By Dr. Vince Gomez

Recently, the wrist has become the subject of some golf chatter surrounding the pro tour. For those who follow Jennifer Rosales (our own JRo) closely, they know that her wrists were the source of many problems and injuries requiring her to modify her swing to prevent injury and help her game. Michelle Wie fell while jogging and hurt her wrists. Although she was supposed to have recovered, she still couldn’t play well enough to break 80 and she had to withdraw rather than risk losing her card due to the dreaded “88” rule. And, most significantly, there was Lefty (Phil Mickelson) who hurt his wrists and has been playing dismally since.

Many of you golfers have also had your share of wrist problems. The most common complaint I get in my clinic regarding the wrist is pain after grounding the club or hitting a branch, rock or root. The pain is usually in the leading arm, in the ulnar side of the wrist. The pain is worse when the wrist is rotated or when the wrist is cocked back and carries the club. This pain can be very disabling and can make playing golf impossible. If you have a back spasm, you can still play with a corset brace. If you have an ankle sprain, you can still take the cart practically up to the ball and play it. If you have golfer’s elbow, you can still swing the club and hit the ball as long as your swing is shorter. But, the wrist? If the wrist hurts, you can’t pick up the club but if you can pick it up to swing it, you are so afraid of hitting the ground that in most cases, you flinch or drop the club. So, you can’t play and this, in many ways, makes the wrist the most important area of the body as far as playing golf is concerned. A study conducted among the top 226 American players in the PGA and the LPGA showed that 93 (24%) had left wrist problems with the right affected in only 3%.

What is interesting to note is that in elite golfers like Tiger and Vijay (and Phil M), the wrists do not uncock. The forearms rotate and this causes the rolling over of the wrists.

So how do you hurt your wrist?

The main injuries when your wrist is hurt playing golf are divided into two types:

1) Tendinitis from overuse. This is from repetitive microtrauma. Due to bad golf mechanics or inadequate strength, too much stress is placed on the collagen fibers of the tendons around the wrist causing a micro-rupture of the fibers. The tendons don’t tear but they become stretched out causing pain tenderness and inability to move the wrist without pain. This is not necessarily from too much practice. If the mechanics of the swing are wrong meaning your grip is wrong, or the wrist tendons work too hard to hang on to the club and this causes tendinitis.

From a practical point of view, avoid three things:
* Overswinging, letting your wrists break at the top of the swing and the club drops.
* Casting the club rather than controlling the club through the swing, you throw it through the downswing and you try to flick or lock and unlock the wrists as you hit the ball.
* Weak grip. Women often have tendonitis if the grip is weak. This is because the tendons work harder to keep the wrist steady during the swing.

2) Ulnar-Carpal (wrist) joint injuries. The ulnar bone is the long bone of your arm that starts at the point of your elbow and ends where the 5th finger is on the hand. The ulna is slightly raised at the wrist and you can feel it. There is a ligament you can feel, like a band between the ulna and the bones of the wrist. This is called the TFCC (triangular fibro-cartilagenous complex). It is the link between the forearm and wrist at this point. If it is strained from overswinging or from grounding the club forcefully, you can tear or overstretch this ligament causing pain most especially when you roll your wrists. As long as your wrists are locked when you hold a club, it doesn’t hurt but once you swing the club, the TFCC presents with pain. Another thing you will notice is that when you rotate your forearm from a palm down position, the small bone (the ulna) pops up and becomes more prominent than on the other side.

Most women and beginner golfers have not yet developed adequate forearm power and thus have weaker wrists and grip strengths. Many beginners are taught to hold the clubs in more neutral positions and if they do not understand the concept of “grip strength” or how hard to hold the club, the wrists will break through the course of the swing. This is the basic underlying problem in the grip that causes injury.

Why?:

* If the grip is weak, there is adequate control of the club and as the club flaps around, the wrists are under a lot of strain.
* Stronger grips lock the wrists and neutral grips only work if proper grip strength is applied.
* In an attempt to get more power and distance, there is a conscious attempt to hinge or cock the wrist and then rapidly uncock them through impact. This is the “misconception” of the delayed hit. What delivers the speed at impact is not a delayed uncocking but an acceleration by a quick rolling of the forearms at impact.
* People try to break this down into components. The mistake is that all of these parts should come together in one complete motion.

Knowing your pain and keeping it away

Whenever you get this type of pain, no matter what you do, you cannot play through the pain. It is important to rest the wrist. Apply ice on the pain area and, if the pain is really bad, benefit from wearing a wrist brace or splint. Pain relievers such as anti-inflammatory tablets or topical creams can give immediate relief. If the pain persists, then you may need to have treatment in the form of physical therapy, ultrasound, or paraffin. You should see a doctor, preferably an orthopedic surgeon but more specifically, one who understands the golf swing. The reason for this is that, resting the wrist and therapy will relieve the pain but if you go back to your old swing habits, then it will only be a matter of time before the pain comes back. Your doctor should be able to identify what your problem is and help you with it. Personally, I have a shortened club in my clinic and I ask the golfer to grip and go through the motions of the swing so I can identify the flaws.

Many fitness professionals prescribe wrist flexion and extension exercises in golf training programs. This is wrong due to a poor understanding of the golf swing. During the golf swing, there should be very little through range wrist movement except in the thumb up to thumb down positions. All programs should aim to provide symmetry and a smooth transition from thumbs up to thumbs down to create good rolling of the forearms. Strengthening does not need to work on bringing the wrist up and down with weights but should focus on grip strength and left versus right balance. If no assessment has been done and your program includes these exercises, seek advice from a golf-trained physiotherapist or a knowledgeable coach.

Published on Golf Digest Philippines, August-September 2007 issue