By Paul Perry, MD

Shoulder pain is a common complaint among avid golfers. During the golf swing, the leading shoulder is subjected to a number of loads and stresses that place it at risk for repetitive overuse-type injuries. Stresses occur both at the top of the back swing and at the end of a full textbook follow-through. These significant stresses and the full arc of shoulder motion are what cause the leading shoulder to be responsible for 90 percent of the shoulder symptoms golfers experience.

For golfers, the most common shoulder condition is inflammation in the joint between the collarbone and shoulder blade, the acromioclavicular joint. This joint is subjected to the most severe loads, particularly at the top of the back swing of the leading shoulder when the joint is maximally compressed in that position.

First, play less

Because repetitive overuse mechanisms predominate in shoulder problems, the primary manner to alleviate these symptoms is to play and practice less intensely. To treat any one of these conditions adequately often requires an evaluation by a physician experienced in treating shoulder difficulties. A careful history, physical examination, and X-rays of the shoulder will often identify the exact source of the pain. On occasion, magnetic resonance imaging (MRI) is required to assist with obtaining the correct diagnosis.

Treatment of these shoulder conditions can vary widely. Simple activity limitation and use of nonsteroidal anti-inflammatory medications, such as ibuprofen or naproxen, are effective methods to treat the most straightforward of these shoulder problems.

If shoulder instability or rotator cuff problems exist, a referral to a physical therapist wellversed in shoulder difficulties is an important adjunct to rest and the use of anti-inflammatory medications. Rotator cuff strengthening exercises are a simple and straightforward manner of dealing with the rotator cuff tendonitis and impingement problems. These exercises are also effective at addressing shoulder instability issues, which are a common source of shoulder pain, especially in low handicap amateurs and professional golfers.

When rest, oral medication, and physical therapy do not fully alleviate shoulder pain symptoms, then the use of injectable cortisone is a legitimate option for effective treatment. In very refractory cases, sometimes shoulder surgery is required – for example, in the case of golfers who develop substantial tears in their rotator cuff tendons or fail to respond to other therapies.

Adjusting the swing

As with most golf injuries, taking appropriate measures to prevent injury is important. At the earliest signs of shoulder discomfort, restriction of overuse activities is an important first step. To remove stress from the shoulder, you can make small swing adjustments, such as shortening the end of the back swing with the club head moving back to one or two o’clock instead of the normal three o’clock position. Conditioning the rotator cuff and muscles around the shoulder blade with light weights and other resistance training is also beneficial. Consulting your local PGA of America professional for instruction and proper mechanics can be worthwhile.

Shoulder pain is both a preventable and treatable problem associated with avid golfers. A high percentage of golfing-related shoulder conditions can be alleviated with appropriate and timely treatment. The most important piece of advice, however, is that if the simple solutions for alleviating shoulder pain do not work, seek professional help to identify the source of the pain and its appropriate treatments.