Does Warming-Up Reduce the Risk of Injury to Golfers? A Cluster Randomised Controlled Trial

Abstract

Golf is a popular sport that is enjoyed by millions of people worldwide of differing ages and abilities. The game of golf is considered relatively benign in nature, however, it has been well documented that injuries do occur. A number of studies have revealed the prevalence of golf injuries related to the back, elbow, and shoulder that could potentially be prevented by the commonly proposed countermeasure of performing an appropriate warm-up. PURPOSE: To investigate the effect of a golf-specific warm-up program on the incidence of injuries to golfers. METHODS: This study was a cluster randomized controlled trial. A total of 344 golfers aged 18 – 66 years were randomly allocated to either the control (n = 166) or warm-up (n = 178) group. Participation in practice and games, and, in the warm-up group, compliance to the warm-up program was monitored over a 6-month period in 2004 / 2005. All injury characteristics (location, time of injury, and severity) were recorded using a golf specific injury reporting form. The severity of the injuries was calculated using both treatment length and time away from golf play and practice. RESULTS: There were no statistical differences between the groups in relation to number of golfers (p=0.7), age (p=0.6), handicap (p=0.4), gender (p=0.9), and previous 12-month injury status (p=0.6). During the 6-month period, 68 injuries occurred; 10 in the intervention group and 58 in the control group (p<0.001). Golfers in the intervention group were at a lower risk of injury compared to golfers in the control group (odds ratio = 9.0, 95% C.I. 4.4, 18.4). The intervention group sustained their injuries later in the round compared to the control group (median hole 8 vs 14), and the severity of the injuries were more pronounced in the control group compared to the intervention group both in treatment length and time lost. The intervention group did not sustain any severe injuries, with the majority of the injuries sustained being mild (<7 days) under both conditions, while the injuries in the control group were classified moderately severe (7–21 days) under both conditions. The non-injured intervention group golfers warmed-up appropriately 96.0% of the time compared to the injured intervention group golfers 63.0% of the time. CONCLUSIONS: The incidence of injury in golfers using a golf-specific warm-up program prior to play and practice was significantly reduced, especially the incidence of severe injuries. The reduction in incidence is highly significant and has been adjusted for the cluster sampling. This is the first randomized controlled trial with sufficient sample size to show that golf injuries can be prevented by performing a golf-specific warm-up program.