The nature of golf is such that both the backswing and downswing affect the knee. The entire swing takes a little over one second. However, it can exert a force of 4 times the body weight on the front knee and 3 times the weight on the back knee (1). This makes knee injuries just as prevalent as back injuries for both amateur and professional golfers.
Here’s everything you need to know about the golfer’s knee.
Why Does My Knee Hurt During Golf?
The knee joint is a compound synovial joint. It comprises the patellofemoral joint and tibiofemoral joint. In golf, there’s a large amount of torque or rotational force that is placed on the knee. The ligaments that stabilize the knee joint balance the valgus and varus stress on the knee.
Injuries and a high amount of stress that can affect this delicate balance can destabilize the knee joint. The knee is vulnerable to injuries during golf because of its complex anatomical structure.
Parts Of The Knee Joint
Here are the parts of the knee joint.
- Bones: There are three bones involved in the formation of the knee joint namely the patella (kneecap), the tibia (shin bone), and the femur (thigh bone).
- Ligaments: There are four main stabilizing ligaments of the knee. This includes the anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL), and lateral collateral (LCL).
- Tendons: There are tendons of various muscles that operate in groups that are attached to the knee. Tendon tissue is what connects a muscle to bones. The quadriceps, the hamstrings, and the calf muscles are all attached to the knee joint and are responsible for the movement of the knee.
- Cartilage: Two fibrocartilage structures between the articular surfaces of the tibia and femur are present. These are the medial and lateral menisci. They absorb shock, stabilize the knee and reduce friction during articulation.
Common Causes Of Pain In The Knee Joint
The knee is a weight-bearing joint that can fully flex, extend and carry out some valgus and varus movement. It is also vulnerable to injury during sports and trauma. Here are some of the most common causes of pain in the knee joint.
- Overuse: Overuse and repetitive motion of the knee joint can lead to wear and tear of the menisci, microtears in the muscles and the bursae, and the ligaments. Over time, if these injuries persist with new ones appearing, the knee joint develops inflammation. Overuse also prevents adequate healing of these injuries which causes knee pain.
- Soft Tissue Injury: Soft tissue injuries due to trauma or sports like muscle tears, ligament tears, and torn menisci can all cause knee pain. The pain is associated with the limitation of movement. The location of the knee pain and the nature of motion restriction can help identify the type of soft tissue injury.
- Arthritis: Inflammation of the knee joint either due to an immunological condition like psoriasis or rheumatoid arthritis or age-related arthritis is a very common cause of knee joint. 13% of females and 10% of males over sixty have knee osteoarthritis (2).
- Strains: Muscle and tendon strains of any of the muscles around the knee joint can also cause knee pain. When the collateral ligaments get overstretched during sports or physical activity, then these ligament sprains can cause knee pain ranging in severity.
How Golf Makes Knee Pain Worse
The dynamics of golf can affect various parts of the body, especially the knee. Two primary causes are the mechanics of the sport and the gear you use while playing golf figure primarily when it comes to knee injuries. They are explained in detail below.
How Poor Golf Mechanics Hurt The Knee
Golf relies on rotational force and during the swing, the knee experiences almost four times the load during this motion. In those with poor golf mechanics, it’s easy to hurt the knee by doing the following:
- The first knee that supports the swing is called the lead knee. The rotational force during the backswing puts a huge load on the lead knee.
- The follow-through of the swing loads the supporting knee as it balances the body during the rotational movement. Poor technique and not over-rotating the knee can cause injuries to the menisci and the ligaments that support the knee joint.
- The knees must remain flexed to absorb the rotational stress of the swing. If for some reason, the knee is fixed and does not flex, there are more chances of hurting your knee during the rotational movement.
- Individuals who play golf with tight back muscles and hip muscles, indirectly stress the knees to generate more turn on the backswing. It’s important to recognize that the back muscles and hip muscles play a huge role in generating the force for the swing.
The Effect Of Golf Gear On Knee Pain
The kind of golf gear you use can also affect your knee and the development of golfer’s knee injuries.
- Golf shoes: Wearing golf shoes with no arch support can lead to a pronated foot position. When the foot is pronated, it can rotate the knee which can lead to meniscus tears and ligament sprains. Golf shoes with arch support prevent feet pronating during walking and standing thus lessening the stress on an already stressed knee joint.
- Golf clubs: The length of your golf club is important. You have to choose a golf club that is suitable for your stature. This is because the length of the club can change your stance. The wrong length can alter your stance, changing the dynamics of the swing and putting more stress on the knee.
- Golf shafts: The right shaft for your swing makes all the difference. Not only in performance, but also in injury prevention. Don’t choose a shaft solely based on swing speed but rather based on your playing style. Using a flexible driver which doesn’t match your playing style can alter the mechanics of the knee.
Meniscus Tears: The Most Prevalent Knee Golf Injury
Torn menisci are quite prevalent in golfers and the general population.
The pain role of the meniscus is to absorb shock and stabilize the knee when there is a large force being transmitted via the joint. When the knee pivots, there is a huge rotational force that is transmitted through the knee, nearly four times as much as the original load on the knee which can damage the menisci when done repeatedly.
The forceful twisting and sudden stopping inherent to the golf swing thus frequently damages the menisci.
The menisci do not have sufficient blood supply throughout the majority of the tissue and so injuries to the menisci are very slow to heal. BUT we have to keep in mind that many meniscus tears are degenerative in nature and often are not the cause of knee pain.
That’s why a discussion with an expert physician of your history and thorough exam is crucial, rather than just seeing a tear on a MRI.
Does Golf Cause Arthritis?
Golf does not cause knee arthritis. However, playing golf can aggravate symptoms of arthritis including joint pain. It can affect arthritis in the following ways.
Osteoarthritis
Osteoarthritis is caused by a number of factors, including wear and tear on the cartilage in the joints. Golf can worsen osteoarthritis-related symptoms in two ways:
- Golf especially with poor mechanics can add extra stress to the worn cartilage and ligaments causing them to wear out further.
- Weak muscles supporting the knee joint, obesity, and previous injuries can also add more load on the weight-bearing knee during golf thus worsening the existing osteoarthritis.
Rheumatoid Arthritis
When it comes to rheumatoid arthritis (RA), golf can worsen the condition by two mechanisms:
- It can worsen the inflammation in the knee joint due to micro-injuries thereby causing antibodies to further destroy the menisci.
- RA can cause stiffness of joints and restriction of motion. This can alter the mechanics of the swing. Playing golf with this stiffness can cause the knee to forcefully rotate or flex which can cause injuries to the structures of the knee.
What About Chondromalacia?
Chondromalacia is caused by the softening of the undersurface cartilage of the patella because of wear and tear. It is a word commonly used in diagnostic imaging reports such as MRI, so you may have seen it before.
- This occurs in many sports including golf when the posterior articular surface of the patella loses density.
- As the surface of the patella deteriorates, it can become softer with further tearing and erosion of the articular surface.
- Individuals with progressing chondromalacia experience dull pain or grinding of the patella.
- The symptoms can worsen while walking uphill and downhill.
How To Prevent Golfer’s Knee Pain
There are many ways to prevent golfer’s knee pain. Using a combination of these techniques can prevent it from occurring in the first place.
Warm Up And Stretch
Warm up and stretch for 10-15 minutes on the range before your round. This will increase the blood flow to the knee joint and the muscles. It will also increase the amount of oxygen delivered to the area which will improve the metabolism within the tissues during a time of increased need.
Stretching will also improve the flexibility of the muscles keeping them pliable during your actual golf motion.
Condition Your Body For Flexibility
Conditioning your body to be more flexible is helpful to prevent golf injuries. Since golf involves the entire body, it is important to ensure you don’t have any tense back or hip muscles.
Conditioning your body means improving flexibility and strengthening the muscles that support the spine, hip, and knees. This involves working on breathing, posture, frequent stretches, physical therapy, squats, lunges, and lifts.
Try Other Gentle Forms Of Exercise On Your Off-Days
It is not necessary to work out every day. During your off days, practice other gentler forms of exercise that are not so hard on your knees like yoga, swimming and tai chi. These will keep you limber and also condition your body.
Stay Hydrated
When you are dehydrated, without water and electrolytes, the muscles get tired faster. As a result, they are more susceptible to injury and heal slower. By staying hydrated, you ensure that the muscles have enough water and electrolytes for proper contraction and relaxation.
Wear Well-Fitting Golf Shoes With Arch Support
Choose well-fitted golf shoes with arch support to prevent foot pronation. During a round of golf, you will be walking a significant distance, even if riding in a cart. Keep that in mind as you purchase your golf shoes. If you play in wet conditions, you may want to have spiked shoes for extra grip. Semi-custom or custom orthotics can also be beneficial as all of our feet are shaped differently.
Practice Good Body Mechanics While Playing
Technique is key. A Titleist Performance Institute (TPI) certified golf professional can help you with the right technique for your swing and your body. All of our golf swings are unique and many times it’s due to various pathologies or injuries we have developed over time.
Don’t Depend On A Brace Forever
You cannot depend on a knee brace forever. In the long term, a knee brace will further weaken your knee. The knee relies on its ligaments to naturally stabilize the knee. By using a brace, the ligaments become weaker and are therefore more susceptible to injury.
Non-Surgical Treatments For Golfer’s Knee Pain
For the majority of conditions,surgery is not warranted nor is it effective when it comes to knee pain. It can permanently alter the biomechanics and stability of the knee. There are many non-surgical treatment options for golfer’s knee pain.
At Centeno-Schultz Clinic (CSC), we like to recommend regenerative, orthobiologics based options when considering long-term results. Here are some of the non-surgical alternatives for golfer’s knee pain.
Rest
Rest is crucial when there is a knee injury in the golfer. The majority of muscle and ligament sprains are self-limiting and will heal by themselves when allowed to rest. By resting, there is no aggravation or overuse of the knee joint, and the soft tissues can recover without extra stress or increased metabolic needs.
This allows nutrients, blood supply, and oxygen to be solely used for the recovery of the injured tissue.
Physical Therapy
Physical Therapy plays a very important role in strengthening the muscles of the knee joint. It can also rehabilitate your body by preventing injuries before they become significant enough to warrant further treatment.
This is done through movement drills and resistance exercises. Physical therapy is done not just on your knee but the whole body. Physical therapists can address posture issues, mobility issues, and weaker muscles of the knee that need strengthening.
Regenerative Options
At CSC, we offer orthobiologics treatments, regenerative alternatives for golfer’s knee pain. This includes image-guided injections to place high-dose platelet-rich plasma (PRP) or bone marrow concentrate containing stem cells in the knee to help the body heal itself.
These cells are taken from the individual and processed in our own lab along with nutrients that are specific to your injury. This highly customized treatment addresses your injury so that you can heal faster and in a more natural way as an alternative to surgery.
How To Play After A Knee Injury
If you’ve already had a knee injury here are some tips on how to return to golf after recovery.
- Start with gentle mobility exercises and low-level resistance exercises before you begin.
- Begin your return to the driving range where you can get back into the swing gradually.
- Start with short shots like chips and putts before doing the entire swing until you are comfortable.
- If available, use a golf cart instead of walking to ease the pressure on the recovering knee.
- Wear golf shoes that provide support for your arches.
- Watch out for any redness or swelling of the knee. If there is swelling, stop and rest.
- Carrying your clubs can put increased stress on your body. If walking, using a push cart can help alleviate some of this.
Make A Comeback After Healing From Golfer’s Knee Pain
A full recovery from golfer’s knee pain is possible with the right combination of medical intervention and physical conditioning. Many golfers find that they keep injuring the same knee over and over simply because they haven’t fully healed, don’t have the right conditioning, or didn’t fully treat the cause of the knee pain.
At CSC, we follow a different approach. We work on rehabilitating your knee, conditioning it, and strengthening it through our physical therapy department.
In addition, we have the experts to diagnose and treat the cause of your knee pain through orthobiologic based treatments such as platelet rich plasma (PRP) and bone marrow concentrate (BMC). This is to ensure that you can make a full comeback after the golfer’s knee injury.
Get ready for your comeback on the golf course. Browse through our articles on golf injuries and conditions to see how it’s possible to recover without surgery.
References
- D’Lima DD, Fregly BJ, Patil S, Steklov N, Colwell CW Jr. Knee joint forces: prediction, measurement, and significance. Proc Inst Mech Eng H. 2012;226(2):95-102. doi:10.1177/0954411911433372
- Magnusson K, Turkiewicz A, Englund M. Nature vs nurture in knee osteoarthritis – the importance of age, sex and body mass index. Osteoarthritis Cartilage. 2019;27(4):586-592. doi:10.1016/j.joca.2018.12.018
