Golfer's Shoulder

What is golfer's shoulder?

The golf swing puts unusual demands on the shoulders. The lead arm is pulled across the body at the top of the backswing, then the shoulder rotates rapidly through impact and follow-through. Repeating this hundreds of times a week, especially with poor technique or after time off, overloads the tendons and joints.

Golfer's shoulder is not the same as golfer's elbow (medial epicondylitis), which is pain on the inner side of the elbow from the forearm tendons.

Common causes in golfers

Why the lead shoulder?

For a right-handed golfer, the left shoulder is stretched across the chest at the top of the backswing, compressing the AC joint and stretching the back of the shoulder. Then it is pulled forward hard in the follow-through. The trail (right) shoulder is more often affected by impingement as it lifts at the top of the swing.

Risk factors

• age over 40, when tendons become less elastic
• increasing practice or range sessions suddenly
• poor swing mechanics, such as an overly long backswing or "arm-only" swing with little hip and trunk rotation
• limited mobility in the upper back (thoracic spine), which forces the shoulder to do more of the work
• weak rotator cuff and shoulder blade muscles
• hitting thick rough or the ground hard

Symptoms

• aching or sharp pain at the top, front or outer side of the shoulder during or after play
• pain at a particular point in the swing, often the top of the backswing or impact
• a painful arc when lifting the arm out to the side
• night pain when lying on the shoulder
• weakness or loss of distance
• clicking or catching

Diagnosis

A doctor or sports physical therapist will ask when in the swing it hurts, then test your range of movement and strength and use specific shoulder tests to pinpoint the tendon or joint involved. Imaging is used when pain persists or weakness suggests a tear:

• X-ray: for arthritis and bone spurs
• Ultrasound: shows rotator cuff tendons and tears quickly
• MRI or MR arthrogram: for labral tears and detailed cuff assessment

Treatment

Relative rest

Stop full swings for 1 to 3 weeks, or switch to gentle putting and chipping if they do not hurt. Complete immobilization is not needed and can cause stiffness.

Pain relief

• Ice for 15 minutes after activity
• Ibuprofen or naproxen for a short period, following the label dose, unless you have stomach, kidney or heart problems
• A corticosteroid injection into the space above the rotator cuff can calm severe impingement pain, allowing rehab to start. Repeated injections are avoided

Physical therapy

Rehab is the main treatment:

• rotator cuff strengthening with resistance bands, especially external rotation
• shoulder blade (scapular) stabilizing exercises
• stretching the back of the shoulder capsule
• improving thoracic spine rotation and hip mobility so the body, not the arm, powers the swing

Swing changes

A lesson with a golf professional can make a big difference. Common adjustments include shortening the backswing, improving trunk rotation and reducing grip tension. Warm up for 10 minutes before playing.

Return to golf

Return gradually: putting and chipping, then half swings with short irons, then full swings, then a full round. Most people are back within 6 to 12 weeks.

Surgery

Surgery is considered only for a significant rotator cuff tear, a labral tear with instability, or persistent pain after 3 to 6 months of good rehab. Arthroscopic repair usually means 4 to 6 months before full-swing golf.

Prevention

• Warm up with arm circles, trunk rotations and gradually longer swings.
• Do rotator cuff and shoulder blade strengthening exercises twice a week.
• Increase practice volume gradually after a break.
• Get a swing assessment if pain keeps recurring.

Frequently asked questions

What is golfer's shoulder?

Golfer's shoulder is a non-medical term for shoulder pain caused by the golf swing. It usually means rotator cuff tendinopathy, impingement or AC joint irritation, most often in the lead shoulder. It is different from golfer's elbow, which affects the inner elbow.

Why does my left shoulder hurt after golf?

In right-handed golfers, the left shoulder is the lead shoulder. It is stretched across the chest at the top of the backswing, compressing the AC joint and stressing the rotator cuff. Poor trunk rotation and a long backswing make this worse.

How long does golfer's shoulder take to heal?

Most cases improve within 6 to 12 weeks with relative rest, physical therapy and swing changes. Rotator cuff tears or labral injuries that need surgery take longer, often 4 to 6 months before returning to full golf.

Can I keep playing golf with shoulder pain?

If pain is mild and settles quickly, you can often continue with shorter swings and fewer range balls. If pain is sharp, causes weakness or night pain, or is getting worse, stop and have it assessed so a tendon injury does not progress.