrical nerve stimulation) and Golf
TENS is an effective treatment for osteoarthritis that is safe, noninvasive, and drug- free. I encountered more and more patients in my clinic that do not want to, or want to limit their medication use. A TENS unit is an excellent option.
A TENS unit delivers a comfortable electrical stimulation to skin and muscles around a painful area. Patients describe the feeling as a “buzzing” or “pulsing” sensation. TENS works in two main ways to limit or eliminate pain. The first pain relieving mechanism uses the principals of the gate theory of pain.
This simple to understand theory basically states that the brain can interpret only one sensation from a certain area of the body at a time. For instance, if a bee stings you, your first instinct is to scratch the area. The scratching of the painful area overcomes or interferes with the pain message and less pain is felt. The sensation of the TENS unit is specifically tuned to completely take over the sensation of whatever area it is applied to.
Second, the TENS unit stimulates the release of enkaphalins from the central nervous system and endorphins from the pituitary gland, both of which provide pain relief that can last for several hours.
Typically, a TENS unit is a small electrical unit about the size of a walkman radio (if you can still remember what a walkman radio is!!)that can be clipped on your belt and even put in your pants pocket. Two to four wires extend from the TENS device to sticky electrode pads that you stick to your skin around the painful area to be treated.
You can use it anytime, even on the golf course so you can play a pain- free round. Generally, a 20- minute treatment will reduce or eliminate pain for up to 4 hours at a time. Approximately 95% of the patients that I treat with TENS love it!
Most quality TENS units cost anywhere from $100 to $300.
The best TENS unit that we recommend to our golfers is truMedic TENS Unit Electronic Pulse Massager . We have partnered with Amazon to offer you this very easy to use TENS unit for only $39.97. Click the link below to see the offer.
The unit comes with an easy setup guide and display buttons are clearly labeled with words such as “Shoulder”, “Waist”, and “Hands”, not “Pulse-Width”, or “Waveform.”
The large LCD display shows you at a glance exactly what is happening, including the type of massage “Massage, Beat, or Knead” and the time left on the cycle. This is an FDA approved unit. An additional bonus is the accompanying DVD’s with a series of pain management videos from Tildet. These videos are also available on line.
V. The Joint Friendly Golf Swing
There are several adjustments that you can make to your golf swing and golf game that can reduce the stress and strain on your back and joints.
In your golf setup, make sure that you stand tall with your back flat. Try not to hunch or bend over too much. To help with this, you can try longer golf clubs and you should absolutely look into long putter.
You should already have your left foot toed out about 20-30 degrees at address, but you can reduce the strain on your right hip and back by turning your right foot outward as well. This position may make it more difficult to be still, so make sure that your right knee does not slide as you take your backswing.
You might also want to try a more closed or open stance at address. Generally, a closed stance will help reduce strain during your backswing and an open stance my reduce strain through impact and to follow through.
Golf Swing Adjustments
Go ahead and allow your left heel to come off of the ground during your backswing. It is not as important as many people think to keep your left heel down. You will see lots of senior professionals on the PGA lift the left heel. It is much more important that your right knee is stable during your backswing.
You may also need to shorten your backswing and follow through swing. As golfers get older with more joint pain, it becomes more important to concentrate on the width of your swing than the length of your swing. So shorten up your swing and focus on width for power.
Finally, as you follow through to the finish of your swing, allow the right foot to be dragged forward instead of being planted. This will reduce the strain on your left hip. In severe cases of left hip osteoarthritis, we have successfully taught players to walk towards their target a few steps after they hit the ball.
Try the “walkthrough drill.”
Around the Green
As mentioned earlier, you should definitely try a long putter to reduce stress on your back. Also, make a conscious effort to lean on your putter when reading putts or retrieving your ball out of the cup. There are rubber ball retrievers that you can stick on the end of your putter so that you do not have to bend over to pick up your ball.
A lot of older golfers are switching to larger grips to reduce pain with arthritic hands and fingers. However, remember that the bigger your grips are, the greater your tendency to block the ball to the right because it is more difficult to rotate the club face to square at the impact position.
There are also golf gloves specifically designed for golfers with arthritis, Click Here for More Info.
If you have a lot of pain in your wrists, hands, or fingers you should also consider hitting the ball off of a tee with all shots. Light graphite shafts can also help. And remember; never, ever carry your golf bag on your shoulder or back!!! Even pull carts can be painful to your shoulder. I suggest using a pushcart, a powered push/pull cart, or living the good life and riding in a golf cart.
In addition, it is important to seek out a good physical therapist that is a good golfer or, even better, is a trained golf teacher. These professionals can give you strategies that are more specific to your exact diagnosis and pain.
Thank you for taking time to review this chapter in our new book. Other chapters in the book more specifically address back pain, shoulder pain, wrist/hand pain, neck and mid-back pain, and balance. I hope it helps you play pain free and enjoy golf more. If you would like a copy of our book, you can follow the link below.
Our Newest Book!!
Learn How To Combat Arthritis And Play Golf: Pain Free Golf
Safe And effective Ways To Treat Arthritis
Dr. Ryan York, DPT CGS
Doctor of Physical Therapy
Certified Golf Performance Specialist
Age Defying Golf