Senior Golf and the Effects of Aging


Edward C. Jones, MD, MA

Edward C. Jones, MD, MA

Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Chairman, Institutional Review Board, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College


Introduction

Golf caters to the senior player more than any other sport. There is no age limit, and the handicap system allows an ongoing and organized competition. A good thing, since the population is aging, with nearly twenty percent of Americans - or sixty million people - over the age of 65.

Contrary to Mickey Mantle’s observation, “If I had known I was going to live so long, I would have taken better care of myself,” most people today are well nourished, more active, and generally committed to keeping their health in order. Many of the physical limitations associated with aging are as much the result of inactivity and disuse as they are due to physiological deterioration. Form does indeed follow function, and somewhere in the formula for long-term success and pleasure in golf is a commitment to regular exercise and proper nutrition.

When aging sets in, however, it may take more than proper exercise and nutrition to maintain and restore the joints of the body to the condition necessary to resume playing “the greatest game.”


The Effects of Aging

The physical hallmarks of aging are a gradual loss of strength, endurance and, most of all, flexibility. We all suffer the consequences of wear, particularly in our joints. In the extreme, this wear results in the loss of articular cartilage that cushions the moving surface of our joints, i.e. osteoarthritis. Often quoted are estimates that 15 percent of the population develops symptomatic “wear and tear” or osteoarthritis, but that seems like a low estimate.

Until twenty-five years ago, the most common treatment for arthritis of the hip or knee was aspirin and a cane, resulting in severe disability, loss of independence, and a sedentary, painful existence. We now appreciate the merits of mobility, both for general health and for specific joint problems. We generally do better if we keep going by maintaining motion and strength in those arthritic joints.

In recent years, with the evolution of joint replacement surgery, the level of continued independence and pain-free function has had a profound effect on the quality of life of many individuals with arthritis of the hip and knee. Today, hip and knee replacement surgeries are commonly performed with only rare serious complications, and many golfers resume play without significant change in handicap. In fact, golfers and other low-impact exercisers benefit in the long term with harder bones and healthier bodies, and the resultant heightened sense of well being.


Treatment of Arthritis

The best remedy for early arthritis is to minimize stiffness with regular stretching and to maintain strength with low resistance exercise. For the golfer, this can range from swinging a weighted golf club to elaborate exercise programs. As with all exercise, proper technique is essential for maximal benefit and to avoid injury. If you are interested, many well-known golfers, from Gary Player to Tiger Woods, have devised exercise programs to meet these needs.

Technological advances quickly find their way into the golf market and can be a great help to senior players. In addition to oversized club heads and other design and material changes, custom club fitting can meet the needs of a variety of body types, swing styles, and physical limitations. Generally, senior golfers should consider lighter clubs with more flexible shafts. Built-up grips can protect sore hands. Longer clubs with more loft are easier to hit, but optimum club length is variable and not easy to determine. Demonstration equipment is readily available and one can always benefit from good professional advice.

Professional instruction is also the way to develop stance adjustments and swing techniques that minimize stress and adjust for various physical problems. Long-hitting professionals get tremendous distance from extreme rotation of their shoulders and upper body. However, for the senior recreational golfer, the classical golf swing (which matches hip and shoulder rotation) will significantly reduce stress on the low back.


Joint Replacement Surgery

When it comes to relief of suffering, improving quality of life, and enhancing senior golf, the most effective procedure for osteoarthritis, and perhaps musculoskeletal conditions in general, is total joint replacement surgery. More than 350,000 hip replacements and 300,000 knee replacements are performed yearly in the United States. It is estimated that more than seventy percent of these procedures are performed on those 65 and older. A very common sport related question from prospective hip or knee replacement patients is, “will I be able to continue playing golf?” The answer in most cases is an unqualified yes. Your surgeon is the final authority in determining what to do and not do after surgery.


Total Hip Replacement

Most hip surgeons feel that their golfing patients do not have a higher complication or revision rate than their other patients. In hip replacement surgery, the components are held in place by either cemented or bone ingrowth fixation. This may be a factor in determining when to resume golf.

Generally, two conditions are necessary. The first is secure fixation of the implant, which may take a bit longer in the noncemented hip. The second is muscle strength. Before returning to golf, rehabilitation should emphasize strengthening the muscles which optimize hip joint stability and function. The most important muscle groups after hip replacement are the hip abductors, flexors, and extensors.

The abductor muscles control the lifting of the leg out to the side and away from the other leg. The flexor/extensor muscles pull the leg back and forth, extending and flexing the hip.

Following hip replacement, the surgeon determines a suitable period of time for healing during which certain positions are to be avoided, specifically extreme flexion and internal rotation. As muscle tone progresses, most people are able to gradually return to golf in three to four months. Use of a golf cart is generally recommended for up to a year after hip replacement; once good hip strength is restored, it is safe to resume walking the course, as tolerated. Carrying your clubs is inadvisable, as this puts an unnecessary load on the hip.


Total Knee Replacement

Knee replacement surgery has improved dramatically in recent years. Some surgeons are concerned about the torque generated on the knee with the golf swing, particularly the stresses on the left knee in a right-handed golfer. However, most surgeons feel their knee replacement patients will be able to return to golf in three to four months after surgery. Some start their patients gradually with chipping and putting until motion and strength are maximized. It makes sense to use a cart for at least a year and perhaps indefinitely, given the hazards of uneven ground.

In the golf stance, slightly splaying open the feet will reduce pivot. Consider a more upright stance, with less knee flexion, and be conscious of an even distribution of weight on both legs and smooth transfer of weight from back to forward leg during the swing. There is less stress to the knees when short irons are played, and more stress and rotational strain hitting for distance with the long clubs. Wear shoes with soft rubber spikes and avoid over-swinging. Sam Snead’s solution to over-swinging was to practice barefoot.

For knee replacement patients, the most important muscle group to be restored is the quadriceps muscle in the front of the thigh. These are the muscles that extend the knee against resistance and really determine the level of knee function.


Total Shoulder Replacement

Much less common is the need for shoulder replacement surgery. A golfer will need three to six months to regain preoperative range of motion and a good level of strength. Here too, the patient should begin with putting and chipping, advancing to longer shots as comfort permits. Most surgeons advise their total shoulder patients to play “winter rules” and perhaps even tee the ball up on all fairway lies to minimize the shock transmitted to the shoulders at impact.

The usual indication for joint replacement surgery is relief of the pain caused by a severely arthritic joint. The resulting comfort and improved mobility allows the golfer to return to the game with muscle memory intact and at about the same level of proficiency. Best of all is regaining the beneficial effects of a comfortable round of golf on a regular basis for years to come.

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