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.

Strength and Balance in Recreational Golfers and Non-Golfers Aged 65-79 Years in Community Settings.

Inactive older adults tend to have decreased strength and balance compared with their more active peers. Playing golf has the potential to improve strength and balance in older adults. The aim of the study was to compare the strength and balance of recreational golfers with non-golfers, aged 65-79 years. Grip strength, single leg balance, and Y Balance Test (YBT) were assessed. Golfers (n = 57) had significantly (right, p = .042; left, p = .047) higher maximal grip strength, than non-golfers (n = 17). Single leg stance times were significantly longer in golfers (right, p = .021; left, p = .001). Normalized YBT reach distances were significantly greater for golfers than non-golfers for composite, posteromedial, and posterolateral directions on both right and left legs. Playing golf appears to be associated with better grip and both static and dynamic balance in 65-79 year olds, indicating that a study of the effects of playing golf is warranted through a larger, fully powered, longitudinal study.

Evidence-based classification in golf for athletes with a vision impairment: A Delphi study.

Vision-impaired (VI) golf is a global para-sport currently played under several different classification systems under different bodies. This study aimed to gather expert opinion to determine whether the current classification systems are fit for the purpose intended and to identify any particular issues where VI impacts the game of golf for the disabled (G4D). A panel of 20 participants with expertise in G4D took part in a three-round Delphi study. The panel agreed that the current classification system(s) for VI golf did not or only partially fulfilled the aim to minimise the impact of VI on the outcome of competition and that there should be one, internationally recognised, classification system. It was agreed that other metrics of VI, in addition to the measurement of visual acuity (VA), need to be considered. Intentional misrepresentation of VI was identified as a cause for concern. The panel agreed that the current classification system does not fully achieve its purpose. Any changes that are made to these classification systems need to be evidence based specific to VI golf. Further research is required to determine how measures of VI affect golfing performance and whether other metrics other than VA are required.

Maximising and evaluating the uptake, use and impact of golf and health studies.

INTRODUCTION: The dissemination of research, and evaluation of its impact is an increasing priority for the scientific community and funders. We take the topic of golf and health and aim to outline processes that may contribute to improved research uptake, use and impact proposing a research impact (RI) tool. We then evaluate our published research using the Research Contributions Framework (RCF). METHODS: Building on existing research and frameworks we i) assessed the need for, ii) carried out and iii) published research, before iv) creating digital resources, v) sharing these resources widely and vi) evaluating our research.To evaluate uptake, use and impact of our three principal golf and health research outputs, we performed a contributions analysis, using the RCF first proposed by Morton. RESULTS/DISCUSSION: We developed a specific six-step Research Impact tool. Having implemented this, research uptake and use included over 300 press articles, a dedicated website and social media channels. Golf's global industry leadership dispersed information across >150 countries, embedded golf and health into curricula for industry professionals and used leading tournaments to promote health. National policy makers hosted dedicated meetings regarding golf and health and began to implement policy change. CONCLUSION: To date, strong uptake and use can be demonstrated for these studies, while a final contribution to impact requires further time to determine.Frameworks we used aiming to maximise impact (Research Impact tool) and evaluate its contribution to uptake, use and impact (Research Contribution Framework) could potentially add value to public health/sports medicine researchers.

International consensus statement: methods for recording and reporting of epidemiological data on injuries and illnesses in golf.

Epidemiological studies of injury in elite and recreational golfers have lacked consistency in methods and definitions employed and this limits comparison of results across studies. In their sports-generic statement, the Consensus Group recruited by the IOC (2020) called for sport-specific consensus statements. On invitation by International Golf Federation, a group of international experts in sport and exercise medicine, golf research and sports injury/illness epidemiology was selected to prepare a golf-specific consensus statement. Methodological stages included literature review and initial drafting, online feedback from the consensus group, revision and second draft, virtual consensus meetings and completion of final version. This consensus statement provides golf-specific recommendations for data collection and research reporting including: (i) injury and illness definitions, and characteristics with golf-specific examples, (ii) definitions of golf-specific exposure measurements and recommendations for the calculation of prevalence and incidence, (iii) injury, illness and exposure report forms for medical staff and for golfers, and (iv) a baseline questionnaire. Implementation of the consensus methodology will enable comparison among golf studies and with other sports. It facilitates analysis of causative factors for injuries and illness in golf, and can also be used to evaluate the effects of prevention programmes to support the health of golfers.

Systematic review of musculoskeletal injuries in professional golfers.

OBJECTIVE: The distribution of injuries affecting professional golfers is yet to be fully understood. We performed a systematic review of the clinical literature to establish the epidemiology of musculoskeletal injuries affecting professional golfers. DESIGN: Systematic review. DATA SOURCES: Searched databases in July 2018 were PubMed, SPORTDiscus and Embase. ELIGIBILITY CRITERIA: Published observational research articles relating to the incidence or prevalence of musculoskeletal injuries in professional golfers, which were written in the English language and not restricted by age or gender. RESULTS: Of the 1863 studies identified on the initial search, 5 studies were found to satisfy the inclusion criteria for analysis. The mean age of the golfers in these studies was 34.8 (±3.6) years. The gender of patients in included studies compromised 72% males and 28% females. Four studies reported that lumbar spine injuries were the most common (range 22%-34%). Excluding injuries to the spine (lumbar, thoracic and cervical), the hand/wrist was the next most common region of injury (range 6%-37%). The quality of the studies was relatively poor with no study satisfying >50% of the quality assessment tool questions and only one study giving a clear definition of how they defined injury. CONCLUSION: There is a paucity of well-designed epidemiological studies evaluating musculoskeletal injuries affecting professional golfers. Injuries to the spine are the most frequently affected region, followed by the hand/wrist. This study has identified targeted areas of future research that aims to improve the management of injuries among professional golfers.

Relationships between Challenge Tour golfers' clubhead velocity and force producing capabilities during a countermovement jump and isometric mid-thigh pull.

A number of field-based investigations have evidenced practically significant relationships between clubhead velocity (CHV), vertical jump performance and maximum strength. Unfortunately, whilst these investigations provide a great deal of external validity, they are unable to ascertain vertical ground reaction force (vGRF) variables that may relate to golfers' CHVs. This investigation aimed to assess if the variance in European Challenge Tour golfers' CHVs could be predicted by countermovement jump (CMJ) positive impulse (PI), isometric mid-thigh pull (IMTP) peak force (PF) and rate of force development (RFD) from 0-50 ms, 0-100 ms, 0-150 ms and 0-200 ms. Thirty-one elite level European Challenge Tour golfers performed a CMJ and IMTP on dual force plates at a tournament venue, with CHV measured on a driving range. Hierarchical multiple regression results indicated that the variance in CHV was significantly predicted by all four models (model one R2 = 0.379; model two R2 = 0.392, model three R2 = 0.422, model four R2 = 0.480), with Akaike's information criterion indicating that model one was the best fit. Individual standardised beta coefficients revealed that CMJ PI was the only significant variable, accounting for 37.9% of the variance in European Challenge Tour Golfers' CHVs.

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.

Hip morphology in elite golfers: asymmetry between lead and trail hips.

AIM: During a golf swing, the lead hip (left hip in a right-handed player) rotates rapidly from external to internal rotation, while the opposite occurs in the trail hip. This study assessed the morphology and pathology of golfers' hips comparing lead and trail hips. METHODS: A cohort of elite golfers were invited to undergo MRI of their hips. Hip morphology was evaluated by measuring acetabular depth (pincer shape=negative measure), femoral neck antetorsion (retrotorsion=negative measure) and α angles (cam morphology defined as α angle >55° anteriorly) around the axis of the femoral neck. Consultant musculoskeletal radiologists determined the presence of intra-articular pathology. RESULTS: 55 players (mean age 28 years, 52 left hip lead) underwent MRI. No player had pincer morphology, 2 (3.6%) had femoral retrotorsion and 9 (16%) had cam morphology. 7 trail hips and 2 lead hips had cam morphology (p=0.026). Lead hip femoral neck antetorsion was 16.7° compared with 13.0° in the trail hip (p<0.001). The α angles around the femoral neck were significantly lower in the lead compared with trail hips (p<0.001), with the greatest difference noted in the anterosuperior portion of the head neck junction; 53° vs 58° (p<0.001) and 43° vs 47° (p<0.001). 37% of trail and 16% of lead hips (p=0.038) had labral tears. CONCLUSIONS: Golfers' lead and trail hips have different morphology. This is the first time side-to-side asymmetry of cam prevalence has been reported. The trail hip exhibited a higher prevalence of labral tears.

Professional golfers' hips: prevalence and predictors of hip pain with clinical and MR examinations.

AIMS: This study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics predicted hip symptoms. METHODS: Male elite professional golf players were invited to complete questionnaires and undergo clinical and MR examinations while attending the Scottish Hydro Challenge 2015. Questionnaires determined player demographics, self-reported hip pain and an International Hip Outcome Tool 12 (iHOT12) score (hip-related quality of life). Clinical examinations determined hip range of motion and the presence of a positive impingement test. MR scans determined the presence of labral pathology and player hip morphology with measures of α angle (cam), acetabular depth (pincer) and femoral neck antetorsion. RESULTS: A total of 109 (70% of tournament field) of players completed questionnaires, 73 (47%) underwent clinical examination and 55 (35%) underwent MR examination. 19.3% of players reported of hip pain. 11.9% of lead and 9.1% of trail hips were painful (p=0.378), iHOT12 scores were lower in the lead (94.1) compared to the trail hip (95.3) (p=0.007). Stepwise multiple linear regression modelling was able to predict 20.7% of the variance in iHOT12 scores with mean α angles between 12 and 3 o'clock, and increasing age-significant variables (R(2)=0.207, p<0.001; ß=-0.502, p<0.001 and ß=-0.399, p=0.031, respectively). CONCLUSIONS: 19.3% of male professional golfers reported hip pain. The presence of an increasing α angle and increasing age were significant predictors of reduced hip-related quality of life.

Sports-related extensor carpi ulnaris pathology: a review of functional anatomy, sports injury and management.

The extensor carpi ulnaris (ECU) muscle plays a key role not only in the active movements of wrist extension and ulnar deviation but also in providing stability to the ulnar side of the wrist. Its position relative to the other structures in the wrist changes with forearm pronation and supination. As such, it must be mobile yet stable. The ECU tendon relies on specific stabilising structures to hold it in the correct positions to perform its different functions. These structures can be injured in a variety of different athletic activities such as tennis, golf and rugby league, yet their injury and disruption is predictable when the mechanics of the ECU and the techniques of the sport are understood. The ECU tendon is also vulnerable to tendon pathologies other than instability. It lies subcutaneously and is easily palpated and visualised with diagnostic ultrasound, allowing early diagnosis and management of its specific conditions. Treatment includes rest, splintage and surgery with each modality having specific indications and recognised outcomes. This review described the functional anatomy in relevant sporting situations and explained how problems occur as well as when and how to intervene.

The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour.

OBJECTIVES: Golf is a popular sport played by an estimated 57 million people. Previous studies on wrist injuries in elite golfers have been of simple design and have demonstrated such injuries to be frequent, although no studies report the incidence, variety, severity or impact on the activity of wrist injuries in detail. This prospective cross-sectional study assesses these factors in a cohort of elite professional golfers. METHODS: European Tour golfers eligible to compete at the 2009 BMW PGA Championship at Wentworth were studied. Study design involved the completion of a structured questionnaire supplemented by interview and examination when required, with performance statistics provided by the European Tour. The severity of injury was assessed by the number of missed tournaments and the amount of time of missed practice. RESULTS: 128 of 153 eligible golfers, (84%) completed the study with 38 golfers (30%) reporting 43 problems. The majority of injuries (67%) occurred in the leading wrist at the most common location, the ulnar side of the wrist (35%). 87% of all ulnar-sided and 100% of radial-sided problems were in the leading wrist. CONCLUSIONS: There were clear side differences reported by the players with the lead wrist demonstrating much higher injury rates in all areas. The most significant injury, in terms of absence from competition, was extensor carpi ulnaris tendon subluxation. Specific injuries are explained in relation to the biomechanics of the golf swing. Most structural injuries have a specific treatment and rehabilitation plan, which can involve significant periods of time away from the sport, while the management of many of the more minor problems is through alterations in technique or practice regimes, aiming to keep a golfer playing during recovery.

Golf participants in Australia have a higher lifetime prevalence of skin cancer compared with the general population.

Objective: To estimate the age-specific lifetime prevalence of skin cancer in a sample of Australian golf participants and estimate skin cancer risk in golf participants compared with a general population-based sample. Methods: Golf participants in Australia (n=336) completed the Australian Golf Health Survey which collected data on skin cancer diagnosis (self-reported history), physical activity levels and participant demographics. Data were compared with a sample of the Australian general population (n=15780, Australian Health Survey). Age-specific lifetime prevalence of skin cancer in golf and general population-based samples was determined, and modified Poisson regression (adjusted for age, sex, education and smoking status) was used to estimate the association between playing golf and the risk of a current or past skin cancer diagnosis. Results: One in four golf participants (n=91; 27%) had received a skin cancer diagnosis compared with 7% (n=1173) of the general population. Golf participants were 2.42 (2.01 to 2.91) (relative risk (95% CI)) times more likely to report a skin cancer diagnosis than the general population after adjusting for age, sex, education and smoking status. Conclusion: Playing golf in Australia is associated with a higher age-specific lifetime prevalence of skin cancer compared with the general population. Golf organisations, clubs and facilities should inform golf participants about the risk of skin cancer and promote preventive strategies including use of high-Sun Protection Factor (SPF) sunscreen, appropriate hats and clothing.

Australian golfers with and without osteoarthritis report reduced psychological distress and improved general health compared to a general population-based sample.

OBJECTIVES: To (i) evaluate psychological distress and general health in Australian golfers and compare with a general population-based sample, and (ii) explore the relationship between playing golf, psychological distress and general health in individuals with osteoarthritis. DESIGN: Cross sectional. METHODS: A cross-sectional survey collected outcomes in 459 Australian Golfers (Kessler-10 Psychological Distress Scale, Short-Form 12 (Health Status), International Physical Activity Questionnaire, osteoarthritis status). Outcomes were compared between Australian golfers and a general population-based sample (Australian Health Survey, n = 16,370). Modified Poisson regression estimated the relationship between playing golf and general health in all participants and a subgroup with osteoarthritis (n = 128 golfers, n = 2216 general population). All analyses were adjusted for age, sex, education and smoking status. RESULTS: Playing golf was associated with lower psychological distress (adjusted mean difference (95 % confidence interval) -2.5 (-4.1 to -0.9)) and a greater likelihood of reporting good to excellent general health (adjusted relative risk (95 % confidence interval) 1.09 (1.05 to 1.13)) compared to the general population. Amongst people with osteoarthritis, playing golf was associated with lower psychological distress (adjusted mean difference -4.0 (95 % confidence interval -6.5 to -1.5)) and a greater likelihood of reporting good to excellent general health (adjusted relative risk (95 % confidence interval) 1.3 (1.2 to 1.4)). CONCLUSIONS: Golfers had lower levels of psychological distress and better general health than the general population, and this relationship was strongest in individuals with osteoarthritis.

The global state of play: A study of the demographic characteristics of disability golfers.

BACKGROUND: Golf is a moderate-intensity physical activity that provides positive physical and mental health benefits. However, the inclusiveness of the sport for individuals with disabilities globally is unknown. OBJECTIVE: To characterize the demographics and disability characteristics of individuals engaging in disability golf globally. It was hypothesized that the majority of participants would be middle-aged, male, and from countries with higher gross domestic product, similar to the nondisabled population. DESIGN: Descriptive, cross-sectional analysis using European Disability Golf Association (EDGA) database. SETTING: Various international golf tournaments. PARTICIPANTS: Golfers (n = 1734) with disability from 44 countries registered with the EDGA (2017-2021). INTERVENTIONS: Not applicable. MAIN OUTCOMES: Descriptive analyses of frequencies, distributions, and means differences of demographic characteristics (age, gender, type of disability, level of handicap, golf cart use, and country of origin) of golfers with disability were performed. Data provided analysis of the association between number of participants and a country's gross domestic product (GDP). RESULTS: Individuals had a mean age of 52.5 (±15.6) years: 1589 (91.6%) male and 145 (8.4%) female. Twenty-three countries had female participation. The most commonly reported primary disability diagnoses were neurologic (24.8%), orthopedic (21.4%), and amputation below the knee (14.4%). Neurologic impairments (24.7%) were most common in men and orthopedic impairments (29.7%) were most common in women. Individuals with neurological impairments (27.4%) most frequently required golf carts to play. The GDP of a country had a positive correlation (r = 0.68) with the number of registered golfers with disability. CONCLUSION: Golf is played by individuals with a variety of disabilities and provides numerous benefits. However, there is an underrepresentation of youth, women, and individuals with certain impairments and from lower-income countries. These are the potential areas of opportunity to improve engagement and inclusiveness of golf.

Perceived Facilitators and Barriers to Participation in Golf for People With Vision Impairment: A Qualitative Study.

OBJECTIVES: This study aimed to identify facilitators and barriers to participation in vision impaired golf. DESIGN: Semistructured interviews were conducted with 12 vision impaired golfers, 10 guides, and 5 novices during the British VI Golf Open tournament in August 2021. RESULTS: Qualitative content analysis identified the benefits, facilitators, and challenges of playing vision impaired golf. The role of guides and future developments of the sport were furthermore identified. The benefits extend beyond those related to health, including personal development and a sense of purpose for players and of reward for guides. Facilitators were largely organizational and having appropriate support and a guide. The challenges to playing and guiding were practical, financial, and logistical. The need to attract a more diverse range of players, along with a reconsideration of the eligibility criteria, was central to the perceived sustainability of vision impaired golf. CONCLUSIONS: These results highlight the practical, financial, and logistical challenges contributing to vision impaired golf activity limitations and participation restrictions. Because of the health, personal, and psychosocial benefits, ways of providing practical, financial, and support networks to facilitate engagement in vision impaired golf should be sought. An evidence-based, sport-specific eligibility system was thought to be critical for the future promotion of vision impaired golf.

Rate and Timing of Return to Golf After Hip, Knee, or Shoulder Arthroplasty: A Systematic Review and Meta-analysis.

BACKGROUND: The physical and mental health benefits of golf are well recognized, and as a moderate-intensity activity, it is an ideal sport for patients after joint arthroplasty. PURPOSE: To assess the rate and timing of returning to golf and the factors associated with these after hip, knee, or shoulder arthroplasty. STUDY DESIGN: Meta-analysis; Level of evidence, 4. METHODS: A search of PubMed and Medline was performed in March 2021 in line with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Search terms included sport, golf, and arthroplasty. The criterion for inclusion was any published research article studying return to golf after arthroplasty. Random-effects modeling was used to measure rates of returning to golf for each type of arthroplasty. RESULTS: A total of 23 studies were included for review. All studies were retrospective in their methodology. The mean age of patients was 66.8 years (SD, 3.37). Four studies reported on hip arthroplasty, 6 on knee arthroplasty, and 13 on shoulder arthroplasty. Among 13 studies, the mean rate of returning to golf was 80% (95% CI, 70%-89.9%). Hip, knee, and shoulder arthroplasty had mean return rates of 90% (95% CI, 82%-98%), 70% (95% CI, 39%-100%), and 80% (95% CI, 68%-92%), respectively. Among 9 studies, the mean time to return to golf was 4.4 months (95% CI, 3.2-6). Change in handicap was reported in 8 studies (35%) with a mean change of -0.1 (95% CI, -2.4 to +2.2). There were no studies presenting factors associated with return to golf. CONCLUSION: This is the first meta-analysis of returning to golf after joint arthroplasty. The study reports a high rate of returning to golf, which was greatest after hip arthroplasty. However, the study highlights the paucity of prospective data on demographic, surgical, and golf-specific outcomes after arthroplasty. Future prospective studies are required to eliminate response bias and accurately capture golf and patient-specific outcomes.

Golfing after Orthopaedic Surgery: A longitudinal follow-up (GOLF) study protocol.

Aims: The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery. Methods: This is a multicentre, prospective, longitudinal study between the Hospital for Special Surgery, (New York City, New York, USA) and Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, (Edinburgh, UK). Both centres are high-volume arthroplasty centres, specializing in upper and lower limb arthroplasty. Patients undergoing hip, knee, ankle, or shoulder arthroplasty at either centre, and who report being golfers prior to arthroplasty, will be included. Patient-reported outcome measures will be obtained at six weeks, three months, six months, and 12 months. A two-year period of recruitment will be undertaken of arthroplasty patients at both sites. Conclusion: The results of this prospective study will provide clinicians with accurate data to deliver to patients with regard to the likelihood of return to golf and timing of when they can expect to return to golf following their hip, knee, ankle, or shoulder arthroplasty, as well as their joint-specific functional outcomes. This will help patients to manage their postoperative expectations and plan their postoperative recovery pathway.