Episode 19 | Ask the Expert | Guest: Pat Gillham, Specialist Golf Physiotherapist, Driving Performance Golf
Golf has a reputation it doesn’t entirely deserve. Perceived as sedate, low-impact, and forgiving on the body, it is none of those things for anyone swinging a club with any real intent. The forces involved are substantial, the movement patterns are highly loaded and rotational, and the injury rate among amateur golfers is higher than most people assume.
In this episode of the London Bridge Sports Medicine podcast, Dr Ajai Seth is joined by Pat, a physiotherapist who has specialised in golf injury and performance and runs his own golf injury clinic at World of Golf London in New Malden, Surrey. Between them, they cover the physical demands of the game, the most common injuries and their root causes, the role of strength training, and how to build a sustainable practice that keeps you on the course for life.
Golf is more physically demanding than it looks
A 1990 study found that elite golfers generate forces through the spine equivalent to around 750 kilograms per swing. That figure will be higher for today’s professionals, who generate considerably more clubhead speed. For amateur golfers, the forces are lower – but still three to four times body weight through the lumbar spine with every full swing.
Pat uses an analogy from strength coaches on the European Tour: if you want to increase the size of your engine – generating more force and speed through the ball – you also need a stronger, more stable chassis to handle it. The same principle applies at every level. Equipment technology has improved dramatically, allowing amateurs to generate more power than ever before. Without a body capable of managing that power, injury becomes increasingly likely.
The most common golf injuries – and what really causes them
Golfer’s elbow gets all the attention – largely because of the name – but it is not typically what experienced golfers present with. The most common injuries, according to Pat, break down as follows:
- Lower back: the most prevalent complaint, affecting an estimated 18–36% of injured amateur golfers
- Elbow: 8–33% of golfers
- Wrist and hand: 10–32%
- Shoulder: 4–18%
But Pat’s key clinical observation is this: elbow, wrist, and shoulder injuries in golfers are very often compensation injuries rather than primary ones. The body is a kinetic chain – force should be generated through the large muscles of the trunk, hips, and legs, with the arms and hands following. When the big muscles are weak or restricted, the smaller joints of the upper limb overwork to make up the difference. “Our body goes into areas of least resistance,” says Pat. Treat the elbow without addressing why it’s being overloaded, and the problem will return.
The neck is also a frequent site of pain, and is often related to the same trunk and hip restrictions driving the other upper limb injuries.
The role of strength and conditioning
The most visible shift in professional golf over the past decade has been the transformation of the sport’s relationship with the gym. Players like Rory McIlroy have demonstrated that serious strength work and elite golf performance are not only compatible – they are complementary. The evidence backs this up: stronger lower bodies generate more explosive force, which translates directly to greater clubhead speed and distance.
For amateur golfers, the performance gains matter – but the injury prevention case is arguably more compelling. Pat’s single most important piece of advice: get into the gym and work with someone who can design a structured programme around your golf. Three sessions per week of strength training, he says, will produce gains that most golfers would find remarkable.
The focus should be on the muscles that drive the golf swing: the trunk, the hips, the glutes, and the legs. These are the engine. Building them reduces the load placed on the more vulnerable joints of the shoulder, elbow, and wrist.
Managing training load at the range
Volume management is as important in golf as in any other sport. Coming straight from a desk to the driving range and hammering 100 balls with a driver is a reliable recipe for injury – yet it is exactly what many golfers do.
Pat’s guidelines for a sensible range session:
- Warm up properly: 15 minutes of gym-type exercises and club swings before hitting any balls. Evidence shows adequate warm-up meaningfully reduces injury risk.
- Build up through the bag: start with pitching wedge half-swings and work progressively through to longer irons and finally the driver. Around 10 balls per club is a sensible structure.
- Keep total volume sensible: for most amateurs, 50–80 balls per session is enough. Vary the clubs throughout.
- Apply the 10–20% rule: when increasing frequency or volume, do so by no more than 10–20% at a time. Spikes in load are a primary injury risk factor.
- Be cautious with swing changes: implementing a new technique – even on good professional advice – can temporarily change load distribution and trigger injury. Introduce changes gradually.
Technique, biomechanics, and when to get assessed
The relationship between physical restriction, swing mechanics, and injury is genuinely complex. A golfer told to “use your hips more” may try to force rotation through a joint that simply cannot produce it – causing the body to find that range elsewhere, often through the lower back or shoulder. What looks like a technical flaw may actually be a mobility or strength limitation, and the right intervention is clinical rather than coaching.
Pat’s assessment approach integrates swing video from the teaching professional, a biomechanical examination of the relevant joints (particularly hip and thoracic rotation), and grip strength measurement. The goal is to identify what the body is actually capable of – and to relay that clearly to the teaching pro, so that swing guidance is tailored to what is physiologically achievable rather than what is theoretically ideal.
For more complex cases, Dr Seth adds the medical layer: imaging, structural assessment, and clinical diagnosis of any underlying pathology. The optimal MDT for a golfer with a persistent injury is a sports physician, a specialist physio, and a teaching professional – each contributing their own expertise rather than any one person trying to cover all three.
Don’t play through niggles
Both Pat and Dr Seth are emphatic on one point: the tendency among golfers to dismiss pain as part of the game, and to play through it, is one of the most damaging things they can do. “The sooner you get things looked at, the quicker you can get it sorted – and you stop it becoming a chronic issue,” says Dr Seth.
A niggle that has been present for three weeks is far easier to treat than one that has been running for six months. And the investment in getting it assessed – which many golfers are reluctant to make, despite happily spending on equipment and green fees – is almost always smaller than the cost, in time and pain, of leaving it alone.
“You could play golf for the rest of your life, pain free,” says Pat. “As long as you’re willing to spend a little more time on it and a bit more investment in it.”
The bottom line
Golf is a physically demanding sport that rewards preparation. Strength training, sensible load management, timely treatment of niggles, and collaboration between the right professionals are the four pillars of staying injury free and performing well over the long term. The game is more accessible than ever – and with the right foundations, there is no reason it cannot be a lifelong sport.
Patrick Gillham is a specialist golf physiotherapist and founder of a golf injury clinic based at World of Golf London, New Malden, Surrey. Find out more at drivingperformancegolf.com.
If you’re managing a golf-related injury or want to discuss your performance with the LBSM team, visit lbsm.co.uk/booking
Listen to the full episode below ↓
