Where does golfer’s knee pain come from?

Marc Darrow, MD

For most, golfer’s knee pain is a degenerative process caused by the repetitive motions of the golf swing and the twisting of the forward knee in the follow through. The force of continued impact on the knee is usually manifested as chronic, dull pain; cracking or popping sounds from the knee while walking; and, pain from swelling and inflammation. These symptoms can come on slowly or more rapidly depending on the technique of the golfer and the remedies they chose to administer to themselves.

The interior damage to the knee
The knee can be injured in many ways during golf. The force of the golf swing can place extreme force on the knee. The resulting twisting of the knee can can result in acute tears of the ligaments, tendon attachments, cartilage, and meniscus. The continued wear and tear on the knee can result in degenerative wear on the knee’s sift connective tissue and cartilage. This degenerative wear can also result in the development of knee osteoarthritis.

The ACL (anterior cruciate ligament), the MCL (medial collateral ligament) and the PCL (posterior cruciate ligament), are powerful ligaments responsible for holding the knee, the thigh bone (femur) and the shin bone (tibia) in their proper place in respect to each other.

When these ligaments suffer from excessive wear caused by a twisting golf swing, they become lax, they loosen up and a tight knee becomes a “wobbly knee.” When the thigh and shin bone are allowed to become hypermobile they can grind down and wear out the protective padding between them, the meniscus and the articular cartilage.

The articular cartilage is the protective padding covering over the bottom of the thigh bone and the top of the shin bone. The meniscus is the soft pad between the bones that absorb the impact of walking, running and jumping. When they wear down, bone-on-bone osteoarthritis occurs.

There are many treatment options available to the golfer. Most physicians will recommend a conservative route rich in anti-inflammatory medications, ice, pain-killers, and rest. When these options fail, as most times they do, the next conservative option is to “live with it,” or have the surgery.

Why do these treatments fail?
Because they all inhibit inflammation. Inflammation is the body’s healing mechanism. No inflammation, no healing. The problem with inflammation is excessive inflammation. The injured knee cannot heal itself and the body turns up the inflammatory response with its accompanying pain and discomfort.

The key to treating the injured knee in golfers, or any athlete or patient with chronic knee pain, is to control the inflammation. Platelet Rich Plasma Therapy and Prolotherapy are injection techniques that helps concentrate inflammation and maximize its benefits in a controlled situation.

In a July 2021 study, (1) researchers compared the acute (immediate) effects of walking the golf course versus using a golf cart during a round of golf on biological markers of joint disease, joint pain, and cardiovascular parameters in individuals with knee osteoarthritis.

  • Ten golfers with knee osteoarthritis participated in this study. They were all above age 50.
  • The tests were performed after these golfers completed two 18-hole rounds of golf either walking the course or using a golf cart.
  • Five control participants performed the walking condition only.

Results: In knee knee osteoarthritis participants, walking the course was associated with significantly higher step count and duration of moderate/vigorous physical activity but did lead to a significant increase in knee joint pain and increase in inflammatory markers. For these patients, the use of a golf cart is recommended.

1 Jayabalan P, Bergman R, Jauregui E, Hanaoka C, Stoker AM. The acute physiological effects of continuous versus intermittent walking during golf in individuals with knee osteoarthritis: a pilot study. American Journal of Physical Medicine & Rehabilitation. 2021 Jul 23.


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