Whenever I hear any golfer mention pain in their wrist, I start to worry. Wrist injuries have the potential to be career-ending if not taken seriously and not treated properly.
When it comes to wrist injuries, we have our usual suspects of sprains and strain. These are usually caused by hitting a shot fat, tree root, or something along with that nature. Now, with golfers, there are a few injuries that we do not see every day. The one I want to talk about today is triangular fibrocartilage complex (TFCC) tears.
The TFCC is a complex group of ligaments and cartilaginous structures which stabilize the distal radioulnar joint. It stabilizes it during pronation (palms to the ground) and supination (palms to the sky) of the forearm. The TFCC is a triangular shape, and the central portion acts like a meniscus much like the meniscus in the knee. Injuries occur from ulnar overload, and the mechanism of injury can be acute (hitting the ball fat) or repetitive (improper swing mechanics). In my experience, the TFCC is a very common injury and almost always leads to surgical repair.
Since this injury tends to lead to surgery – our goal is to prevent or correct the issue quickly. Poor use of the lower body is the primary swing mechanic that leads to this injury. This is more of a general statement than a swing characteristic. Most players believe their wrist or hand pain is due to an upper-body problem, but in our experience, it can usually be traced back to a lower-body dysfunction. Anytime a player is not using their lower body effectively to initiate the downswing, the upper body is forced to overcompensate and becomes more active. This only puts more stress and strain on the structures of the upper extremities.
This first step in diagnosing a wrist or hand problem is to evaluate how effectively the player uses their lower body. Here is a quick list of the most common examples of poor use of the lower body:
- Hanging Back - the first thing to look for is a normal initiation of the downswing with a shifting of weight from the trailside to the lead side. If this does not happen, most players are forced to throw the club excessively from the upper body instead.
- Early Extension - Since the player’s lower body is thrusting forward, their upper body responds by standing up and moving backward to maintain balance. Because of this corresponding lifting up of the upper body in the downswing, the wrist is forced to excessively ulnar deviate to get the club to the ball. This puts stress on the TFCC and can lead to De Quervain’s tenosynovitis. Many of these players are custom fit into long and upright clubs which only feed their injury.
- “S”-Posture - Any excessive anterior tilt of the pelvis due to loss of core stability, rotary mobility problems, or improper set-up, dramatically reduces the effectiveness of the lower body in the golf swing. Most players who start in an “S”-Posture or go into an “S”- Posture as they swing will not use their lower body properly and put more stress on the upper body.
- Swaying or Sliding - Any excessive lateral movement of the lower body, reduces the ability of the body to generate rotary speed. Therefore, the player is forced to use more upper body power to compensate for the ineffective lower body.
The second step is to diagnose why we have poor use of the lower body. We determine this by performing different movement screens designed to look at how the body moves. We typically find three areas that do not function properly.
- Internal rotation of the lead hip is paramount for allowing the lower body to fully rotate without forward thrust toward the golf ball. If the pelvis is unable to rotate around the lead hip due to joint or muscular restrictions, then forward and lateral movements will dominate the pattern.
- The ability to separate the upper body from the lower body allows the golfer to maintain a stable posture and proper sequence of motion during the swing. Limited thorax-to-pelvis separation is usually caused by reduced spinal mobility and shortened lat flexibility.
- Finally, the ability to stabilize your lower body is directly proportional to gluteal and abdominal strength. A stable neutral pelvic posture helps prevent the lower body from thrusting toward the golf ball during the swing.
The third step is proper treatment. If we are having wrist pain and we find that there is nothing torn, the first thing we want to talk about is sleep. If one irritates their wrist for 8 hours a night, it does not matter what activities you are doing during the day or treatments you may be doing - your wrist will not be able to fully heal. At night, it is best to look for if you sleep with your hands up by your head, or sleep with them in flex or an extended position. These positions can lead to extra stress on the wrist. A good rule of thumb is to try to sleep with your arms down by your side or folded over your stomach.
If you are having wrist pain - do not play through the pain. Let’s get you in and assess your movement patterns. At Impact Health and Performance, we work closely with golf teaching professionals to ensure that you can continue to play golf injury and pain-free.