The Importance of Pelvic-Trunk Dissociation

The definition of dissociation is “the disconnection or separation of something from something else.”  In golf, this is especially important in regards to pelvis and thorax (trunk) separation.  The reasons are many and include everything from proper sequencing/ timing of the swing to production of club head speed and power.  This is clearly observed in what the Titleist Performance Institute coined “The Kinematic Sequence.”  A full review can be found —> HERE, but the basics are as follows:

Notice how the red line increase
The above graphs compare the swing sequence of a professional (left graph) and two amateurs (middle and right graph). Notice that in the left graph the red line which represents the pelvis/lower body rapidly slopes upward starting at the top position and is followed closely in sequence by the thorax, arm, and club.  Also, notice that because of this sequence the club rotation speed is much greater than the two amateurs (indicated by the yellow line being much higher). However, in the amateurs, the lines are not in sequence and it is obvious that the pelvis line is flatter which represents less acceleration.  See below for more details from TPI.

1) There is an identical sequence of speed or energy generation for all great ball strikers. That sequence is: lower body first (red line on the graph above), trunk or torso second (green line), arms third (blue line), and the club last (yellow line). This sequence occurs during the downswing.

2) Each segment of the body builds on the previous segment, increasing speed up the chain. (Red is less than green, which is less than blue, which is less than yellow).

3) Each segment of the chain slows down once the next segment begins to accelerate. This is due to the distal segment pushing off the proximal segment.  Imagine a child jumping off their dad’s shoulders in a swimming pool.  As the child jumps, the force rapidly slows down the dad’s energy.  This causes a sequential deceleration or stabilization of the segments.

4) Unorthodox styles may have no effect on your ability to generate a good kinematic sequence. In other words, Jim Furyk and Davis Love can have the same kinematic sequence.

As with any graph, the kinematic sequence graph can be confusing.  But, the take home message is that all great ball strikers initiate the downswing with the lower body and pelvis first allowing the other body parts to accelerate and generate speed behind it in the proper sequence.  If this does not happen, it can be due to a technique flaw which would require the guidance of a golf professional to improve swing mechanics.  But, it also can be a physical limitation whereas the golfer is unable to dissociate the pelvis from the trunk because of flexibility or motor control deficits.  If this is the case, it makes it very difficult to create a large turn in the back swing and/or begin the downswing with the lower body.  Thus, the trunk comes with the pelvis causing improper sequencing and an unpredictable shot pattern (usually a block, slice, or duck hook).  This is especially apparent in the over the top and early extension swing characteristics.  A review and video of “over the top” can be found —> HERE and “early extension” —> HERE.

The only way to truly know if a physical limitation is contributing to the inability to dissociate during the golf swing is to assess the athlete by administering a physical screen.  There are several tests that we use to qualitatively and quantitatively assess dissociation and they are as follows.

  1. The Pelvic Rotation Test which qualitatively tests the ability to dissociate the pelvic on a stable trunk (think downswing).
    1. View the test —> HERE.
  2. The Torso Rotation Test which qualitatively test the ability to dissociate the torso on a stable pelvis (think backswing).
    1. View the test —> HERE.
  3. The Seated Trunk Rotation Test which quantitatively tests if the golfer has enough mobility in the trunk (important in the backswing and downswing).
    1. View the test —> HERE.
  4. The Lower Quarter Rotation Test which quantitatively tests if the golfer has enough hip mobility (important in both backswing and downswing).
    1. View the test —> HERE.

Let’s identify dissociation in a real swing….

tiger-woods-golf-swing

To help illustrate dissociation, let’s pretend that the golfer above is standing in the middle of a clock and his club in image #1 (address) is pointed towards 6 o’clock.  Likewise, in this image his belt buckle (pelvis) and buttons of his shirt (trunk) are pointed towards 6 o’clock.  Here there is no dissociation or separation.  However, at the top of his backswing (image #2) his belt buckle is pointed towards 7 or 8 o’clock and his trunk is pointed at least to 9 o’clock.  Now we are beginning to see some separation; in other words the pelvis and trunk aren’t pointing in the same direction.  Furthermore,  during the downswing (image #3) there is even more separation in which his belt buckle is pointing towards 5 o’clock, and his trunk is still back at around 8 o’clock.  This increase in separation that begins in the down swing is called X-Factor Stretch and will be discussed later.  Basically, this helps take the potential energy stored in the backswing and transfers it to kinetic energy and increase club head speed.  If you want to read more about it please click —> HERE.

In summary, the ability to create separation and dissociate the hips from the torso is paramount in golf especially with the modern swing.  In order for this to occur the golfer must have adequate neck, spine, shoulder, and hip mobility as well as proper coordination and motor control for the kinematic sequence to occur.  Poor skill and swing mechanics can negate this from happening, but more often than not it is a physical limitation (flexibility or strength deficit) which can be assessed and corrected with specific exercises.  If you are interested in learning if you have any physical limitation that is hindering your golf performance, find a Certified TPI Professional near you by clicking —> HERE.  

 

 

 

 

 

Get Better At Golf Without Touching a Club!

It's that easy....
This will not lower your handicap…

I hope the title grabbed you. That was the intention. However, I am not going to propose some magic pill, swing aide or formula that will instantaneously improve your golf game.  I am sorry to disappoint.  On the other hand, I can suggest a proven way that has been supported numerous times in research studies. The only problem is that it requires time and a little work.

As we have already learned —> HERE, low handicap golfers are stronger, more flexible, and have better balance than high handicap golfers.  It makes sense that better golfers are better athletes.  But, how do they get that way? Is it genetics? Did they pick the right parents?  Possibly.  However, a golf specific strength and conditioning program has been well documented to elicit improvements in strength, flexibility, balance and ultimately club head speed!

It is no secret that golf performance is multi-factorial, and that other parameters such as swing mechanics, mental preparation, course management and golf equipment are implicated in golfing success [2].  But, there is more than enough rationale for physical conditioning as a modality for improving the physical factors affecting golf performance [1,2].  With that said, lets review some important information presented in question and answer form.

Should I just work out or should I perform some type of “golf specific” training program?

This is a great question.  Without getting too off track, lets get something out of the way.  There is no such thing as “golf specific.”  The only thing that is golf specific is actually playing golf.  However, a “golf relevant” program that takes motor control, specific flexibility demands, and specific strength and power considerations is of utmost importance when training golfers.  With that said, every exercise that is performed does not have to look like the golf swing to be effective for golf.  Let me explain this quickly and easily.  Are the glutes (butt and hip muscles) important in golf?  Of course!  TPI considers the glutes to king and the abdominal muscles to be queen in terms of importance for power in golf.  So, what exercise is great at developing glute strength and power?  How about swinging a weighted club or performing weighted rotations that mimic the golf swing?  This is not a bad idea but one of the best exercises of all time at developing hip strength and power is the deadlift.  But the deadlift does not look like a golf swing?!  Exactly!  And, trust me, it does not have to.  Building hip and glute strength (among other things) by using exercises like the deadlift will pay dividends in the integration of fitness to golf.

Rory performing the deadlift.  I wonder why he would do something crazy like this?! (wink wink).
Rory performing the deadlift. I wonder why he would do something crazy like this?! (wink wink).

What other exercises should I perform?

The answer here is not so simple.  It is not only a matter of which exercises are the best, but also, which exercises are best for you and YOUR body.  The philosophy is competency in movement before capacity.  If Rory (pictured above) was not able to get his body into a position (because of flexibility issues, poor form, core instability, etc.) he would first develop those attributes then start increasing his weight/strength on the deadlift.  The same goes for any other exercise.  So, a medical or fitness professional should be able to progress and regress a program as needed to put their athlete in the right position to succeed.  With that said, the recreational golfers in the studies reviewed performed exercises to strengthen their chest, abdominals, back, shoulders, hips, and legs, as well as improving flexibility in their shoulders, trunk, spine and hips.  These are all important areas in golf, but an evaluation may reveal the need to focus on these areas or others primarily.

seated trunk rotation test

Okay, so I know that strength and flexibility training can help improve the game of pro’s and young/ middle aged amateurs, but what about older adults?

Another great question.  Simply, yes!  A study by Thompson et al. in 2004 revealed that an 8-week multi-modal fitness program improved golf performance in 55-79 year old men.  This may be news to some of you but this study is already over 10 years old and the authors reported that Senior PGA Tour players had been partaking in fitness programs for years prior with the hope that increased physical activity will help maintain their competitiveness and avoid injury [2].

What kind of results can I expect?

Finally! The question and answer (hopefully) we have all been waiting for.  Wait no longer because I have some objective data for you.  As previously stated, numerous studies have found that 8-weeks or more of strength and conditioning including a personalized flexibility program will help improve those parameters.  Furthermore, this increase in strength, flexibility, endurance, and balance all equates to one thing….increased club head speed.  But, how much should you expect?  Well, the average increase in club head speed reported was between 2.7 and 5.0 mph.  The interesting thing is that all of the studies that compared strength training only to a multi-modal approach including strength, balance, and stretching found that the multi-modal approach was superior.  It is also important to know that theoretically an increase in 1.0 mph in club head speed equates to an increase in 2.5 yards of carry.  So, the aforementioned studies found that their subjects increased their distance between 6 and 12 yards!  Who would not want that?!

This could be you!
This could be you!

Resources

1. Lephart, SM., Smoliga, JM., Myers, JB. An eight-week golf-specific exercise program improves physical characteristics, swing mechanics, and golf performance in recreational golfers. J. Strength Cond. 21(3), 860-869. 2007.

2. Thompson, CJ., Osness, WH. Effects of an 8-week multimodal exercise program on strength, flexibility, and golf performance in 55 to 79 year-old men. J. of Aging and Physical Activity. 11, 144-156. 2004.

 

 

The Value of the Titleist Performance Institute’s Movement Screen

A hallmark of The Titleist Performance Institute is a concept they refer to as “The Body-Swing Connection.”  Simply, the type of swing that a golfer can perform is dependent on what their body can physically do.  So, the swing is connected to the body’s available strength, balance, flexibility, coordination, etc.  As we already know, proficient golfers score better on physical performance tests than high handicap golfers which should be no surprise because it makes sense that being stronger, more flexible, and having more balance would help improve your mechanics.  Click —> HERE for an article I wrote on this topic.

Does this surprise you?!
Does this surprise you?!

With this understanding, TPI has created a movement screen that is specific to golfers.  The goal of the screen is to identify physical limitations that may hinder golf performance and potentially increase risk of injury.   This should be of interest to any golfer because of the high prevalence of injuries in professional and recreational golfers.  Check out this overview of golf injuries —> HERE.  Furthermore, understanding a relationship between key movement patterns and a golfer’s mechanics can help tailor a training program to maximize golf performance.  To view the TPI movement screen click —> HERE.

Hopefully it is easy to see that physical limitations can hinder the golfer from performing an “optimal” swing, and the movement screen gives us a holistic view of mobility and potential stability deficits in specific areas of the body.  However, do we learn anything about the golf swing by putting someone through the movement screen?  In other words, can we predict swing faults based on the results of an athlete’s movement screen?  The answer is YES!

In a 2014 study by Gulgin et al., the authors set to investigate The TPI movement screen’s relationship to golf swing faults.  Interestingly, the authors were the first to administer formal research on this topic even though TPI has suggested several correlations in the past.  Several finding were the same, but some of the findings did not validate TPI’s previous claims.

Before we dive into the study, check out the list of the body swing connections presented by The Titelist Performance Institute below. This list helps make the connection between the physical screen and the Big Twelve swing characteristics that may result from a failed test.  TPI also is forthcoming with the fact that they call these swing “characteristics” because they report that many successful golfers have these characteristics.  Before reading ahead, click —> HERE for examples of the swing characteristics.

 STANDING TESTS

  • Pelvic Tilt – S-Posture, Early Extension, Reverse Spine Angle
  • Pelvic Rotation – Over the Top, Casting, Scooping, Chicken Winging, Slide, Sway, Hanging Back
  • Torso Rotation – Loss of Posture, Flat Shoulder Plane, Early Extension, Sway, Slide
  • Overhead Deep Squat – Early Extension, Loss of Posture
  • Toe Touch – C-Posture, Too Much Knee Flex, Loss of Posture
  • 90/90 – Loss of Posture, Flying Elbow, Chicken Winging, Early Extension
  • Single Leg Balance – Sway, Slide, Hanging Back, Loss of Posture, Early Extension, Reverse Spine Angle
  • Lat Test / Reach, Roll and Lift – Loss of Posture, Flat Shoulder Plane, Early Extension
  • Lower Quarter Rotation – Sway, Slide, Reverse Spine, Hanging Back, Early Extension
  • Cervical Test – Loss of Posture, Early Extension, Reverse Spine Angle
  • Wrist Patterns – Casting, Over-the-Top, Chicken Winging, Loss of Posture

SEATED TEST

  • Seated Trunk Rotation – Loss of Posture, Flat Shoulder Plane, Reverse Spine Angle, Early Extension, Sway, Slide

SUPINE TEST

  • Bridge w/ Leg Extension – All 12 possible
Loss of Posture as presented by TPI.  It is important to know how to diagnose it, but it is also important to know which physical limitations promote it!
Loss of Posture as presented by TPI. It is important to know how to recognize it during the swing, but it is also important to know which physical limitations contribute to it!

Now lets get back to the study.

The authors looked at thirty-six subjects who were instructed on how to perform each of the tests in the TPI movement screen.  After, they were instructed to hit several golf balls with their 5-iron while being recorded.  The video recording was performed on a commercial software program that had the ability to pause their swing at any point which allowed the authors to identify swing faults.  The results are as follows:

  • The most frequent physical test limitations were overhead deep squat, toe touch, single leg balance, and bridge with leg extension.
  • The most common golf swing faults associated with those physical tests were early hip extension, loss of posture, and slide in the downswing.
  • A golfer who was unable to perform an overhead deep squat is 2x more likely to early hip extend in the golf swing, and 54% of golfers who failed the deep squat demonstrated a loss of posture.  A golfer who was unable to perform a toe touch is 6x more likely to hip extend.  A golfer who is unable to balance on their left leg is 3x more likely to early extend, lose posture, and slide during the swing.  A golfer who is unable to bride on their right side is 5x more likely to early hip extend, 6x more likely to lose posture, and 2x more likely to slide on the downswing.

The authors went on to discuss some incite into why they feel this is important for the golf swing.

  • Early hip extension does not allow the golfer to drop the arms into the proper slot during the downswing, and thus may shots may get “blocked” or hooked.  Furthermore, early hip extension may affect one’s ability to properly rotate their hips during the swing which may cause a slide during the downswing.
  • Loss of posture is an indicator of an inefficient golf swing because this makes the golfer’s ability to return the club on plane less likely.
  • A Slide makes it difficult to stabilize the lower body during the down swing which takes away power from the upper body or transfer of momentum.  This lateral shift or slide generates a feeling up the club being behind the golfer and makes it difficult to square the face in relation to the swing path.

The authors concluded that the physical limitations that relate to swing characteristics should be addressed by the fitness and/or medical professional to prevent the golfer from swinging with improper mechanics.

Regardless of how the findings of the study compare to TPI’s previous list, it is important to know that the study used a small sample size (36 subjects), so further investigation is warranted to be able to generalize findings and validate Gulgin et. al’s work.

However, there is a take home message!  Both the study and TPI agree that there is a clear connection between physical limitations including flexibility, strength, and balance and the ability to perform proper golf swing mechanics.  This illustrates yet again a huge reason why a full evaluation of each golfer (including a movement screen) is of utmost importance to optimize performance and injury prevention.

 

References

Gulgin, HR, Schulte, BC, Crawley, AA. Correlation of Titleist Performance Institute (TPI) Level 1 Movement Screen and Golf Swing Faults. J Strength Cond Res 28(2): 534-539, 2014.

Failed Seated Trunk Rotation Test? Now What?

Before we get started, let’s review the Seated Trunk Rotation Test (STRT).  To view the test on TPI’s website click —> HERE.

1) Assume a seated position with knees and feet together 2) Place golf club on chest 3) While keeping the club parallel to the ground, rotate as far as possible 4) Repeated with club on back
1) Assume a seated position with knees and feet together 2) Place golf club on chest 3) While keeping the club parallel to the ground, rotate (both directions) as far as possible 4) Repeat all with club on back

As per TPI, the test is designed to “identify how much rotational mobility is present in the thoraco-lumbar spine.” This is very important to understand because most would assume a failed test is caused by the thoracic spine alone.  Though this is most often the case, it is incorrect to assume because the lumbar spine does contribute to approximately 10-15 degrees of axial rotation which is most limited by the sagittal orientation of the facet joints. Each joint/segment only allow 2-3 degrees of rotation [1].  Contributing the most to rotation of the trunk is the t-spine which should rotate 45-50 degrees [1].  Therefore, we need to have the ability to dissociate thoracic mobility deficits from lumbar mobility deficits to identify the specific area that is limiting motion.  More on this later.

Architecturally incompetent for rotation compared to the T-spine and Hips!
Architecturally incompetent for rotation compared to the T-spine and Hips!

It is also important to understand how a failed Seated Trunk Rotation Test is interpreted. The STRT is part of the TPI Screen which is used to screen golfers.  This screen is a series of tests that can be used by any member of The Team, and as we know from the Functional Movement Systems principles, only evaluates risk.  It is not a medical evaluation or performance test.  In other words, do not get caught up on trying to diagnose the cause of the dysfunction from this quick screen, or to determine the skill of the athlete.  Just understand the findings, and put that athlete in the hands of someone who can further assess the impairment.

This leads us to the first member of The Team – the golf instructor.  For more information on the team approach click —> HERE.  Just as it is not appropriate for a medical or fitness professional to give swing advice, it is not appropriate for the golf professional to give medical or fitness advice (unless they are licensed or certified).  With that said, if the golf instructor determines that the athlete has failed this test they should consult the medical professional.  It is my opinion that the medical professional should be consulted before the fitness professional because Low Back Pain is the #1 injury in golf and thoracic spine pain is the top injury related to lost practice time [2].  So, we want to make sure that a mobility deficit is all that needs to be addressed.  Together, the medical and golf pro can determine whether this deficit is causing a swing fault, and if movement optimization would improve their swing.

Further Evaluation of the STRT (a.k.a. The Breakout)

dds
…”a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation.” In other words, use it to find the cause of the problem.

Once the golfer is referred to a medical professional, he or she will systematically evaluate (breakout) the movement pattern by using a standardized evaluation process.  In my opinion, the most sophisticated is the Selective Functional Movement Assessment. However, other tests should be used especially if there is pain associated with this movement.  It should be understood that the STRT is part of the breakout of one of the top-tier tests in the SFMA.  However, it is not the purpose of this post to elaborate on this, but only to educate the reader on how to determine if the mobility deficit is thoracic or lumbar (or both) in nature from a failed STRT.  The medical professional will evaluate all movement patters of the athlete, but in terms of spinal rotation they will use an algorithm that uses to primary tests: 1) Lumbar Locked T-Spine Rotation Extension and 2) Prone on Elbow Unilateral Rotation/Extension.

ddfdfds
1A) Lumbar Locked T-Spine Ext/Rot ER….Functional = 50 degrees.

 

dfsdfsd
1B) Lumbar Locked T-Spine Ext/Rot IR…..Functional = 50 degrees.

 

sdfdfsd
2) Prone on Elbows Ext/Rot…..Functional = 30 degrees.

Starting with the Lumbar Locked position which isolates the thoracic spine, the athlete will assume a hands on head (ER) position shown in the picture 1A above.  A video demonstration can be seen by clicking —> HERE.  If this is found to be functional the t-spine is clear and the prone on elbows test will be conducted to assess the lumbar spine.  However, if the lumbar locked ER test is dysfunctional (<50 degrees) the lumbar locked IR position will be performed as shown in 1B.  This helps to isolate the t-spine and rule out the shoulder girdle’s relationship a rotation limitation.  If both are found to be dysfunctional, then the t-spine is in fact the culprit.  If 1A (ER) is dysfunctional but 1B (IR) is functional the shoulder girdle should be evaluated further (broken out), as well as the lumbar spine.

To further evaluate the thoracic spine, all planes of motion should be performed and overpressure can be used to increase the sensitivity of the test.  In other words, have the patient flex, extend, and rotate in isolated planes and add overpressure to understand full active and passive motion in addition to the above tests.  If the clinician determines that further isolation is necessary, local joint play testing can be used to determine segmental mobility.

Once a conclusion is drawn to the area of the spine that is limiting spinal rotation, the golf pro and medical professional should consult and devise a plan that is individualized.  Once this plan is created, the golfer should be educated on the findings of the test and evaluation, its implications to the golf swing, and how interventions relating to improving spinal mobility will improve their swing/ durability/ performance/ etc.

 

References

1. Pearcy MJ, Tibrewal SB. Axial rotation and lateral bending in the normal lumbar spine measured by three-dimensional radiography. Spine. 1984;9(6):582–587.

2. Cabri J, Sousa JP, Kots M, Barreiros J.  Golf-related injuries: A systematic review.  European Journal of Sport Science. 2009; 9(6):353-366.

5 Reasons Why Self-Directed Golf Fitness Programs Fall Short

Today’s post was taken from the Titleist Performance Institute website.  It was written by Ryan Blackburn, owner of Orlando Golf Performance and TPI certified fitness professional.  I am not going to comment on it that much, but it is interesting to note that 3 out of the 5 reasons that he gives is directly related to the assessment process and individualization of programming.  To put it simply, it matters.  I have not had the opportunity to meet Ryan, but I think he hit the nail on the head with this one. Click the link below to read the article, hope you like it.

http://www.mytpi.com/articles/fitness/5_reasons_why_self-directed_golf_fitness_programs_fall_short

What Common Physical Characteristics Do Low Handicap Golfers Have?

As presented —> HERE, highly proficient golfers tend to have greater club head speed and increased driving distance.  This is such a desirable goal that researchers looked at how performance in specific low tech tests correlate to club head speed.  As expected, more power in the legs, arms, and trunk equals more CHS and driving distance.  I wrote an entire post on that topic —> HERE.  However, until somewhat recently no research has examined physical performance characteristics and their relationship with handicap differences.

In 2007, Sell et al. examined whether strength, flexibility, and balance in specific areas of the body are common in different groups of handicap. The authors believed that understanding these trends and improving them would facilitate the design of a golf specific strength and conditioning program, and that lower handicap golfers (<0-9 handicap) would have better strength, balance, and flexibility scores overall than higher handicap golfers (10-20).

They evaluated over 250 golfers that were split into 3 groups, <0 handicap, 1-9 handicap, 10-20 handicap, and were put through common strength, flexibility, and balance testing.  Their findings were not shocking, but very interesting in that scientific research is suggesting what we probably should have known all along.

Strength Results

The authors found that “core” strength, especially around the hips, pelvis, and low back is essential to performance in golf because an effective swing requires the golfer to maintain a stable lower body while rotating the torso, upper extremities and head. The faster the torso rotates the greater the strength of the lower quarter needs to be, and golfers with a lower handicap had consistently greater lower body and core strength than the high handicappers. Interestingly, the authors also found low handicappers to have greater shoulder strength (especially in the rotator cuff).  This is important not only in the delivery of the club head, but also in the prevention of injuries.  Check out an article on shoulder injuries in golf —> HERE.

Stable lower body, mobile trunk, stable shoulders....I feel like a broken record.
Stable lower body, mobile trunk, stable shoulders….I feel like a broken record.

Flexibility Results

Range of motion and mobility is obviously important in the golf swing.  The authors discovered that the shoulders, hips, and torso are consistently more flexible in lower handicap golfers.  Specifically, right shoulder external rotation (think back swing), right shoulder extension, left shoulder flexion and abduction (again think backswing).

This is why we perform the Shoulder 90/90 Test —> HERE, and the Lat Test —> HERE.

As for the hips, the most notable was right hip extension (which makes sense because optimal glute function is achieved if you can get into extension), and left hip extension.

This is one reason for why we perform the Bridge with Leg Extension Test —> HERE.

Right torso rotation range of motion was higher in golfers with lower handicaps.

This is a great reason to get screened specifically by the Torso Rotation Test —> HERE, as well as the Seated Trunk Rotation Test —> HERE.

Balance Results

Interestingly, the only difference here is that the golfer’s with better handicaps performed better on the Single Leg Stance Test on their right leg.  There was no statistically different findings on their left leg.  However, other studies have shown otherwise.  In my opinion, it is important to achieve good balance during single leg stance especially due to the fact that the golf swing requires a large weight shift to the right leg on the back swing and left leg for the down swing (for a right handed golfer), as well as occasional requirements to hit from an uneven lie (downhill/uphill/ bunker/ awkward stance/ etc.).  Remember, the average PGA TOUR professional can maintain single leg stance with their eyes closed for 16 seconds.

Try the Single Leg Balance Test —-> HERE.

Balance Required.
Balance Required.

Hopefully you enjoyed this post and are beginning to realize that major differences in performance are of physical qualities, not just skills.  Just like the difference between NBA players and college players are attributes like speed, ability to jump higher, stronger, bigger, more endurance, more coordination; golf is no different.

 

Resources

Sell, T. C., Tsai, Y.S., Smoliga, J. M. Strength, Flexibility, and Balance Characteristics of Highly Proficient Golfers. J. Strength Cond. Res. 21(4), 1166-1171. 2007.

 

 

The Team Approach to Golf Training

The team approach is something that is at the forefront of healthcare in the United States.  Even in physical therapy school we were encouraged to co-treat with other members of the healthcare team such as nurses, physicians, pharmacists, social workers, etc.  This, in theory, should maximize patient care by employing what I refer to as “division of labor”.  Every member of the healthcare team has a specialty, and should the patient need that specific division of service, the outcomes will be improved. Everyone is happy. Everyone wins.

This same model is the hallmark of the Titleist Performance Institute and is a new wave, cutting edge approach to golf training. No matter how high or low the handicap, I believe that this approach should be part of every golfer’s training regimen.

Before I discuss the modern team approach and what it means for the potential improvement of every golfer, let’s discuss “the old approach” of the 1990’s.  As described by TPI, the PGA of America would teach their instructors that the best way to fully serve their golfer was to have them consult with three professionals:

  1. The Golf Coach/ Instructor
  2. The Sports Psychologist/ Psychiatrist
  3. The Golf Club Manufacturer

Then, in 1996 something happened that would change the game as we know it.  Perhaps a more appropriate phrase is that someone happened.

Love him or hate him, he changed the game.
Love him or hate him, he changed the game.

Tiger’s game was different than anyone had seen before.  Power, strength, flexibility, and a chip on his shoulder.  These attributes began to affect the way competitors were preparing for the game,  and with that, the “team” became larger.  The newest addition was what was termed “physical conditioning” and included improving aspects of the body that influence performance.

The Modern Approach

The Modern Approach to the team has all of the members that were included in the old approach including golf coach, club manufacturer, and sports psych.  Now, several new members are on every tour pro’s team including business manager, strength and conditioning coach, and the medical professional (usually a physio).  This post will detail three of members of the modern team and how the communication between these three professionals can improve the performance of the golfer.  It is also important for each member to understand the “division of labor” and know when to consult another team member.  The three team members that will be detailed include:

  1. The Golf Coach/ Swing Instructor
  2. The Medical Professional (Physiotherapist/ Physical Therapist)
  3. The Fitness Professional (Strength and Conditioning Coach)

The Team

  1. The Golf Coach/ Swing Instructor
    1. It goes without saying how important the swing instructor/ golf coach is to the golfer.  Understanding the swing and implementing drills and exercises with the use of modern technology to optimize the player’s grip, stance, backswing, downswing, spin, launch angle, etc. is paramount.  However, I would like to propose something that many golf instructors may not consider. I believe that optimizing movement (improving flexibility, strength, balance, and other physical characteristics) so that the golfer is capable of performing the tasks that are instructed by the coach and to have durability to endure hours of practice will allow the player to rapidly improve their game.  Likewise, a coach should know if there is a significant flexibility limitation or previous injury so that they can appropriately coach and put the golfer in a position to succeed.  This, in a way, is building a swing around the golfer, not trying to make every golfer perform the “ideal swing”.  These reasons, among others, are why the golf coach should build a team around themselves and their student.
      1. Maybe his swing truly is "ideal."  But, perhaps his flexibility and balance is as well!
        Maybe his swing truly is “flawless.” But, his ideal flexibility, power and balance allow him to have that swing!
  2. The Medical Professional 
    1. The final two are what has adapted from the original “physical conditioning” team member in the 1990’s.  The medical professional obviously would lead the way when the athlete is in pain or recovering from injury. However, they also should take the lead in regards to the functional movement assessment.  The physiotherapist (physical therapist) can offer something that no other team member can – manual therapy and therapeutic exercises.  If the golfer is in pain or needs to correct muscle imbalances that are effecting his/her strength or flexibility, the physical therapist can use specific manual techniques to alleviate the dysfunction.  I may be biased, but PT’s are experts in evaluating and treating human movement, and understand where stretching or strengthening can be added to optimize movements specific to the golf swing.  This can be done with the Selective Functional Movement Assessment – a systematic approach to assess fundamental movement patterns to isolate the specific area of the body causing the limitation.  That does not mean that they should write strength and conditioning programs for the golfer.  That is the job of the fitness professional.  But, if the athlete does not have the competency to perform movements related to golf or training, the physio should be consulted.  There is a second key job of the medical professional.  As stated previously, the best coaches understand their athlete’s strengths and weaknesses and build unique to them.  So, another innovative model by TPI is that the medical professional can assess the golfer using the TPI Golf Specific Screen, then consult with the golf coach to allow them to know where their main deficits reside.  This will allow the coach to understand positions and movements that the golfer will have difficulty performing at that time.
  3. The Fitness Professional
    1. Once the athlete has the competency required to partake in a strength and conditioning program (no pain, no major ROM restriction), the fitness professional will evaluate the golfer and implement a physical conditioning program. Strength, balance, flexibility, power, and endurance are all important characteristics for golf performance and injury prevention, and the fitness professional is the best team member for the job.  With the expert knowledge of performance, strength and conditioning and programming to optimize human movement, the strength and conditioning coach is of utmost importance in the training of a golfer.
    2. Don’t just take my word for it, check out this quote from Brad Faxon in an interview with The Wall Street Journal, “A lot of the old guard still blame equipment for the increased distance on Tour, but so much more of it is the quality of the athletes,” Mr. Faxon said. “You don’t have to work out to play on Tour, but if you don’t, you get passed, because you’re not strong enough. And the stuff we do these days is all full-body, functional movement.” The entire article can be found —> HERE.  I encourage you to read it as it piggy-backs this post.

There is not one member of the team that is more important.  They all work in unison to maximize potential by correcting flaws that limit a player’s swing, and improving performance and durability to keep the athlete healthy and strong.

So, if you want yourself, your son/daughter, or your student to reach their full potential in the game of golf, I believe that surrounding him/her with a great team can help to streamline their success.

team

The Need for Speed (and how to test for it)

Golf performance has become more mainstream with technological advancements and cutting edge research by golf performance companies such as, The Titleist Performance Institute (TPI).  Knowledge of fitness, performance, and technique is essential to anyone in golf who is looking to get an “edge” on their competition.

At the forefront of golf coaching, performance, and rehab!
At the forefront of golf instruction, performance training, and rehab!

As stated earlier —> HERE, it is well established that club head speed (CHS) is a golf specific objective measure that correlates directly with driving distance, lower handicaps, and the enhancement of overall golf performance (Fradkin et al., 2004).

Previously, high tech tests were the only way to test for club head speed.  However, this is very difficult to the majority of golfers because of the requirement for expensive equipment.  Recently, field-based tests have been found to reliably measure golf specific power and correlate to club head speed.

There are several ways to test for power and human performance, but which tests correlate directly to golf and increased club head speed?  The three tests most commonly cited in research are listed below.

And, to the golfer!  That is, if you want lower scores...
And, to the golfer! That is, if you want lower scores…

FIELD-BASED TESTS

  1. Vertical Jump: The vertical jump tests for lower body power.  There are many ways to test for vertical jump, but many of them require extra equipment.  The least expensive and least involved way to test for vertical jump requires only a tape measure, a wall, and chalk.
    1. To perform, the subject marks his/her finger tips with chalk.  Then, they will stand as close to the wall and reach one arm as high on the wall as possible in order to make a chalk mark.  After this mark is established, the subject will then assume an athletic position near the wall and jump as high as possible touching the wall in order to make a second chalk mark.  The distance between the two chalk marks are considered the vertical jump height – measured in inches.  The best of 3 trials is recorded.
      1. Here is a youtube video describing how to perform the test.  Click —> HERE.
      2. The average PGA TOUR professional scores between 18-21 inch vertical jump.
  2. Seated Medicine Ball Chest Pass: This test measures upper body power. This test only requires a few items including a chair (with a back), a medicine ball (4kg for men, 2kg for women and juniors), and a tape measure.
    1. To perform, the subject sits in the chair with their back touching the seat back.  Without losing contact, the subject performs a chest pass and launches the ball as far as possible using his/ her upper body and chest.  The best of 3 trials is recorded.
      1. The average PGA TOUR professional scores between 18-20 feet.
  3. Supine Medicine Ball Sit-Up and Throw: This tests measures core power.  More specifically, it tests the ability of the athlete’s core to transfer force through their upper body to propel an object.  Does that sound familiar?  It should, because that is what the core does in the golf swing! All you need here is a medicine ball (same weight as above) and a tape measure.
    1. To perform, the athlete starts supine (lying on their back), brings the medicine ball overhead and as they sit up launches the ball as far as possible.
      1. The average PGA TOUR professional scores between 18-20 feet.

KEY POINTS

  1. Club head speed is important in terms of golf specific power.  Increasing your club head speed can help to lower handicaps and improve your game.
  2. Power can be trained in the gym by using strength and plyometric exercises.  Find a golf fitness instructor or physio to get you on track and individualize your program!
  3. Field-based tests have been examined and found to correlate to club head speed.  Each of the three test upper body, lower body, and core power.
  4. All three are equally important, so if there is a major imbalance in an area, attempt to improve that score to “balance” the three instead of increasing an already adequate number and creating a larger imbalance.
    1. For example, if a golfer scores the following: 15 inch vertical jump, 19 foot chest pass, and 20 foot sit-up/throw, then a program that focuses on lower body strength, stability and power would be warranted.  A program that has an upper body and core focus would further the imbalance.
  5. Attached is a video from TPI explaining each of the tests in further detail.  To view it click —> HERE.

 

References

Fradkin, AJ, Sherman, CA, and Finch, C (2004).  How well does club head speed correlate with golf handicaps? J Sci Med Sport 7: 465-472.

Read, PJ, Lloyd, RS, and Oliver, JL (2013). Relationships between field-based measures of strength and power and golf club head speed.  J Strength Cond Res 27: 2708-2713.

 

Elbow, Wrist and Hand Injuries in Golf

elbow pain

As previously presented HERE, injuries of the elbow, wrist, and hand are second most common of all injuries sustained by golfers.  Not surprisingly, these injuries are more common in amateurs versus professional golfers.  The flexor and extensor tendons (muscles in the front and back of forearm) of the elbow are particularly susceptible to injury due to the repetitive demands of the golf swing, and the requirement of those muscles to be active during impact with the ball and the ground.

Lateral Epicondylitis (Tennis Elbow). Humerus, Lateral epicondyle, Olecranon, Ulna, Extensor carpi ulnaris, Extensor digitorum, Extensor carpi radialis brevis, Extensor digiti minimi. MendMeShop¨Ê  ©2011

Two main elbow injuries are seen in golfers, medial epicondylitis (Golfer’s Elbow) and lateral epicondylitis (Tennis Elbow).  Interestingly, tennis elbow is as much as five times more common in amateurs than golfer’s elbow! These injuries are most often caused by repetitive use or a single traumatic event like hitting a “fat shot.”  As stated HERE, overuse injuries are usually seen in professionals and competitive golfers because of large practice times, and amateurs usually suffer from trauma especially with improper form or a bad swing.  It is no surprise that the incidence of elbow injuries increase with an increase in rounds of golf per week (especially if its 2 or more rounds per week).

Currently, limited to no research relates physical qualities of the golfer to factors that predispose them to elbow injuries.  However, as with most situations it is important to have full range of motion and strength.  Normal flexibility and sufficient strength typically allows our bodies to be more resilient especially when repetitive stresses are being applied to the same area.  This is analogous to runners having a strong lower body and core as well as mobile hips to attenuate the ground reaction forces being applied from the ground during each stride.

With that said, below are three quick tests that you can use in order to determine whether you have enough wrist range of motion.  Again, this is not exhaustive, so even if you pass these tests but have some wrist/ forearm or hand pain you should be evaluated by a medical professional.

RANGE OF MOTION

  • Wrist Flexion: Click the link —> HERE to perform the screen.
  • Wrist Extension: Click the link —> HERE to perform the screen.
  • Forearm Rotation: Click the link —> HERE to perform the screen.

MUSCLE STRENGTH/STABILITY

It is not within the scope of this post to discuss strength and stability tests of the forearm that would be used in a clinical examination.  Furthermore, there is limited research as to the efficacy behind what is “sufficient strength” and whether or not it reduces the risk of injury.  However, there is some current research that relates decreased shoulder strength/ endurance in individuals with tennis elbow.  View the full abstract —> HERE.

Also, a quick golf specific screen to consider shoulder impairments can be viewed —> HERE.

Again, prevalence and mechanism of upper extremity injuries in golf is relatively well understood; however, there is limited research as to predisposing factors for injury and injury prevention other than improvements in technique in the golf swing.  Hopefully, more research will be performed in the near future.

 

 

 

Golf Injuries: An Overview

golf injuries

The following is an overview of golf injuries including how, why, and who they occur to including comparisons between professional, amateur and the aging golfer.  Furthermore, a brief discussion on risk factors, swing considerations, and injury prevention strategies will be presented.  More detail of each will be presented in future articles, but this general overview serves to develop a background knowledge base for the athlete, parent, coach, fitness and medical professional.  It is quite long, so sit back, grab and Arnold Palmer and hopefully it will expand your knowledge base about injuries in golf.

Introduction

Over the last decade, an increase in the popularity of golf has been well documented.  An estimated 55 million people worldwide participate in the great game of golf!  With that, the number of courses in the USA, Europe, and Asia has increased tremendously.  With this increased accessibility and participation (among other things), an increase in injuries has also occurred.  Golf is usually described as a game that requires mild to moderate activity level; however, injuries in golf should not be underestimated or undervalued.  Additionally, many mechanisms and characteristics of injuries appear to be consistent with different skill and age groups who participate in the game.  Having an understanding of these consistent occurrences should facilitate the decision making process on developing strategies for prevention, rehabilitation, and enhancement of golf performance.

Golf Injuries in General

In general, golf injuries originate from either over-use or from a single traumatic event, and primarily affect the low back and upper extremity.  Amateur golfers have an annual prevalence of between 25.2-62% (1.19-1.3 per golfer per year), and the main risk factors appear to be low handicap and age over 50 years old.  On the other hand, in the professional golfer, it is closer to 88% or 2.0 injuries per golfer per year.  The higher prevalence in pro golfers is likely due to the increase practice times and repetitive nature of the game.

There are slight differences in regards to body parts affected, but in general the most common sites for injury are: Low Back (28-35%), Elbow (25-30%), Hand/ Wrist (15%), Shoulder (10%) followed by the lower extremity equally (hip, knee, ankle).

Who is at Risk for Golf Injuries?

Two primary groups of golfers are at risk for injuries: amateur golfers comprising of recreational and occasional, as well as professional golfers.  Occasional golfers are documented to be prone to injuries related to a poor knowledge of execution of golfing skills, resulting in traumatic injuries (usually at impact) or injuries related to badly executed golf swings.  In addition, amateurs in general are prone to overuse injuries due to various behaviors such as lack of warm-up, reduced mobility/ flexibility, limited strength, lack of physical conditioning, etc.

Competitive golfers (professionals and highly skilled amateurs) usually report soft tissue and musculoskeletal injuries associate with overuse.  This is usually due to the repetitive nature of the golf swing with intense or long practice sessions that cause imbalances in strength and range of motion predisposing these players to overuse syndromes.

Additionally, older golfers are considered “higher than normal risk” for injuries not only due to the nature of the game but also physiological factors associated with aging.

Injuries by Anatomical Location

Low Back and Trunk: As stated previously, the most commonly injured area is the low back.  However, reduction in participation was no more than one month for any episode of low back pain, and the most common injuries were minor which resulted in only one week of practice lost. Furthermore, the number of golfers with a history of LBP may be as high as 55% but it is unclear as to whether it is due to golf practice alone. Author’s note: This is consistent with orthopedic research regarding low back pain, which is said to be self limiting and resolving on its own in the majority of cases in 4-6 weeks.  Interestingly, the area of the body that has the largest practice time lost due to injury is the thoracic spine and not the lumbar spine.

Upper Extremity: Elbow injuries are the second most common, and moreso in amateur golfers than professional.  Medial epicondylitis (Golfer’s Elbow) occurs most in the right arm (for right handed golfers) usually due to repetitive resisted forces or from a single traumatic event like striking the ground and taking too large of a divot.  Lateral epicondylitis (Tennis Elbow) also affects amateurs more than pros, and occurs in the leading elbow.  The incidence of both conditions increases when the frequency of golf is increased (i.e. >2-3 rounds per week).  Interestingly, in amateurs Tennis Elbow is more prevalent than Golfers elbow!

Shoulder injuries are the third most common across the board, and most often related to overuse injuries due to excessive shoulder rotation at the top of the back swing and in the follow through.  In all reports, the leading shoulder was more commonly injured resulting in AC joint problems, impingement, rotator cuff tendonitis/ tears, instability, or arthritis.  Finally, wrist and hand injuries occur especially during forceful swings with high impact on the ground.

Lower Extremity: Lower limb injuries are no very prevalent in golfers, but it should be noted that the literature on the occurrence and mechanisms is limited.

Injury Distribution by Age

The average age for occasional golfers in the USA is 45 years old and one third of all American golfers are 50 years of age or older.  Not surprisingly, golfers 50-65 years old have the highest injury prevalence.  The reason for this is due to physiological changes that occur with aging such as changed in the musculoskeletal, cardiovascular, and neural systems.  Decline in strength, flexibility, coordination, bone and tendon resiliency and ability to deal with stress may increase rate of injury.  Author’s Note: This is another area of importance for the benefit of exercise in golf, but it is not the scope of this review and will be discussed later.  However, it should be noted that many of these declines in the aging adult can be mitigated with consistent resistance training due to the fact that type II muscle fiber (fast twitch) declines with age.  It is well documented that reduction of power and strength occur with normal aging, and with that a reduction in club head speed (golf’s demonstration of power) occurs between ages 40-59.

Mechanisms of Golf Injury

In amateurs that play an average of 2 rounds per week were most often injured by overuse, striking the ground with the club (hitting it “fat”), and poor swing mechanics.  Over-swinging, poor or incomplete warm-up, twisting of the trunk during the swing, and gripping too tight are other potential causes.  In professionals, overuse accounts for 80%, hitting it fat was 12%, and twisting of the trunk was 5%.  Professional golfers have almost negligable injuries due to poor swing mechanics, over-swinging, poor warm-up, or grip/swing changes.

Injury Versus Handicap

As mentioned several times, there are differences between professional and amateur golfers.  Professionals partake in regular competition and follow intense organized schedules of practice.  However, they are also usually engaged in carefully structured conditioning programs, and have better strength and flexibility indicators than recreational golfers.  Authors note: It is well documented that skill and fitness enhancement can reduce the risk of injury in other sports, why is it so hard to believe that golf would be any different? Spoiler alert…there is no difference!

Okay back the the details.  This next sentence is music to my ears!  Many problems detected in the amateur player  would probably disappear if a new and improved technique were adopted.  At the peak of the backswing, pro players were shown to exhibit significantly higher left shoulder horizontal adduction and right shoulder external rotation.  Professionals also have more trunk rotation at the height of the backswing and at the moment of ball contact.  How can you tell if you have enough trunk rotation? Click —> HERE.

Furthermore, low-handicap golfers who suffer LBP tend to demonstrate reduced erector spinae activity at the top of the backswing and impact, yet greater external oblique activity throughout the swing.  These findings are consistent with the “reverse spine angle” and “inverted-C” patterns.  More detail on these patterns are discussed —> HERE.  To piggy-back this idea, it is thought that this increased side-bending and early lumbar extension is a compensation from limited trunk rotation and frequently observed in recreational players.

Overall, low handicap golfers are injured more frequently than high handicappers, but the mechanisms and types of injuries are different.

Swing Phases and the Incidence of Injuries

With the understanding of how high club head velocities need to be reached in a short amount of time, it is easy to see that high stresses are applied to the body which can cause overuse or traumatic injuries.  Most articles separate the swing into several phases: (1) Ball Address, (2) Back-swing, (3) Down-swing, (4) Impact, (5) Follow-through.

Note the extreme ranges needed in the hips, shoulders and trunk!
Note the extreme ranges needed in the hips, shoulders and trunk!

With that said, most injuries occur at the end of the down-swing (18%) and follow-through (42%).  Many authors credit this to the high forces when the club is contacted with the ground and place emphasis on forearm muscle strength to maintain control of the club.  However, injuries may occur in any phase of the swing.

(1) Ball Address and (2) Back-swing: Ball address is characterized by adopting an optimal pre-stroke posture which may be different for some golfers but is generally an athletic stance with a neutral spine (flat back).  This posture will allow the golfer to generate maximal potential energy.  Structures may be stressed due to compromised starting position including: excessive loading of the spine through hyper-extension.  During the back-swing, shoulder injuries can occur through compression of the rotator cuff or sub-acromial bursa, or from instability of the lead shoulder.  Likewise, over-rotation of the trunk during the back-swing can cause injury.

(3) Down-swing and (4) Impact: It has already been established what forces occur during impact and the effects on the wrist/hand/elbow, yet the downswing has not been discussed.  Injuries during the downswing (and even impact) occur in the range of movement of greatest muscle activity.  Players who are less skilled have up to 50% less trunk rotational capacity than younger more skilled players.  This means that to compensate and be able to hit the ball as far, a higher muscle activity will be demonstrated.  Thus, higher loading of the spine is a result due to reduction in flexibility, strength and stabilization of the trunk/ spine.  This is another important reason for optimizing mobility and stability (i.e. strength and conditioning).

(5) Follow-through: During the follow through there is a rotary motion of the hip and shoulders so that the body faces the target.  With this, the lumbar spine is at risk for injury if the deceleration stops too briskly or if the final motion is too pronounced (ex. reversed “C” or over rotation).  To minimize excessive spinal load the spine should be vertical at the end of the follow through.

As for the shoulder musculature and rotator cuff in particular, the supraspinatus and infraspinatus of the lead arm are activated primarily during follow through, while the subscapularis remains active during the forward swing and ball impact.  Thus, these muscles are not only important for stabilizing the shoulders during the swing, but also during the follow through.

Summary

  • The general nature of the golf swing and subsequent injuries is quite similar among golfers.
  • Recreational golfers are more likely to suffer traumatic injuries from bad technique, insufficient warm-up and poor physical fitness.
  • Competitive and professionals are usually affected by overuse injuries which stem from strength and range of motion imbalances.
  • Low back pain is the most common complaint but its not clear if it is related to golf practice.  Find out more here.
  • Shoulder problems are also common, with the lead shoulder being more often reported.
  • Elbow injuries are second most common, with tennis elbow being more prevalent than golfer’s elbow.
  • Traumatic and impact injuries are more common in young or old players, and players with low skill levels.

If you enjoyed this post, but are interested in more detail about specific injuries and their prevalence in golfers, we have you covered!

Low Back Pain —> HERE

Shoulder Injuries —> HERE

Elbow/ Wrist/ Hand Injuries —> HERE

 

 

 

 

 

References

Cabri J, Sousa JP, Kots M, Barreiros J.  Golf-related injuries: A systematic review.  European Journal of Sport Science. 2009; 9(6):353-366.