Knee injuries are not the most common type of golf injury, representing about 10 percent of the total, but they do happen. And playing golf may aggravate pre-existing knee problems, such as a torn cartilage, technically called a "torn meniscus." The meniscus is a disc of cartilage between the shin bone and thigh bone that serves to cushion the joint. It guides movement and serves as a shock-absorber.
A torn meniscus is a common knee injury often caused by a sudden twisting movement while putting weight on the knee. As we get older, the cartilage may also weaken and tear over time, and we may not even know it unless we develop symptoms.
A minor tear following an injury or an existing cartilage tear that starts causing symptoms can often be managed with conservative treatment such as physical therapy.
If someone experiences a catching or locking sensation, is unable to straighten the knee and has frequent pain and problems with mobility, he or she may opt for an operation called a menisectomy, in which the meniscus or part of the meniscus is removed. Another option is a meniscal repair, in which the torn cartilage is anchored to the bone and repaired.
Studies show that people who have a meniscectomy are at greater risk of premature arthritis. So if a golfer has meniscus surgery, he or she should consider intensity of play, body mechanics and the benefit of targeted exercises prior to returning to the game to decrease the risk of early arthritis.
Walking the course, bending down repeatedly to pick up a tee or ball, and rotating the knees during the golf swing can all lead to a knee injury or exacerbate an existing problem.
The downswing phase, including the impact portion of the golf swing, causes nearly twice the number of golf injuries compared to the backswing. Both the lead and trail legs are vulnerable to injury, and transferring weight to the lead leg during the downswing actually increases the risk to the lead leg. Additionally, knee pain can increase with longer distance shots and as a result of rotation forces that occur in the knee. Certain measures can help golfers overcome these risks and ensure a successful return to the course. These include following a basic exercise/warm up routine, physician guidance for surgical follow-up and minor specific adjustments to your game.
- A golfer with a torn meniscus must fully recover from the injury, whether or not he or she has had surgery, before returning to golf. This will likely include physical therapy and strengthening exercises to make sure the knee is strong enough to play.
- Bearing weight on the knee while twisting may cause or exacerbate a meniscal tear or damage a repair, thus one must minimize these forces during the various phases of swing.
- In the presence of pain or swelling, one should consider decreasing the frequency and/or duration of play.
- A major increase in activity, such as regularly walking 18 holes, may exacerbate symptoms of pain and swelling, as well as increase the risk of early arthritis following a menisectomy.
Adjustments for Golfers with a Meniscal Injury
- Warming up, including basic exercises and stretching prior to play, has been shown to reduce the risk of injury.
- Hitting long-distance shots is more likely to aggravate symptoms. Consider initially clubbing down for shorter distance strokes including short irons or pitching wedges, as these are less likely to cause knee pain.
- Increased twisting or shearing forces across the knee can cause or exacerbate symptoms; using soft spikes may decrease these forces.
- During set up, rotate the lead leg out to the side 20-40 degrees to reduce the amount of twisting and pressure on the knee during the final stages of swing.
Adjustments for Golfers Who Have Had a Meniscal Repair or Menisectomy
- Post-operative protocol, such as physical therapy, must be followed and completed with physician clearance prior to returning to golf.
- A major increase in activity, such as regularly walking 18 holes, may cause symptoms of pain and swelling, as well as increase the risk of early-onset arthritis following a menisectomy. Begin with a cart and progress to walking by adding two holes per round. Modify your activity if you experience pain and swelling.
- Use a ball retriever to eliminate the need for deep squatting to retrieve the ball 18+ times each round.
- Use ice following each round for about 20 minutes. Use a towel or cloth; never put ice directly on the skin.
- See additional adjustments above for a meniscal injury.