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The link between wrist function and injury patterns in golf

Updated: May 29, 2020

In the last edition, I discussed the role of right arm in the backswing and what makes good function. In this article, let’s now explore the link between some common patterns relating to poor wrist mechanics and injury correlations.

As was highlighted, good right arm function in the backswing is primarily underpinned around three main requirements, firstly the scapula remaining connected (depressed) on the ribcage, secondly for the right wrist to move radially as the golfer moves to the top of the backswing and finally, good concepts as to what is good wrist action. Injuries frequently in golf occur when the body attempts to recover in the downswing for a breakdown that existed at set up or in the backswing in an attempt to ‘find impact’. This situation arises as effectively the brain has an inbuilt radar, a little like a GPS system, that when the brain recognises that it is off line and somewhat lost, it will use its GPS to get the golfer and club back on line in order to find impact. Typically, the most successful and skilled players are the ones that can make these corrections the quickest and most accurately. Ultimately, they have better neural systems. However, the flip side of this is this can often cause problems further down the chain. I’d like to look at two typical patterns that I see within golf swing biomechanics and their link to common wrist injuries observed in golfers, namely problems through the scapho-lunate ligament and triangular fibrocartilage complex (TFCC).

Pattern one – wrist extension in transition.

A familiar movement that I observe in the transition phase between back and downswing is for the right wrist to move further into extension as the arms and club start their downswing. Asides from compensations this creates through path, plane, clubface, right arm/scapula function one of the biggest issues associated with this is the compression it can then create around the scapho-lunate ligament. Arguably, this is now the site of one of the most reoccurring injuries observed in golfers, increasingly in younger players due to the body structure not being able to control and support the movements made, poorly fitted equipment and the high volume of shots hit that younger players are now exposed to. The other influence that can impact on this is swing misconceptions and a lack of understanding of the task, essentially what are they trying to achieve? Therefore, the wrist joint gets asked to do much more than it is anatomically designed to do and the range of motion its gets put through inevitably will cause it to breakdown over time. Once the wrist moves into excessive extension, as a response the golfer will invariably lose connection between the right arm and trunk through impact as the bodies GPS attempts to self-correct as the golfer reacts to find impact. This breakdown can then manifest into poor club/ball delivery data which will be detected by Trackman etc..

So, what is good right wrist function and what does it look like?

On the graph below you will see two lines, the blue line represents good right wrist function and the green line poor right wrist/dysfunction. What I would like you to look closely at it what happens to these curves in the early phase of downswing. (On the graphs A, T, I, F relates to – address, top, impact and finish). You will see that with good wrist function, the curve moves gradually upwards which signifies the wrist moving progressively into reduced extension, whereas on the green curve it drops downwards significantly which is showing how the wrist is now moving further into extension, therefore creating compression/overload around the scapho-lunate ligament. You may also note the velocity at which this happens, which is shown by the steepness in the drop in the graph. Additionally, this creates higher levels of supination around the forearm with the wrist trying to move into ulna deviation whilst still extended. It is this combination of supination, ulna deviation and extension that compresses the bones/soft tissue through poor loading patterns. Try for yourself (gently of course!) supinate, ulna deviate and extend the right wrist and feel where you sense the compression. Now imagine doing this 50+ times a day at great speed as golfers typically do. One important note, this description relates purely to the start of downswing, the movement patterns that create left wrist scapho-lunate injuries typically occur in the through swing due to how the wrist moves from impact to finish.

In the 2D video world, below are two examples of how good right wrist function looks and how consequently it relates to improved connection between right arm and trunk on impact and oppositely, excessive extension in the downswing and how this often leads to disconnection between right wrist and trunk through impact (move on this later when we look at the TFCC injury).

Good wrist function.

You will see here how the right wrist is positioned and how this corresponds to good connection between right arm and trunk, both at the top of backswing and impact as shown below.

Thank you to Martin Joyce and Nathan Holman for the use of the pictures.

Poor wrist function

Conversely, you will see here and over extended right wrist and its subsequent impact relationship between right arm and trunk as well as compensatory body movements (which can also cause residual injuries)

From an anatomical perspective, the wrist is asked to work into ulna deviation whilst still in extension, which is what causes overload around the scapho-lunate.

Ulna deviation

Wrist extension

Pattern two - TFCC injury

As we are looking just at the right wrist in this article, the TFCC typically gets overloaded when the right wrist moves into ulna deviation, flexion and pronation which are effectively the movement it makes in the initial movement post impact and early through swing. In simple language, the TFCC acts as a shock absorber and a load transmitter which is often then overloaded as a consequence for poor function of the right arm and often the body in backswing as well dysfunction in the right wrist as described earlier. The morale of the story is such, injuries often occur in the right wrist for all manner of reasons, however one common denominator is the pattern the right arm moves in from set up, backswing, downswing and through impact. In many ways, if the wrist does breakdown, the injury sustained is often reliant on how extreme the movements are at various points of the chain and the consequential recovery move. Despite these two different injuries historically occurring at various stages in the golf swing, essentially it’s the same pattern that lead to the breakdown. Therefore, areas that need consideration when looking at injury and cause and effect patterns need to include:

  1. Swing concepts

  2. Understanding and clarity of the task

  3. Body structure/framework, primarily postural awareness/symmetry, scapula control, good axial skeleton control and range.

  4. Good connection between arm and trunk, in back, down and through swing.

  5. Correctly fitted equipment.

  6. Practice volumes and in winter periods, quality of range mats hitting from.

An example of right wrist dysfunction which can lead to TFCC injury is shown below. Note the blue curve which charts pronation/supination of the forearm, the light yellow curve which measures the flexion/extension of the wrist and the orange curve that depicts the ulna/radial deviation of the wrist. You will see here that on impact and just after, how the blue line drops rapidly indicating excessive pronation, the yellow curve going up steeply, outlining rapid wrist flexion and the orange curve moving up identifying ulna deviation. This pattern linked back to the TFCC injury in this player, however when exploring the cause and effect patterns as to what lead to this movement through impact, it emerged that this was the product of a flawed swing concept based around the golfers definition of connection and spending excessive time hitting shots with a towel under both arms.

Below is how it often looks on video

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