A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures.

ABSTRACT: Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.

Exercise Intensity and Activity Energy Expenditure of Professional Golf Players in Official Competitive Setting.

BACKGROUND: Research regarding the physical needs of professional golf players is lacking. With advances in wearable technology, it has become easier to analyze physiological responses such as heart rate (HR) to determine activity energy expenditure (AEE). The purpose of the study was to evaluate exercise intensity (EI) and AEE during 4 consecutive tournament's golf rounds using a popular wrist-based HR monitoring. HYPOTHESIS: Wearable systems for HR monitoring can be used to provide an accurate estimate of energy expenditure. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 20 male professional golfers participated in the study. Each player was monitored during an official tournament consisting of 4 rounds of 18 holes. EI and AEE were determined using HR wrist monitoring (Whoop Strap 2.0). We calculated the percentage of HRmax (%HRmax) and the percentage of HRres (%HRres) and the AEE in kcal/min using Keytel's formula. RESULTS: The calculated mean %HRmax and %HRres for the study population were 56.4% ± 1.8% and 40.5% ± 2.6%, respectively. Considering American College of Sports Medicine guidelines, these average percentages correspond to a moderate EI. The average caloric expenditure was 5.4 ± 0.4 kcal/min and 1555.8 ± 157.8 kcal per round considering an average golf round duration of 288.3 ± 19.5 minutes. CONCLUSION: A professional player's golf round is moderate physical activity. The AEE of this activity was equal to 5.4 cal/min, which is moderate energy consumption. CLINICAL RELEVANCE: These data could help golf coaches and conditioning coaches to have a better understanding of the load placed on golfers during tournaments.

Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships.

OBJECTIVE: To assess health problems and training environment of female golfers participating in the 2022 World Amateur Team Championships (WATC) and to compare golfers (a) with and without health problems prior the WATC and (b) living and training in countries ranking in the upper versus lower 50% of the team results at the 2022 WATC. DESIGN: Cross-sectional cohort study using an anonymous questionnaire. SETTING: International Golf Federation WATC. PARTICIPANTS: One hundred sixty-two female golfers from 56 countries. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Golfers' answers on the presence and characteristics of health problems, their training environment, and to the Oslo Sport Trauma Research Centre Questionnaire. RESULTS: Almost all golfers (n = 162; 96%) answered the questionnaire. In the 4 weeks before the WATC, 101 golfers (63.1%) experienced 186 musculoskeletal complaints, mainly at the lumbar spine/lower back, wrist, or shoulder. Just half of the golfers (50.6%) performed injury prevention exercises always or often. More than a third (37.4%) of the golfers reported illness complaints and 32.5% mental health problems in the 4 weeks preceding the WATC. General anxiety, performance anxiety, and low mood/depression were the most frequent mental health problems. Golfers with injury complaints rated their daily training environment poorer. Golfers ranking in the lower 50% at the WATC had significantly less support staff, rated their training environment poorer, and had a higher prevalence of illness complaints and mental health problems. CONCLUSIONS: Effective illness and injury prevention programs should be implemented and better access to education and health support in the daily training environment provided.

Assessment of activity energy expenditure during competitive golf: The effects of bag carrying, electric or manual trolleys.

Golf is a sport played around the globe, with an estimated 42.6 million people playing within the United Kingdom and United States of America alone. To date, there is limited data on the energy expenditure of golf. The present study assessed the activity energy expenditure (AEE) of 16 high-standard (handicap under 5) golfers who completed three rounds of competitive golf either carrying the golf bag (BC), using a manual push trolley (MT) or an electric trolley (ET) (Stewart Golf, Gloucester, UK). Prior to each round, participants were fitted with an Actiheart® accelerometer (Camntech, Fenstanton, UK) to estimate AEE, whilst ratings of perceived exertion (RPE) and enjoyment were collected following each round. Data were analysed using a one-way repeated measures ANOVA, with Hedges g effect sizes (ES) calculated. Mean (SD) AEE was 688 ± 213 kcal for BC, 756 ± 210 kcal for MT and 663 ± 218 kcal for ET (p = .05) although these differences were deemed small or less. The ET condition resulted in the lowest mean heart rate, moderate or very large from BC or MT, respectively. There were no significant differences in enjoyment although perceived exertion was lowest in the ET condition. In summary, we report meaningful differences in AEE between the three conditions (p = .05), with perceived exertion and maximum HR being lowest when using the electric trolley. Golf may be considered as an effective intervention to increase step count and improve physical activity levels across the general population regardless of transportation methods of clubs.

An evaluation of temporal and club angle parameters during golf swings using low cost video analyses packages.

The purpose of this study was to compare swing time and golf club angle parameters during golf swings using three, two dimensional (2D) low cost, Augmented-Video-based-Portable-Systems (AVPS) (Kinovea, SiliconCoach Pro, SiliconCoach Live). Twelve right-handed golfers performed three golf swings whilst being recorded by a high-speed 2D video camera. Footage was then analysed using AVPS-software and the results compared using both descriptive and inferential statistics. There were no significant differences for swing time and the golf phase measurements between the 2D and 3D software comparisons. In general, the results showed a high Intra class Correlation Coefficient (ICC > 0.929) and Cronbach's Coefficient Alpha (CCA > 0.924) reliability for both the kinematic and temporal parameters. The inter-rater reliability test for the swing time and kinematic golf phase measurements on average were strong. Irrespective of the AVPS software investigated, the cost effective AVPS can produce reliable output measures that benefit golf analyses.

Design, Assessment and Deployment of an Efficient Golf Game Dynamics Management System Based on Flexible Wireless Technologies.

The practice of sports has been steadily evolving, taking advantage of different technological tools to improve different aspects such as individual/collective training, support in match development or enhancement of audience experience. In this work, an in-house implemented monitoring system for golf training and competition is developed, composed of a set of distributed end devices, gateways and routers, connected to a web-based platform for data analysis, extraction and visualization. Extensive wireless channel analysis has been performed, by means of deterministic 3D radio channel estimations and radio frequency measurements, to provide coverage/capacity estimations for the specific use case of golf courses. The monitoring system has been fully designed considering communication as well as energy constraints, including wireless power transfer (WPT) capabilities in order to provide flexible node deployment. System validation has been performed in a real golf course, validating end-to-end connectivity and information handling to improve overall user experience.

Dermal exposure assessment to trinexapac-ethyl: a case study of workers in golf course in Hawaii, USA.

Trinexapac-ethyl (TE) was more widely used in golf course worldwide. As a plant growth regulator, it inhibited grass development and delayed grass cutting date. Direct contact with TE by workers that handle and apply these agents can lead to harmful effects depending on the exposure dosage and duration. Many studies have focused on the growth regulation of TE in plants, while its health risks to human beings were rarely reported. Here, we investigated the risk assessment of workers directly dermal exposed to TE by using some absorbent paper patches. The exposure intensity (EI) and potential dermal exposure (PDE) of worker body sections were obtained, and different exposure patterns were compared. The EI of each body section among mixing/loading, hand-held power sprayer, and manual sprayer workers was ranging from 7.22 to 73.0 pg cm-2. The maximum EI of TE was found on hands of manual sprayers, while the minimum EI of TE was recorded on upper arms of mixing and loading workers. The maximum contribution sections was 29% for the chest and back from mixing/loading workers, 40% for the chest and back from hand-held power sprayers, and 32% for the thigh from manual sprayers. The unit weight potential dermal exposure (UWPDE) of hand-held power sprayers was 60% lower than that of manual sprayers, indicating that hand-held power sprayers were safer than those of manual sprayers. These findings revealed that trinexapac-ethyl posed relatively higher exposure risks to manual sprayer workers than other operator workers in golf course, mainly responsible for body sections of the chest and back and thigh.

2018 International Consensus Statement on Golf and Health to guide action by people, policymakers and the golf industry.

Scientific and public interest relating to golf and health has increased recently. Players, potential players, the golf industry and facilities, and decision makers will benefit from a better understanding of how to realise potential health benefits and minimise health issues related to golf. We outline an International Consensus on Golf and Health. A systematic literature review informed the development of a survey. Utilising modified Delphi methods, an expert panel of 25 persons including public health and golf industry leaders, took part in serial surveys providing feedback on suggested items, and proposing new items. Predefined criteria for agreement determined whether each item was included within each survey round and in the final consensus. The working group identified 79 scientifically supportable statement items from literature review and discussions. Twenty-five experts (100%) completed all three rounds of surveys, rating each item, and suggesting modifications and/or new items for inclusion in subsequent surveys. After three rounds, 83 items achieved consensus with each with >75% agreement and <10% disagreement. These items are included in the final International Consensus on Golf and Health. The final consensus presented here can inform scientific knowledge, and action plans for (1) golfers and potential golfers, (2) golf facilities and the golf industry, and (3) policy and decision makers external to golf. These outputs, if widely adopted, will contribute to an improved understanding of golf and health, and aid these groups in making evidence-informed decisions to improve health and well-being.

Risk assessment of heavy metals in water and two fish species from golf course ponds in Beijing, China.

To assess the situation of heavy metals contamination, the concentrations of Cu, Zn, Pb, Cd, Cr, As and Hg in water and two fish species (crucian carp and grass carp) from six golf course ponds of Beijing were measured. Differences in metals concentrations in water and fish samples were observed among different sites, but below the relevant standards and safety values. Significant positive correlations were found between metals concentrations in water and fish samples, except for As in grass carp. Health risks to human via dietary intake of fish were then assessed based on the target hazard quotient and hazard index (HI). The HI in all fish samples were lower than 1, indicating the absence of health risks through consuming these fish.

Distribution of arsenic and risk assessment of activities on a golf course fertilised with arsenic-containing Ascophyllum nodosum seaweed.

The use of seaweed fertilisers in sports green maintenance has become a common practice across the globe due to its image as an "eco-friendly" alternative to chemical fertilisers. The aim of this study was to characterise the risk of human exposure to arsenic (As), via dermal absorption, from golfing activities on a private golf course in the UK, where As contaminated seaweed fertiliser (~100mg/kg d.wt.) is applied. This was fulfilled by, 1) determining As concentrations in shallow soils with GIS geo-statistical analysis, 2) measuring As concentrations from an on-site borehole groundwater well, and (3) developing a risk assessment calculation for golfing activities based on field and questionnaire data. Total As concentrations in shallow soils were less than the UK threshold for domestic soils, however, frequent and sustained dermal contact between site-users and surface soil attributed to a maximum carcinogenic risk value of 2.75×10(-4), which is in the upper limit of the acceptable risk range. Arsenic concentrations in underlying groundwater exceeded the WHO's permissible drinking water standard, demonstrating the risk of groundwater contamination following the application of seaweed fertiliser to golf course soils. This is the first risk study on dermal As absorption via the application of a seaweed fertiliser.

Kinematic evaluation of movement smoothness in golf: relationship between the normalized jerk cost of body joints and the clubhead.

BACKGROUND: When the human body is introduced to a new motion or movement, it learns the placement of different body parts, sequential muscle control, and coordination between muscles to achieve necessary positions, and it hones this new skill over time and repetition. Previous studies have demonstrated definite differences in the smoothness of body movements with different levels of training, i.e., amateurs compared with professionals. Therefore, we tested the hypothesis that skilled golfers swing a driver with a smoother motion than do unskilled golfers. In addition, the relationship between the smoothness of body joints and that of the clubhead was evaluated to provide further insight into the mechanism of smooth golf swing. METHODS: Two subject groups (skilled and unskilled) participated in the experiment. The skilled group comprised 20 male professional golfers registered with the Korea Professional Golf Association, and the unskilled group comprised 19 amateur golfers who enjoy golf as a hobby. Six infrared cameras (VICON460 system) were used to record the 3D trajectories of markers attached to the clubhead and body segments, and the resulting data was evaluated with kinematic analysis. A physical quantity called jerk was calculated to investigate differences in smoothness during downswing between the two study groups. RESULTS: The hypothesis that skilled golfers swing a driver with a smoother motion than do unskilled golfers was supported. The normalized jerk of the clubhead of skilled golfers was lower than that of unskilled golfers in the anterior/posterior, medial/lateral, and proximal/distal directions. Most human joints, especially in the lower body, had statistically significant lower normalized jerk values in the skilled group. In addition, the normalized jerk of the skilled group's lower body joints had a distinct positive correlation with the normalized jerk of the clubhead with r = 0.657 (p < 0.01). CONCLUSIONS: The result of this study showed that skilled golfers have smoother swings than unskilled golfers during the downswing and revealed that the smoothness of a clubhead trajectory is related more to the smoothness of the lower body joints than that of the upper body joints. These findings can be used to understand the mechanisms behind smooth golf swings and, eventually, to improve golf performance.

Energy expenditure and sex differences of golf playing.

The purpose of the study was to assess the average physical intensity and energy expenditure during a single round of golf on hilly and flat courses in a heterogeneous group of healthy men and women of varying age and golf handicap. Forty-two males and 24 females completed an incremental cycle-ergometer exercise test to determine exercise performance markers. The heart rate (HR), duration, distance, walking speed, ascent and descent were measured via a global positioning system (GPS)/HR monitor during the game and energy expenditure was calculated. Playing 9 or 18-holes of golf, independent of the golf course design, the average HR was not significantly different between sexes or the subgroups. The intensities were light with respect to the percentage of maximal HR and metabolic equivalents of task (METs). Total energy expenditure of all participants was not significantly different for hilly (834 ± 344 kcal) vs. flat courses (833 ± 295 kcal) whereas male players expended significantly greater energy than female players (926 ± 292 vs. 556 ± 180 kcal), but did not have significantly greater relative energy expenditure (2.8 ± 0.8 vs. 2.2 ± 0.7 METs). As a high volume physical activity, playing golf is suggested to yield health benefits. Since the intensity was well below recommended limits, golf may have health related benefits unrelated to the intensity level of the activity.

Assessment of planarity of the golf swing based on the functional swing plane of the clubhead and motion planes of the body points.

The purposes of this study were (1) to determine the functional swing plane (FSP) of the clubhead and the motion planes (MPs) of the shoulder/arm points and (2) to assess planarity of the golf swing based on the FSP and the MPs. The swing motions of 14 male skilled golfers (mean handicap = -0.5 +/- 2.0) using three different clubs (driver, 5-iron, and pitching wedge) were captured by an optical motion capture system (250Hz). The FSP and MPs along with their slope/relative inclination and direction/direction of inclination were obtained using a new trajectory-plane fitting method. The slope and direction of the FSP revealed a significant club effect (p < 0.001). The relative inclination and direction of inclination of the MP showed significant point (p < 0.001) and club (p < 0.001) effects and interaction (p < 0.001). Maximum deviations of the points from the FSP revealed a significant point effect (p < 0.001) and point-club interaction (p < 0.001). It was concluded that skilled golfers exhibited well-defined and consistent FSP and MPs, and the shoulder/arm points moved on vastly different MPs and exhibited large deviations from the FSP. Skilled golfers in general exhibited semi-planar downswings with two distinct phases: a transition phase and a planar execution phase.

Basal and squamous cell carcinoma risks for golfers: an assessment of the influence of tee time for latitudes in the Northern and Southern hemispheres.

This study investigates the influence of tee time to determine the relative basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) risk for weekly single round competition golfers located in the Northern and Southern latitude ranges between 25°, 35°, 45° and 55°. A comparative risk methodology, employing annual erythemally effective ultraviolet (UVE) exposure calculations was used to determine BCC and SCC risk factors for golfers using a regular weekly tee time. Relative risk was found to be proportional to golf tee time with mid morning tee times generally presenting the greatest risk in each latitude range. The greatest contribution toward the risk of developing basal and squamous cell carcinoma was found to occur for golfers beginning weekly rounds mid to late morning, with specific risk factors of 1.47 (BCC) and 1.98 (SCC) in the Northern hemisphere compared with similar maximum risk factors of 1.51 (BCC) and 2.08 (SCC) in the Southern hemisphere occurring at comparable morning tee times. Differences in annual UVE exposure between the golfer and non-golfer were the largest determinant of BCC and SCC risk. Generally, these risks were found to decrease with lower latitude although contribution toward overall risk was influenced strongly by the global time zone of each studied golf course site.

Hazardous materials on golf courses: experience and knowledge of golf course superintendents and grounds maintenance workers from seven states.

BACKGROUND: The golf course industry has a growing Latino work force. Little occupational health research has addressed this work force. This article examines golf course superintendents' and Latino grounds maintenance workers' pesticide knowledge, beliefs, and safety training. In particular, it focuses on knowledge of and adherence to OSHA Right-to-Know regulations. METHODS: In person, in-depth interviews were conducted with 10 golf course superintendents in five states and with 16 Latino grounds maintenance workers in four states. RESULTS: Few superintendents were in compliance with Right-to-Know regulations or did pesticide safety training with all of their workers. Few workers had any pesticide safety knowledge. Most safety training on golf courses was rudimentary and focused on machine safety, and was usually conducted in the off-season or on rainy days, not before workers were assigned tasks. CONCLUSIONS: More Right-to-Know training is necessary for superintendents and grounds maintenance workers. Culturally and linguistically appropriate Spanish language materials need to be developed or made more widely available to train workers. Better enforcement of safety and training regulations is necessary.

A model of greenhouse gas emissions from the management of turf on two golf courses.

An estimated 32,000 golf courses worldwide (approximately 25,600 km(2)), provide ecosystem goods and services and support an industry contributing over $ 124 billion globally. Golf courses can impact positively on local biodiversity however their role in the global carbon cycle is not clearly understood. To explore this relationship, the balance between plant-soil system sequestration and greenhouse gas emissions from turf management on golf courses was modelled. Input data were derived from published studies of emissions from agriculture and turfgrass management. Two UK case studies of golf course type were used, a Links course (coastal, medium intensity management, within coastal dune grasses) and a Parkland course (inland, high intensity management, within woodland). Playing surfaces of both golf courses were marginal net sources of greenhouse gas emissions due to maintenance (Links 0.4 ± 0.1Mg CO(2)e ha(-1)y(-1); Parkland 0.7 ± 0.2Mg CO(2)e ha(-1)y(-1)). A significant proportion of emissions were from the use of nitrogen fertiliser, especially on tees and greens such that 3% of the golf course area contributed 16% of total greenhouse gas emissions. The area of trees on a golf course was important in determining whole-course emission balance. On the Parkland course, emissions from maintenance were offset by sequestration from trees which comprised 48% of total area, resulting in a net balance of -4.3 ± 0.9 Mg CO(2e) ha(-1)y(-1). On the Links course, the proportion of trees was much lower (2%) and sequestration from links grassland resulted in a net balance of 0.0 ± 0.2Mg CO(2e) ha(-1)y(-1). Recommendations for golf course management and design include the reduction of nitrogen fertiliser, improved operational efficiency when mowing, the inclusion of appropriate tree-planting and the scaling of component areas to maximise golf course sequestration capacity. The findings are transferrable to the management and design of urban parks and gardens, which range between fairways and greens in intensity of management.

Energy expenditure during golfing and lawn mowing in older adult men.

This study compared the intensity and energy cost of playing 9 holes of golf with 40 min of lawn mowing in older men and determined whether both met the current recommendations for health benefits. Eighteen men (age 71.2 +/- 4.4 yr, BMI 27.3 +/- 2.3; M +/- SD) completed a graded treadmill test. During golfing and lawn-mowing field tests, oxygen consumption and walking velocity and distance were measured using a portable metabolic system and global positioning system receiver. The net energy costs of golfing and lawn mowing were 310 and 246 kcal, respectively. The average intensities in metabolic equivalents of golfing and lawn mowing were 2.8 +/- 0.5 and 5.5 +/- 0.9, respectively. Both lawn mowing and golfing met the original intensity and energy expenditure requirements for health benefits specified by the American College of Sports Medicine in 1998, but only lawn mowing met the 2007 intensity recommendations.