Adaptive Golf: History, Rules and Equipment Modifications, and Sport-Specific Injuries

Device

Description

Intended user

Powerglove

Golf glove with loop to secure club grip to glove that ensures a firm hold throughout the swing

Golfers with arthritis or weak grip

Eagle Claw

Golf grip aid which assists with developing and maintaining grip strength and swing accuracy

Golfers affected by arthritis or illnesses that affect grip strength and limit golfing ability

Golf TD

Single piece grip that stores energy on the backswing that helps improve club head speed

Golfers with right or left hand unilateral absence (requires minimal secondhand assistance)

Golf Pro

Flexible grip duplicates the wrist action required for a smooth, controlled swing

Golfers with right or left hand unilateral absence. Intended for more advanced golfers

Tampa Bay Dynamic Recreation Elbow

Replaces the majority of components in a standard trans-humeral prosthesis with a dynamic energy storing system

Golfers with unilateral very short to long trans-humeral absences. Short sport prosthesis is required

Golfers with Loss of Lower Limb Function [24]

Players with loss of limb function in one or both lower extremities may choose to play from a seated position (Table 11.2). There are several prosthetic devices engineered to improve mobility and swing mechanics in the amputee population. Rotation is aided through torque absorbers fixed to either below knee or above knee prosthesis. Additionally, new prosthetic foot designs aid in rotation and shock absorption and adapt easily to uneven terrain. Having the prosthetist work closely with the golfer and their golf instructor during the process of making the prosthetic device is encouraged. It is also helpful to work with a prosthetist that understands the biomechanical properties of each stage of a proper golf swing.

Table 11.2

List of mobility devices for disabled golfers [28–30]

Device	Description	Intended user
ParaGolfer	All-terrain mobility device that lifts players from sitting to standing position allowing eye-level play with other golfers	Wheelchair-bound or players with limited mobility
Golf Express	Single rider golf cart allows golfers to play from a seated or supported standing position	Golfers with limited mobility who can support their own weight
SoloRider	Single rider golf cart with single-hand use capability and sit to supported stand function	Golfers requiring mobility aid due to chronic or abrupt disability

Miscellaneous

A wide variety of other adaptive equipment has been designed to assist disabled individuals with various aspects of the game (Table 11.3).

Table 11.3

List of miscellaneous equipment for disabled golfers [31–35]

Device	Description	Intended user
Chromax Golf ball	High visibility golf ball allows for more accurate putting and ball identification	Golfers with impaired or decreased vision
Backsaver System+	Allows placement and pickup of ball and tee peg without bending	Golfers with injury making bending difficult as well as those with less fine motor in hands
Joe’s Original Backtee	Attachment for any grip that allows ball and tee placement without bending	Golfers with injury making bending difficult as well as those with less fine motor in hands
Ball Pickup	Attachment for any golf putter grip that allows retrieval of ball without bending	Golfers with injury that have difficulty with bending
Adapta-Club	Specially fit golf clubs for disabled golfers. Hinged design allows clubs to lie in a flat position	All golfers with disability based upon personal comfort

Golf Injuries and Rehabilitation

In the United States, there are more than 26 million golfers, of which about six million are avid golfers in that they play 25 or more rounds of golf per year. As the population ages, golf will increase as a popular leisure time activity because it allows a variety of individuals to play simultaneously [36]. Along with this increase in the number of golfers, there will be an expected rise in golf-related injuries. The golfer with a disability is neither immune nor prone to injury during practice or play. In 1996, it was reported that more than 36,000 individuals presented to the emergency room in the United States for treatment of golf-related injuries [37]. In the United States golf injuries in male participants mostly involve the lower back, whereas female golfers are more likely to have problems with the elbow, wrist, or shoulder [38, 39]. To understand the cause of golf-related injuries, one must first look into the mechanics of the golf swing. The golf swing involves a high-torque lateral bending movement, for which the anatomy is poorly suited [40]. Additionally, many beginning golfers use maladaptive swing techniques that adversely affect the kinetic forces on the trunk, shoulders, and legs. Poor technique and overuse can lead to injury; most amateur golfers have injuries due to poor technique, while professional golfers are more likely to have injury caused by repetition and frequent practice [41]. In this section we will discuss the types of golf injuries along with appropriate medical and rehabilitation management options for the injured golfer.

Low Back Injury

The low back is the most frequently injured area of the body in both amateur and professional golfers. Appreciation of golf swing mechanics along with the biomechanics of the spine is essential to understand golf-related low back injuries. The modern golf swing involves a large shoulder rotation with a semi-constricted turn in the hips to build torque in the muscles of the lower back and shoulder [42]. This technique is advocated by many teaching professionals but leads to greater angular displacement of the spine and is suspected of being a major source of injury for professional and amateur golfers. Biomechanical models have demonstrated that the golf swing significantly increases lateral bending, shear, compression, and torsional forces at the L3 and L4 motion segment [43].

The etiology of lower back pain can be multifactorial and may appear as significant medical, orthopedic, or neurologic problems. After successful treatment of the acute injury, it is essential for the golfer to strengthen and improve flexibility in the spine, legs, and shoulders. Improving the function of the latissimus dorsi, hamstrings, and anterior and posterior trunk muscles which stabilize the spine is critical to protect against future injuries or flare-ups of low back pain related to the initial injury [44]. Warming up with gradual stretching before the round and a cooldown phase after play are also helpful to reduce injury. Other considerations include using special equipment such as a long putter to reduce thoracolumbar kyphosis and pushing a cart rather than pulling to decrease torsional forces about the spine [42].

Shoulder Injuries

Overall, there is a relatively low incidence of shoulder injury in golfers compared to other sports. Overuse or high volume repetition with training or practice leads to soft tissue inflammation which may cause shoulder injuries, especially in older golfers. Senior golfers are more prone to shoulder pain due to bursitis or rotator cuff injury secondary to impaired circulation or musculotendinous deconditioning. In younger golfers (less than 35 years of age), joint laxity or repetitive high velocity swing can cause excessive microtrauma to the rotator cuff mechanism [42].

The shoulder of the non-dominant or lead arm is more frequently involved in golf-related injuries. The lead arm is at maximal adduction during backswing, which can cause pain secondary to acromioclavicular joint pathology or impingement syndrome at the top of the backswing. Pain in the posterior aspect of the shoulder can be secondary to posterior capsulitis or a tight posterior joint capsule. During the high velocity downswing, weak scapular muscles can lead to instability and secondary interscapular pain [42].

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