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I am frustrated with pains playing golf; it seems to reoccur each season. What can I do? — Bill, area patient

Bill, your complaint is very common among many amateur golfers who play and practice on a regular basis. Many people think golf is a low-level physical activity with low risk for physical ailments. That is far from the truth. There is a multitude of common "golf injuries or problems."

The following is a list of the golf- related injuries or complaints that I see: Low back pain; shoulder pain; ankle and knee pain; wrist pain; and elbow pain.

Low back pain may be muscular only and resolved with a good physical therapy program and anti-inflammatory medication. The rotational stresses of the golf swing can place considerable pressure on the spine and muscles. Flexibility is important, and an off-season program of stretching and flexibility workout may prevent injuries during the season.

The second most common site of pain that I see is the shoulder. Usually, it is an impingement bursitis or tendinitis due to too high of a shoulder turn on the back swing or too high of a shoulder turn on the follow through irritating the rotator cuff under the bone. Stretching the muscles of the shoulder and correcting the swing angle can cure or prevent this problem.

Golfer's elbow is usually an inflammation of the elbow components but may be a joint impact problem. Forearm rotational strengthening, wrist curls and hand squeezing exercises along with slowing the golf swing can keep this from recurring

Wrist injuries are frequently an inflammation of the tendon that can be resolved with splinting at night and/or a local cortisone shot or anti-inflammatory medication.

The last area and least frequently seen is inflammation of the tendon on the foot from inversion of the left foot (for a right-handed golfer) at follow through and the arthritis knee being irritated by twisting. An off-season program of combined stretching for the trunk, hips, shoulders and a golf specific strengthening program for the core trunk muscles as well as muscles of the back is important to improve your distance and power with the swing.

Obviously, all of these problems can vary from one golfer to another, so a thorough evaluation of the individuals' complaints can lead you to a happier golf season.

Dr. William Hull is a member of the Orthopedics and Sports Medicine Center and specializes in orthopedics surgery and is board-certified in sports medicine. Hull attended medical school at Creighton University in Omaha, Neb., completed his internship at Hennepin Medical Center in Minneapolis and was a resident at the University of Minnesota. He has been with Deaconess Billings Clinic since 1975.