**12. The effect of wrist manipulation on the medial aspect of the leading wrist**

At impact the golf ball, club and ground collide resulting in a counter force that is transmitted up the shaft of the club to the wrist and hands which are on the golf club grip. The majority of golf injuries occur on the downswing and at impact [23].

The golf swing requires complex movement of many components of the body. The co-ordination of muscle sequencing is particularly important and is noted to be the most efficient in the elite golfer. The manipulation of the leading wrist has been a source of a crusade for many golfers as they seek the perfect golf swing. The leading wrist has the ability of storing the kinetic energy which is released at impact, thus resulting in greater power delivery to the ball and greater accuracy [20–24], but it comes at a cost.

With a late hit, skilful golfers apply torque to the leading wrist in an effort to store more energy prior to impact with the golf ball. This stored energy by holding the leading wrist in a forced flexed and ulnar deviated position throughout the first part of the down swing could be considered a compensatory methodology and an effort to compensate for faulty swing mechanics. This may be a purist view, however, the manipulation of the wrist to improve stored energy prior to impact places further extreme pressure onto the leading wrist and particularly the lateral aspect of the wrist. The rapid transitions from a radial deviated, flexed pronated position through a relatively neutral position at impact and onwards to a supinated and ulnar deviated position is the cause of trauma to this anatomical location.

Many skilled golfers manipulate the club face with the hand and wrists as the face of the club impacts with the golf ball. These subtle variations impart different spins onto the golf ball affecting its flight and trajectory as it seeks it target on the green. A "hold off "shot imparts a left to right spin on the ball in a right-handed golfer. This is achieved by holding the left wrist firm (holding it off) at impact, preventing the natural supination of the left wrist as it transitions to impact and the follow through phase of the swing. Resisting this natural movement places great stresses on the medial structures of the left wrist which are activated to resist this natural anatomical motion.

Golfers who have quiet hands and wrists during the golf swing rarely sustain wrist injuries. Wrist manipulation may be a trade off between distance and injury.
