Physically, Andrea is an excellent athlete, having come through the US collegiate system. An experience which gave him a good strength base, as well as technical competency in a variety of lifts. As a result of Andrea’s prior training history, he was able to take to the programmes quickly, he required less supervision and coaching – allowing him to dedicate more time and effort to the work, and he was able to recover well from sessions, without excessive post-exercise soreness. For all these reasons, and more, we would encourage any young aspiring golfer to find a suitably qualified coach and to get in the gym and lifting as early as possible.

The ETPI have been supporting Andrea through the last 2 seasons, and during this time we have transitioned through a series of training focus’.

Andrea first approached us during the start of the 2018 season, and our initial focus was to develop good training habits, based upon programmes which would deliver improved strength during the in-season, but without causing excessive fatigue. Fortunately, due to his previous history, and his excellent consistency, we were able to quickly establish these habits, even despite his busy in-season schedule.

Over the course of the 2018 season and despite a busy competitive schedule, Andrea was able to increase his clubhead speed ~3mph, strength ~28% and explosive strength ~4%, following a largely strength focussed programme. We then continued to increase his strength over his short off-season.

At the ETPI, we typically measure explosive strength using countermovement jump net positive impulse and strength using isometric mid-thigh pull peak force. Andrea’s 2018 in-season improvements are shown below. We will put out a separate blog on our physical profiling approaches in the near future. However, these results clearly highlight the gains that are possible during a busy season of competitions.

2018 Progress

2019 Season

With a new year, came a new set of goals. Having established high levels of strength over our first season with Andrea, we began to move onto an explosive strength focus.

Explosive strength is of great importance in golf. Players are required to generate large forces through the ground, then transmit them through the kinetic chain, into the clubhead to generate speed. All within ~0.5 second window (the golf swing).

Clearly, being able to generate large peak forces is of great value, however if you cannot reach those peak forces within the imposed time-limit, they are not going to be of great use. This can be likened to a car in a drag race. You could be entering the 0.5 mile race with a car that has a top speed of 200mph, but with a 0-60 time of 10 seconds (this is the strong but slow golfer). You could also enter with a 100mph top speed and a 0-60 time of 3 seconds (the fast but weak golfer).

Developing a balance between these qualities is of high importance. In Andrea’s case, we had developed a high top speed over the 2018 season, and needed to shift the focus towards improving his 0-60 time.

The Programme

When working with golfers in-season, we usually use a daily undulating model. This means that we will typically change the training stimuli throughout the week, working towards different focus qualities (strength, explosive strength etc.) on different days. This is usually delivered as a 2-3 day per week programme, starting with more of a strength focus and developing into an explosive focus over the course of the week.

Volume is normally also reduced as the week goes on (especially in less well trained players). This method allows us to control for fatigue over the week, while still getting the hard work done.

Our approach also allows us to work around the lack of ‘out of competition’ time (something which is an inherent challenge in golf). At the highest level, with players competing year round, golf is not a sport which allows for a typical periodisation model, so blending all qualities together, but shifting the distribution and focus is how we work around this.

These points are exemplified in Andrea’s programmes [below] – the first programme shows a 2018 in-season week, with a strength focus. The second programme shows his current 2019 programme, with an explosive focus. It is clear that in both cases, strength and explosive strength exercises are included, but the percentage of time dedicated to each switches.

Andrea’s In-Season Training Programmes – 2018 Strength Focus:

Andrea’s In-Season Training Programmes – 2019 Explosive Strength Focus:

Whether you’re a professional, a serious amateur, or a recreational golfer, you are sure to have heard the phrase ‘golf fitness’ and have more than likely been advised that you should have a gym routine to help your golf.

Given the somewhat vogue status of ‘golf fitness’ at present, there is a large body of information around the topic portraying a complexity which for some creates a barrier to getting started. If you are a professional you are sure to have a busy schedule, and the typical amateur doesn’t have the spare time to devote to over-elaborate routines, so it is important allotted gym-time is used wisely; abolishing components which are unlikely to offer much return.

Herein we present a probability of performance-impact model which underpins the S&C service provided at the European Tour Performance Institute (ETPI). The aim herein is to add clarity to where a golf-impact will most readily be achieved, and reassure that gym programmes need not be complicated. The authors hope this will encourage players of all levels to make that behaviour change towards a healthier lifestyle and compliment their golf training with a no-frills gym routine.

Driving Distance

Sceptics of weight training for golfers will be quick to point out legends of the game who didn’t engage in such activities. Notwithstanding the evolution of the modern golf game (longer courses and more forgiving clubs), of course all this tells us is that it’s possible to be genetically blessed and get away with not engaging in additional physical work.

Despite this few golf coaches or analysts would contest the importance of CHS in modern day golf, research has shown that the faster you swing the club the lower your handicap (r=0.95) (Fradkin et al, 2004). Further, even subtle increases are associated with significantly lower scores on par 4 and 5 holes (Hellstrom, 2014).

Therefore, this is one avenue where a gym programme can have a direct performance impact. Indeed, from Mark Broadie’s (2014) revolutionary book ‘Every shot counts’, it is evidenced that a 20-yard increase in distance off the tee will incur 0.75 strokes gained per round.

As with most striking, hitting or throwing sports, the lower body is the engine (force generation) for the motion of the golf swing. This is why leg strength is a priority.

This is now supported by research indicating significant relationships between lower body strength, explosive strength and CHS (Wells et al, 2018a, Wells et al, 2018b). Most amateurs (and many professionals!) will benefit from increases in driving distance secondary to strength training due to their often ‘untapped’ strength potential. This is particularly true for females and more senior players who generally speaking are more likely to have lower pre-existing muscle mass and strength levels than their younger, male counterparts.

Once the force has been generated by the lower body, this then needs to be transmitted into the clubhead across the trunk and through the arms in a well-sequenced pattern. The trunk should therefore be developed to effectively transmit force, thus enhancing the efficiency of the engine (lower body). The latter is equally important, as otherwise the energy created by the lower body is leaked and not transferred into the clubhead.

Injury and Illness Risk-Reduction

Inherently as CHS increases so does injury risk, as the player has to sustain the increased forces associated with swinging faster. To counter this when we plan to upgrade the engine size we also need to build a well-balanced chassis. This means increasing the ability of the relevant tissues (i.e. muscles and tendons) and structures (i.e. bones) to tolerate load.

The force magnitude at the lumbar spine alone is worthy justification for the inclusion of strength training. Forces of ~7500N (equivalent to ~ 750 Kg) have been reported from elite players swinging with a driver (Hosea, 1990). It is therefore unsurprising that in a published injury audit from the PGA European Tour the lower back, along with the neck and wrist, were the most prevalent injury sites (Smith and Hillman, 2012).

The same report showed that 80% of these injuries were related to overuse, which according to a large meta-analysis and systematic review could be reduced substantially through engaging in strength training (Laursen et al 2014). Many injury resilience strength exercises may actually be the same as the performance enhancement solutions.

By way of example, the deadlift will not only increase leg strength to facilitate longer drives but it will also increase the tolerance of the back, trunk and wrist musculature, with particular supporting evidence that it is useful in the rehabilitation of lower back pain (Welch et al 2015). This is a real bonus as it makes for efficient programming.

Unfortunately, this is not the case for the neck which is insufficiently exposed in traditional compound strength exercises (i.e. deadlifts), so some additional, isolated neck specific conditioning is recommended.

Improving or maintaining mobility is another side effect of good quality strength training. Contrary to common belief, the lengthening phase of muscle activity in strength training exercises increase muscle length and overall mobility (O’Sullivan, McAuliffe, DeBurca, 2012).

Like cardio-respiratory and mobility development, strength training offer an array of health- related benefits which are well documented. Indeed, the American College of Sports Medicine (ACSM) now include (twice weekly) strength training as part of their recommendations for general health. Exercise is now often described as a vaccine to illness given its protective effects against an array of both acute and chronic conditions.

Injury or illness means time away from practice, and given that golf is a highly technical sport this is very likely to have a large negative impact on performance over time. Considering the significance of this, it becomes clear that perhaps the largest (albeit indirect) accumulative performance impact we can have is long-term injury avoidance.

Unlike with determinants of performance (CHS) where we can only suggest strength training may help, we are probably safe to insist that avoiding injury and illness will help performance. If we enable the player to take to the course, range or putting green as often as they like and miss very few practice days or tournaments, this is likely to accumulate into a large positive performance impact. This is a long process and not a sell that is likely to excite a player, but for the reasons discussed this is the primary goal of the S&C service we provide at the European Tour Performance Institute (ETPI) as reflected by our probability of performance-impact pyramid.

Transfer to Technical Ability

It is commonly accepted that a change in technique is a product of a particular activity, drill, practice design, or pedagogical strategy – this underpins the golf coaching process anyone who has had lessons will be familiar with. However, it is perhaps underappreciated how altering a physical capacity (i.e. strength, stability, mobility or control) can over time influence technique.

It is important for players and coaches alike to understand that although ‘golf fitness’ can certainly play an important part in helping a player make a swing change, the gym is not the place to rehearse the aspired movement pattern.

Rather, the gym should be used to drive changes in physical capacities (identified through a discussion with the swing coach) that may impact on the players ability to make the shapes their coach wants from them.

This is best achieved with de-contextualised exercises that don’t resemble the swing pattern, but carry the potential to remove physical barriers that are preventing a player from moving a certain way without loss of posture or compensations.

Changes in technique could then obviously have a whole host of secondary effects on CHS, injury risk, or consistency. For this reason transfer to technical ability shouldn’t be overlooked, but it is difficult to predict cause and effect within this training space due to the complexity of human movement variability and motor learning. The exercises used to impact technical ability will obviously be specific to the individual, but specialist input will be required to identify and implement this.

Even then, the true impact on technique is often unpredictable. It is therefore important that players don’t become perturbed by this area, and let this dominate their allotted-gym time. As a general rule of thumb, no more than 10-20% of the exercises in your gym programme should be designed with this in mind.

Conclusion

Prior to starting a gym programme, players are advised to seek the help of an accredited strength and conditioning coach (ASCC) or certified strength and conditioning specialist (CSCS). One or two coaching sessions under such qualified supervision would be sufficient to establish a gym programme which has a high probability of performance-impact through facilitating longer drives, promoting health and wellbeing, and increasing resilience to known injury sites. Many golfer’s lives are complicated, gym programmes don’t need to be.

References

Broadie, M. (2014) Every Shot Counts: Using the Revolutionary Strokes Gained Approach to Improve your Golf Performance and Strategy. USA: Penguin Random House.

Fradkin, A.J., Sherman, C.A., & Finch, C.F. (2004) How well does club head speed correlate with golf handicaps, Journal of Science and Medicine in Sport, 7(4) 465-472.

Hellstrom, J., Nilsson, J. & Isberg, L. (2014) Drive for dough. PGA Tour golfers’ tee shot functional accuracy, distance and hole score, Journal of Sports Science, 32(5) 462-469.

Hosea, TM., Gatt. C.J., Galli. K.M,, Langrana. N.A., & Zawadsky. J.P. (1990). Biomechanical analysis of the golfer’s back. In A.J. Cochran (Ed.), Science and Golf: Proceedings of the World Scientific Congress Of Golf (pp. 43-48). London: E&FN Spon

Lauersen JB, Bertelsen DM, Andersen L.B. (2014) The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11) 871–877.

Smith, MF and Hillman R. (2012) A retrospective service audit of a mobile physiotherapy unit on the PGA European Golf Tour. Phys Ther Sport; 13:41–4.

Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., Falvey, E. and Franklyn- Miller, A. (2015) The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport and Exercise Medicine, 1(1).

Wells, JE, Mitchell, AC, Charalambous, LH,and Fletcher, IM. (2018a) Relationships between highly skilled golfers’ clubhead velocity and force producing capabilities during vertical jumps and an isometric mid-thigh pull. Journal of Sports Sciences, 36(16):1847-51.

Wells, JET., Charalambous, LH., Mitchell, ACS., Coughlan, D., Brearley, SL., Hawkes, RA., Murray, AD., Hillman, RG. and Fletcher, IM. (2018b). Relationships between Challenge Tour golfers’ clubhead velocity and force producing capabilities during a countermovement jump and isometric mid-thigh pull. Journal of Sports Sciences, 1-6.

O’Sullivan, KO., McAuliffe, S. DeBurca, N. (2012). The effects of eccentric training on lower limb flexibility: a systematic review. British Journal of Sports Medicine, 46(12): 838-845.

Find out more about the health benefits of golf at www.golfandhealth.org.

Among the best golfers in the world playing on the European Tour, the standard and depth of quality is exceptionally high. For them, the difference between winning and coming second or making their tour card versus missing out can come down to the smallest of margins.

From week to week, a huge number of variables place demands on them, their bodies and their performance. These all need to be accounted for and fully understood. For most people (and particularly athletes) the body responds well to and likes routines, structure and balance. As a professional golfer travelling the world with the modern international schedule of golf, this can sometimes be very hard to achieve.

Over the next couple of articles we will be talking about the importance of sleep, diet, hydration and travel for the professional and recreational golfer alike. In this blog article we will be discussing sleep and air travel.

Sleep patterns among professional golfers can be hugely variable due to time zone changes, jet lag, very early or very late tee times, media requirements and travel delays to name a few. We know that sleep is a crucial factor in human physical and mental health and performance.

The recommended amount of sleep varies between people depending on age, sex and activity, but generally 8 hours a night is a guideline figure. It has been shown that sports people require more sleep than the general public and performance factors are increased with an extra hour of sleep a night on top of the average.

Sleep deprivation can have several effects on people and athletes/golfers performance including:

• Hormone changes – reduced duration of sleep has been linked with increased levels of cortisol. This is also known as a stress hormone and has been linked with reduced healing, increased risk of injuries and reduced memory. It is also linked with reduced levels of the body’s natural growth hormone, which helps the body repair.
• Reduced energy – sleep deprivation reduces your body’s ability to store glycogen. Although often seen as an energy source needed during endurance events, it is still a key component of the energy requirements in sports such as golf.
• Reduced decision making and reflexes – evidence shows that sports people who don’t get enough sleep are worse at making split second decisions and are less accurate in their performance (these are also similar effects of dehydration which we will discuss in another piece)

As I write this article I am 35,000 ft in the air on a plane travelling 3 hrs 45 minutes to Morocco for the Trophee Hassan II, with the entire journey today taking 9 hours from door to door. Many of the golfers playing in this tournament have travelled much further and crossed many more time zones.

This is a common necessity for players and staff on the European Tour every week, with the 2014 schedule featuring 48 tournaments in 26 countries worldwide. Air travel has many effects on the body of which ‘jet lag’ is one.

Jet lag is linked with a de-synchronisation of circadian rhythms and its impact depends on a number of factors e.g. the duration and direction of the flight, crossing multiple time zones, repeated and regular journeys with little time for acclimatisation and individual differences between people.

Some simple tips for trying to combat the effects of time zone changes and jet lag are:-

• If over 3 hrs time difference, try and arrive 24hrs prior to your first day practice/training.
• If you want to sleep later in the morning when you arrive, close the curtains and black out the room as much as possible.
• If you want to wake earlier, keep the curtains open when you go to bed, which will accustom you naturally to the morning light.
• Change your watch to the new time zone before you get on the flight, and then start eating/sleeping to the new time zone immediately (if a time change of longer than 4-6 hours try and do this the day before you leave to start your bodies acclimatisation to the new time zone.
• Avoid drinking alcohol/caffeine the day before, during the flight and the day after.- Maintain adequate levels of fluid intake (preferably 2-3L of water/day).
• Wear compression socks during flights

The effects of prolonged periods of inactivity and long haul travel are well documented. As well as professional golfers, it is as important for the general population to ensure that they follow guidance and have regular breaks from sitting on a plane. They should carry out simple, regular exercises to promote blood flow and prevent the effects of prolonged inactivity and static postures on a flight.

In the fiercely competitive world of modern professional golf, it is vital that every aspect of a golfer’s preparation is optimised and good health is maintained as much as possible. The above tips can help to reduce the affects of air travel and maximize the benefits of sleep.

Nigel Tilley is a Consultant Physiotherapist on the European Tour Physio Unit and ETPI.

REFERENCES

Lemmer, B., Kern, R.I., Nold, G., & Lohrer, H. (2002). Jet lag inathletes after eastward and westward time-zone transition.Chronobiology International , 19, 743_764.

Waterhouse, J., Reilly, T., & Edwards, B. (2004). The stress oftravel. Journal of Sports Sciences , 22, 946_966.

Beaumont, M., Bate´jat, D., Pie´rard, C., Van Beers, P., Denis,J. B., Coste, O., et al. (2004). Caffeine or melatonin effects onsleep and sleepiness after rapid eastward transmeridian travel.Journal of Applied Physiology, 96, 50_58.

Drust, B., Waterhouse, J., Atkinson, G., Edwards, B., & Reilly, T.(2005). Circadian rhythms in sports performance: An update.Chronobiology International , 22, 21_44.

Reilly T., Atkinson G., Edwards B., Waterhouse J., Akerstedt T., Davenne D., Lemmer B. and Wirz-Justice A. (2007) Coping with Jet-lag: A position statement for the European College of Sports Science. European Journal of Sports Science, 7, 1, -7

This article originally featured in International Golf Pro News. Visit the IGPN Page to find out more and subscribe for free.

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Golf is a sport with many health and well-being benefits. It is played across the world by people of all ages including into their 80’s and 90’s with a reported 60 million participants.  The health benefits have been widely reported in recent years with an 18-hole round representing somewhere between six to eight kilometres of walking and often requiring physical exertion across variable outdoor terrain.  This can burn more than 1,500 calories as well as requiring more than 8,000-12,000 steps.

A recent Scandinavian study of more than 300,000 golfers showed that people who play golf on a regular basis have a 40 per cent decreased mortality rate compared to their peers, which equates to a five year increase in life expectancy – regardless of gender or socio-economic status.

Another study found that walking 18 holes of golf was the equivalent of moderate-high intensity exercise for the elderly and moderate for the middle-aged.

But it isn’t just physical benefits to be gained from playing golf.  The sport suits participants of all ages, abilities, sex and age, who can all play together providing unparalleled socialisation opportunities and psychosocial benefit.

Golf is much more than just walking and can be very demanding, requiring strength, endurance, explosive power, flexibility and athletic ability to perform a movement which produces some of the fastest club head and ball speeds of any sport.

However. the effect of repeated large forces on the body can lead to a number of different types of injuries. Due to the biomechanical requirements of such an asymmetrical swing, these are often specific to certain areas and sides of the body in golfers depending on their lead side.  For instance, right handed golfers, wholead with the left side, are more likely to suffer from Extensor Carpi Ulnaris (ECU) injuries on the left wrist and Dorsal Rim Impaction Syndrome DRIS injuries on the right wrist.

A wealth of research has been conducted on the types and likelihood of injuries experienced by golfers with the back, shoulder, elbow, wrist and hips appearing the main areas of the body prone to problems.

These injuries are generally caused by acute trauma, poor technique, a lack of physical conditioning, the accumulated effect of repetitive movements over many years or a combination of these factors while, interestingly, the occurrence of certain pathologies differ between amateur and professional golfers.

Now, in the first part of our series on golf injuries and physiotherapy, we look at the wrist, potential injuries to the joint and associated soft tissue, and how physiotherapy can help in the treatment and rehabilitation of an injury in order to fast-track recovery and help return you to activity as effectively and efficiently as possible.

Wrist Injuries

There are a large range of common wrist injuries in golf but in this brief study we will concentrate on one commonly seen in a variety of golfers. – the Extensor Carpi Ulnaris (ECU) injury.

What Is It?

The ECU is a skeletal muscle located on the ulnar side of the forearm which acts to extend and adduct the wrist.  It has to work very hard during the golf swing and so is highly prone to injury in golfers.  ECU pathologies include tenosynovitis of the tendon sheath, tendinopathy, tendon disruption and tendon instability.  These injuries can occur in isolation or combined and can be caused by high force trauma, such as hitting a tree root or thick grass, rapid increase in loading, continued excessive loading and technique faults. This can lead to a variety of changes at the tissues depending on the stage, severity or structure affected including cellular tissue disruption, thickening, matrix breakdown and increased vascularity.

How does physiotherapy treat this type of injury?

The key aim of physiotherapy is to attempt to clearly identify the injury and its cause.  This greatly helps direct the golfer’s treatment and management.  Often this type of injury will require ‘load modification’ with more traumatic sudden onset injuries requiring immediate removal of load and PRICE protocol (protection, rest, ice, compression and elevation) or POLICE (protection, OPTIMAL LOADING, ice, compression, elevation).  The aim here is to reduce the bleeding and swelling from the injury site if severe tissue disruption such as a partial or full rupture has occurred.

In presentations that have a more gradual non-traumatic onset, a reduction rather than removal of load is often required.  This reduction in load can be achieved by encouraging the hitting of less balls or avoiding hitting from hard ground or mats – which often increase the stress on these tissues.  There are several strapping techniques which physiotherapists use that can also help to stabilise the wrist and give support to the structures.

In layman’s terms if your problem is a slow gradual onset of pain and symptoms in the outside of the wrist a reduction in the amount of balls that you hit or stopping practicing on hard winter matts may help to reduce symptoms and allow recovery  In situations where a sharp and sudden onset occurs after a specific incident (like hitting a tree root or when hitting out of heavy rough) you may need to stop playing golf immediately for a period of time and see a physiotherapist of wrist specialist for a detailed assessment of your injury.

The rehabilitation of injuries to the ECU and its associated structures depends on the exact injury and the severity of the tendinopathy.  But where no severe tissue disruption has occurred – as opposed to partial and full ruptures, which could require surgical opinions or interventions- the aim is to gradually restore the tissues ability to tolerate load through load management, isometric and eccentric exercises and graduated return to play.  As with so many injuries in golf it is key that technique and playing habits are reviewed to help identify solutions to poor technique and practice faults which can often lead to excessive stresses on certain parts of the body. For example, reduced ability to separate your pelvis from your upper body during the back swing is often associated with a higher incidence of wrist, elbow and shoulder injuries, due to the poor swing techniques these limitations create.

A golf-specific physio such as those that work at the ETPI in Terre Blanche and Jumeirah Golf Estates will be able to help you with these sort of biomechanical adjustments or conduct a joint assessment with a golf coach or instructor.

For safety, optimum treatment and to reduce the risk of re-injury, players and patients should visit and complete a full assessment of all injuries and receive treatment and rehabilitation under the guidance of a chartered physiotherapist.

Part 2 of this series on ‘Physiotherapy and Golf Injuries’ will look at ‘The shoulder’ and will be out next week.

To see an in depth guide for sports physicians and physiotherapists on examining the wrist and assessing its injuries you can watch this video by European Tour Chief Medical Officer Dr Roger Hawkes and Consultant Wrist & Hand surgeon Mr Doug Campbell:

https://youtu.be/0sewWiHAhk8

The European Tour Performance Institutes in Terre Blanche, France and at the Jumeirah Golf Estates in Dubai have highly qualified and expert physiotherapists, osteopaths, medical staff, biomechanists and support staff that are able to help you with your injury assessment, diagnosis, treatment and improve your golf performance.  To arrange a visit or book an appointment with them email:

Terre Blanche –  Email: info@biomecaswing.com

Jumeirah Golf Estates – Email: ETPI@jumeirahgolfestates.com

Glossary of Terms

Isometric – is a type of strength training (muscle action) in which the joint angle or muscle length do not change during the muscle contraction.

Eccentric – Is active contraction of a muscle occurring simultaneously with lengthening of the muscle.  The muscle elongates while undertension due to an oppossing force greater than the muscle generates.

Concentric – A concentric muscle action is a type of muscle contraction where the muscle is shortening while generating force.  This occurs when the force generate dby the muscle exceeds the load opposing its contraction.