Golf Injuries

Understanding Elbow Pain: How the Golf Swing Stresses the Elbow

The golf swing is a repetitive, explosive rotational motion that stresses the entire body. Swinging the golf club 50-100 times per round at 80-110+ mph can take its toll on the body. I want to specifically talk about how the golf swing stresses the elbow and how you use your forearm muscles during the swing. It is important to note that having elbow pain can influence and change how your hands interact with the club and how your forearm muscles fire during the swing, potentially causing more stress on the elbow.

In this post, I will talk about the biomechanics of the elbow, forearm and wrist during the golf swing, including joint motion and muscular activity.I will also discuss common swing characteristics that may lead to increased utilization of forearm and elbow muscles and the two types of stress that can lead to elbow injury.

Since golf is one-sided rotational sport, the amount and type of stress on the trail and lead elbow are the not the same with each swing. This can influence where and why elbow pain develops.

Biomechanics of the Elbow, Forearm, and Wrist

 

I want to start by discussing the specific motions that take place in each arm during the golf swing. For simplicity’s sake, I will use the terms “lead” and “trail” arm. For a right-handed golfers, the lead arm would be their left and the trail would be the right.

 

 

Great image showing the wrist and forearm action at the impact phase of the swing. You can see the trail (right) side moving into rapid pronation while the lead (left) side supinates.
Credit: Perfect Golf Swing Review

In the above charts, I did my best to compile research on the biomechanics of the golf swing and use my own analysis of swings to generalize the movements. Please recognize that this is probably not a perfect biomechanical analysis of the golf swing, but I think it is relatively close.

Muscle Activity During the Swing

research study from the mid-1990’s looked at EMG data of the golf swing in golfers with and without medial epicondylitis. The EMG data from the study showed the following averages:

Common Extensor Muscles at Address: 33.59% of MVC

Common Extensor Muscles at Impact: 58.77% of MVC

Common Flexor Muscles at Impact: 90.77% of MVC

They found that both symptomatic and asymptomatic golfers showed a similar muscle activation pattern throughout the swing. However, the magnitude of muscle activity was higher in golfers with symptomatic golfers elbow. This shows that golfers with elbow pain are actually using their forearm muscles MORE and may contribute to increased symptoms.

Another study from 2009 looked at the difference in forearm muscle activity between amateur and professional golfers.  They showed that amateurs recruit the pronator teres muscle at a higher magnitude (over 120% of the MVC) than professionals (max of 57% MVC).

Overall, it seems that the forearm muscles are recruited at high levels throughout the swing, especially at impact. It is also apparent that amateurs and golfers with elbow pain seem to utilize the forearm muscles even more, which can perpetuate symptoms.

Variance Between Different Golfers

As you can see in the above picture, there is A LOT of variance between different golfers. Each of these three pro’s have drastically different wrist angles at the top of the back swing.

Each golfer has his or her own unique address position, grip, etc. These factors will influence the amount of stress the elbow and forearm muscles take during the swing. Although recognizing variance in the swing between golfers, the medical literature seems to show that the impact phase is the most stressful on the forearm and elbow.

The important part to realize is how these varied positions at the top impact the golfers position at impact. A suboptimal position may lead a golfer to get very “handsy” at impact in order to generate speed or square the clubface. A swing that is excessively reliant on the hands to make last second adjustments may be more prone to placing more stress on the forearm and elbow.

Swing Characteristics that Infleunce Elbow Stress

Titleist Performance Institute compiled a list of the Big 12 Swing Characteristics that they found were most common in amateur golfers. It is not a comprehensive list of all the swing faults that a golfer can have, but it is a great reference tool to understand the basics and the Swing-Body Connection.

The major take-away from TPI’s Big 12 is that common swing faults are compensations and may caused increased stress on the body. Swing faults are often a manifestation of a physical limitation, such as a mobility restriction, or a suboptimal sequencing pattern throughout the swing.

The following three swing characteristics are compensatory strategies that golfers use and may place increased loading and stress through the elbow and forearm muscles specifically.

To be clear, I do not have EMG data from a research study to back up the claim that these characteristics will alter elbow and forearm muscle patterns, but I feel confident in my reasoning as to why they might. 

Scooping

Credit: TPI

Scooping can be defined as a “premature release of wrist angles,” leading to the lead side hand being excessively cupped or extended through impact. Scooping tends to increase the dynamic loft of the club, causing a leak of power and consistency.

This swing characteristic often does not occur in isolation and is typically a compensation for a physical restriction or sequencing issue that requires the golfer to make a last second adjustment with the hands. Scooping can lead increased stress on both the lead and trail side elbow by requiring greater muscle activity of the forearm and elbow muscles at impact.

 

Chicken Wing

The chicken wing characteristic is characterised by increased lead elbow flexion and lead wrist extension through the impact position. Chicken winging can also lead to increased dynamic loft of the club, excessive backspin, and decreased power.

Credit: TPI

Similar to scooping, the chicken wing characteristic relies more upon the forearm and elbow muscles to generate club head speed. According to TPI, chicken winging can often be caused by an over the top, steep swing plane. It can also be related to poor sequencing through the lower body to generate speed at impact.

Casting

Casting involves an early release of the club through the downswing phase. This swing characteristic can lead to a scooping position at impact, adding loft and spin to the ball and decreasing power.

 

Credit: TPI

Like the other two characteristics discussed, casting over-utilizing the arms to generate power, thus increasing the stress on the muscles of the forearm and elbow. Casting is often a result of a physical limitation such as limited wrist extension, poor core stability, limited lower body mobility, and/or suboptimal sequencing.

The bottom line is that suboptimal swing mechanics and certain swing faults can lead to over-utilizing the upper body during the swing and through impact. These three characteristics rarely happen in isolation, so it is important for a golf coach to determine the root cause. Often times a physical limitation somewhere in the body may be contributing to suboptimal positioning and sequencing. If this is the case, improving the physical limitation should be the first priority followed by golf-specific drills.

Traumatic Stress to the Elbow

Traumatic injuries to the forearm and elbow are typically caused by the golf club impacting an object on the gound. This can mean catching a shot fat, hitting a root at impact, or repeated swings on a hard surface like a driving range mat.

Credit: The Sun

When this type of strike happens, the golf club decelerates suddenly. This can cause a significant traction, or pulling, force to occur at the elbow. Typically, this will occur in the medial elbow of the trail side. The stress that is transmitted from the club through the golfers arm can cause micro-trauma of the common flexor tendon and can lead to pain and dysfunction.

Traumatic elbow injuries tend to happen less frequently than repetitive over-use injuries, but can cause significant pain and discomfort to the elbow. I will talk more about how traumatic stresses can lead to elbow pain in a future post, but I felt like it was important to note here.

Repetitive Stress to the Elbow

Golfer’s love to play and practice golf. For some, this can mean taking hunders upon hundreds of swings in a single day. A high volume of repetitive stress to the muscles of the forearm and elbow can eventually lead to developing pain or discomfort.

This reminds of an article I wrote about Low Back Pain where I described the Cumulative Load Theory and the Acute-Chronic Workload Ratio and how they can lead to a golfer suffering from low back pain.

The same principles apply to forearm and elbow pain. Although one golf swing may not be excessively stressful, when repeated thousands of times it may surpass the threshold of what our body can handle. I’ve often found that golfers experience repetitive over-use injuries for two reasons:

  • Taking way too many golf swings (Cumulative Load Theory)
  • Sudden spike in swing volume (Acute-Chronic Workload Theory)

Managing practice and play over the course of a single day, month, season, and year seems to be the best way to avoid devleoping an overuse injury. Combine that with a solid strength and conditioning program and you’re likelihood decreases even more. I will discuss in detail how to do this in a later article, so stay tuned!

Conclusion

The elbow, forearm, and wrist move through a large range of motion at a high rate of speed throughout the swing.The muscles of the forearm are highly active, and tend be recruited even more by amateurs and golfers with elbow pain. The high demands on these muscles can eventually lead to developing an overuse-based injury.

Certain swing characteristics can lead to increased reliance on the upper body for speed generation. These compensations most often occur as a result from a problem somewhere else in the body.

Traumatic injuries are less common than overuse injuries but can also lead to pain and dysfunction.

Stay tuned for the next article in the series which will describe how to make sense of elbow pain. This article will include various types of elbow injuries, how they commonly present, and some of the ways I use to diagnose elbow pain.

6 thoughts on “Understanding Elbow Pain: How the Golf Swing Stresses the Elbow

  1. As a former masters swimmmer I know all too well your mentioned stress both too fast and repetition. 2013 surgical repair after years of recurring medial epicondylitis proves this- when doctor origanally poo-pooed complaints -good article keep it coming

  2. Thanks, Mike! Great data. As a TPI Med Pro, I try and show my golfers how elbow pain is typically because of limitations somewhere else in their body (T-spine, etc), causing some sort of swing fault. Phone cameras are fast enough now that you can utilize them to show swing faults that most golfers have no idea they have developed. Keep up the great info! Thank you!!!

    1. Definitely agree! Besides an obvious traumatic incident i.e. hitting a root, most golfers with elbow pain have key areas of physical limitations or sequencing issues impacting their swing. Thanks for the read, Chris!

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