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Rotator Cuff Injuries: The Shoulder’s Impossible Dual Demand
The golf swing requires the shoulder to simultaneously provide extreme mobility allowing the massive range of motion necessary for proper swing mechanics while maintaining the stability preventing injury during the violent forces at impact. This mobility-stability paradox proves particularly challenging for the lead shoulder (left for right-handed golfers) which must move through extraordinary ranges during the swing while absorbing deceleration forces and maintaining control through impact.
Rotator cuff pathology in golfers typically develops through cumulative microtrauma rather than acute tearing. The repetitive overhead positioning during backswing, the explosive acceleration forces during downswing, and the eccentric loading during follow-through create progressive tendon degeneration when swing volume or mechanics exceed tissue adaptive capacity. The supraspinatus and infraspinatus (posterior rotator cuff) prove most vulnerable given their role stabilizing the humeral head during the dynamic movements throughout the swing.
Mechanisms and Presentation
Lead Shoulder Vulnerability
At the top of backswing, the lead shoulder positions in maximum horizontal adduction (across the chest) combined with some internal rotation. This positioning creates compression of the rotator cuff tendons beneath the acromion (internal impingement) as the greater tuberosity approaches the posterior-superior glenoid and labrum. The compression becomes problematic when inadequate scapular upward rotation, thoracic mobility limitations, or poor swing plane force compensatory excessive shoulder motion.
During the downswing and impact, the lead shoulder must maintain stability despite massive forces attempting to distract the glenohumeral joint. The rotator cuff contracts intensely maintaining humeral head centering within the glenoid while the powerful prime movers (pectoralis major, latissimus dorsi, subscapularis) generate swing velocity. When the club strikes the ball, sudden deceleration creates jarring forces transmitted through the arms into the shoulders—the lead shoulder’s rotator cuff must absorb these forces eccentrically maintaining joint integrity.
The follow-through requires the lead shoulder to continue moving through internal rotation and horizontal adduction while decelerating. This eccentric loading on the posterior rotator cuff (infraspinatus and teres minor resisting the internal rotation) creates substantial strain particularly during full-intensity swings with maximal follow-through.
Trail Shoulder Mechanics
The trail shoulder (right for right-handed golfers) faces different stresses. During backswing, the trail shoulder moves into extreme external rotation and horizontal abduction positioning the arm behind the body. This extreme positioning stretches the anterior shoulder structures and compresses posterior structures potentially creating posterior shoulder pain from internal impingement (the posterior rotator cuff compressing against the posterior glenoid and labrum).
During downswing, the trail shoulder explosively internally rotates and horizontally adducts generating power. The violent acceleration requires substantial concentric rotator cuff activation maintaining stability despite the powerful prime mover contraction. Poor scapular control or rotator cuff weakness allows abnormal humeral head positioning creating impingement or instability symptoms.
Clinical Presentation and Treatment
Symptoms: Anterior or lateral shoulder pain during and after golf, sometimes radiating into the upper arm. Pain often worsens with overhead reaching or specific swing phases (backswing for internal impingement, follow-through for eccentric overload). Night pain disturbing sleep occurs in more advanced cases. Weakness or fatigue during later holes suggests rotator cuff dysfunction affecting endurance.
Physical examination: Painful arc (pain between 60-120 degrees of arm elevation), positive impingement tests (Neer, Hawkins-Kennedy), rotator cuff strength deficits particularly in external rotation, and sometimes scapular dyskinesis (abnormal scapular positioning or movement).
Treatment: Activity modification reducing swing volume, physical therapy emphasizing rotator cuff strengthening (progressive resistance training for all four rotator cuff muscles), scapular stabilization (serratus anterior, lower/middle trapezius), thoracic spine mobility work, and technique correction addressing swing plane issues or excessive compensation. Advanced cases might require imaging (MRI) ruling out significant structural pathology like rotator cuff tears requiring surgical consideration.
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