Tag Archives: Golf

Why do you need to be strong anyway?

Considering the name of this blog, and the length of time I’ve been running it, it is pretty shocking to admit I’ve never actually addressed this question before now, I’ve made mention to reasons to be strong in almost every article but never actually fully answered this question, all in one place, in a (hopefully) succinct and useful manner, so this is my intention right here right now. And as it’s taken so long I guess I had better be good!

At first glance golf doesn’t seem to a sport that requires much in the way of strength. The club is a light implement and a highly co-ordinated movement in which flexibility and speed are clearly required to execute effectively. That may be the case but strength is vital to all of those physical qualities. Indeed, research has shown strength training to:

  • Reduce injury risk in golfers
  • Increase Club-head speed by 7-10 percent, or the equivalent of 10-15 yards, without any ill-effects on accuracy.
  • Increased strength and flexibility allows golfers to adopt more optimal swing mechanics
  • Improve muscular strength and muscular endurance, which has a positive impact on golf swing consistency during an 8-hour, 36-hole round of competitive golf.
  • Improve shot dispersion stats
  • Increase greens in regulation hit as a result of being closer to the hole after drive
  • Improve putting distance control
  • Lower scores
  • Strength training in lengthened position has even been shown to increase muscle length more effectively than static stretching

The strength-speed continuum

If you’re a golfer you’ve probably swung a 400 gram club your entire life, and have therefore got pretty good at swinging light objects at near maximal velocity. In other words, you are able to put the force you have into the golf ball reasonably quickly, but you don’t have much force in absolute context to put into the ball. This explains why research has shown time and time again that strength training improves club head velocity (there are still some that claim that weight training is bad for golfers and to them I will add this caveat; bad weight training is bad for anybody, good weight training can certainly help).

The speed strength continuum, then, goes from absolute speed on the left to absolute strength on the right.

AbsoluteSpeed

Somewhere in the middle lies a sweet spot between general force production abilities and the abilities specific for your sport, this will obviously vary from sport to sport with a power lifter needing more absolute strength and a golfer needing to be slightly towards the speed/ speed-strength end of things.

We have the average golfer on the far left side of this continuum from years of swinging a light club at near maximal velocity and we need to bring you towards the right side, because absolute strength is the basis for a lot of things, not just power output but also stability.

Once we’ve developed some strength and brought guys towards the absolute strength end, we can begin to work exercises that work on that ideal middle area with a little more specificity to golf. This is where med-ball throws, weighted jumps, kettlebell swings, etc come in. There is fairly obviously a consideration for individual needs here too, the classic big strong guy for example might need to be moved towards the speed end of this continuum and we would focus our efforts on speed and speed-strength work rather than strength work. There may even a place for expanding the continuum further and incorporating overspeed (underload) training in or supramaximal loading with some individuals. That said, the vast majority of golfers start way towards the speed end and moving them towards the strength end represents the largest and most easily improved window of adaptation.

Reduce injury risk

Right handed golfers typically display adducted or internally rotated right hips, low right shoulders, left thoracic rotation and rib flare (see picture below??)

To a certain extent many of these are sporting adaptations that help to perform the task of swinging a club, however they are also imbalances that left unchecked can lead to injury. As Eric Cressey said recently:

“Specificity works great until you’re so specific that you wind up injured and have forgotten how to do everything else”

A well designed strength training programs will include rotational drills on the opposite side, and you take you through various ranges of motion in various stances so as to round you out as an athlete and counteract the effect of the golf swing to reinforce these imbalances. As noted physical therapist James Porterfield says, a well designed strength training program, working within the individuals current movement capabilities will do wonders to prevent and rehab injury.

Strength is also the basis of stability – a lot of injuries issues are brought about when flexibility/ mobility are greater than your ability to stabilise in the end range position – indeed I’ve often said from an injury prevention point of view I’d rather have an athlete that is tight but stable than a hyper mobile athlete with no stability, as that person is typically spending a lot of time on the physio table!

A good example of this is the lower back, we know that repeated extension and rotation isn’t necessarily the best thing for our spines, hence why a huge percentage of  golfers suffer low back pain. Good core and glute strength provides more spinal stability and helps us to achieve better spinal positioning as we rotate, taking some of the pressure of the lower back.

Increased body awareness and movement context

As the world renowned golf biomechanist Mark Bull once put it to me,

“The biggest advantage of S&C as I see it is movement context”

The golf swing is a highly complex, co-ordinated movement requiring precise timing of movements of pretty much every muscle in the body. You need, therefore, a good understanding of where your body is in space to execute it effectively.

Strength training is a great educational tool to develop awareness of how your body is moving and how to control it. Further, external load has a seemingly magical property to make a movement pattern ‘stick’ and become engrained in our memory.

Take the hip hinge for example, in a good hip hinge the muscles responsible for thoracic extension must be activated to prevent c-posture. The core musculature must do the same to keep the lumbar spine from extending as we rotate, putting the back in a compromised position. Pushing the butt back loads the powerful muscles of the hip that create so much of the speed in the golf swing. Good golf posture requires the ability to bend from the hips whilst maintaining the neutral pelvic tilt and spinal alignment essential for efficient rotation. In short a good hip hinge teaches us many of the skills we need to get into and maintain a good golf posture, come to think of it many of the cues we use in the gym to teach the hinge, such as screwing the feet into the ground, pushing the butt back and bracing your core will drastically improve you golf posture.

stronger-golf-hip-hinge

Not only that but the more movement variability we have, the broader the foundation we build. The wider the base, the more we can stack specific skills on top of it. An athlete who is solely engaging in golf like movements and oftentimes cannot or has lost the ability to perform basic movement patterns, they therefore have also lost those wide foundations to build their sports specific skill upon.

The golfer who establishes wider context has a wider array of movement perspective and greater kinaesthetic awareness, they are therefore more likely to quickly grasp new coaching cues or swing changes. In short, they are more coachable. This is also my major argument against early sports specialisation for kids.

Hopefully this post has given you more of the why behind getting strong for golf, the rest of this blog is littered with articles on the how so please take a look around, then go pick up heavy things!

5 reasons why ‘golfish’ exercises don’t work

I’m not a fan of golfers using exercises that mimic the golf swing for ‘fitness’ benefits at all. There are much more effective methods to develop the raw materials of mobility, strength, speed and power we need in the golf swing, but more than that these exercises aren’t really that ‘specific’ in the first place. The law of speciality states that training should be specific to the sporting activity in terms of joint movement, direction of force, load and velocity.

Quote- New post design

1.Not appropriate when generally weak

To put it another way ‘golf-specific’ strengthening exercises are not appropriate or necessary when generally weak. It’s much more valuable to become strong overall, and only then pursue golf-specific strength. Staying injury free should be the goal of any training program first and foremost. The ability to absorb the forces generated in the golf swing, for instance, is important in staying injury free and generally associated with eccentric strength.

2.Competing motor demands

Mobility drills standing in golf posture for example – assuming appropriate stability has been developed these can be a great way to develop dynamic and functional mobility in the golf swing. As golf posture is being mimic the conditions and loads in which the body will be required to produce mobility are also replicated.

However if stability is an issue and the golfer doesn’t possess the ability to maintain these positions and joint loads while trying to demonstrate mobility then mobility will not be displayed nor will these exercises improve it. They could even do more harm than good as the athlete could attempt to generate more ROM and in doing so obtain it in a less than ideal manner (typically in this case by gaining ROM from the lower back and not the thoracic spine), potentially affecting motor control of the golf swing, applying faulty movement mechanics and even leading to injury.

This is where regressions moving away from the specific and allowing the introduction of more stability are vital.

3. Soley focusing on golf like motions leads to a lack of context and poor skill acquisition

It goes without saying that some athletes pick up new movements faster than others. Usually, this occurs because they have context from which to draw.

As an example, an athlete might have a great hip hinge because they’ve done it previously whilst playing sports that utilise the athletic base position. Having that hip hinge proficiency helps the individual to efficiently learn a deadlift pattern (among many other athletic movements).

Establishing context is just one of many reasons that children should be exposed to a wide variety of free play and athletic endeavours. The more movement variability we have at younger ages, the broader the foundation we build. The wider the base, the more we can stack specific skills on top of it once the time is right.

An athlete who is soley engaging in golf like movements and oftentimes cannot or has lost the ability to perform basic movement patterns, they therefore have also lost those wide foundations to build their sports specific skill upon.

The golfer who establishes wider context has a wider array of movement perspective and greater kinaesthetic awareness, they are therefore more likely to quickly grasp new coaching cues or swing changes. In short, they are more coachable. This is also my major argument against early sports specialisation for kids.

4.Direction of force

We talked earlier about the importance of direction of force as it pertains to specificity, citing the work of Mel Siff. One of the problems with many ‘golfish’ exercises using bands or cables is that the actually fail to apply direction of force specific to the golf swing. Take this cable backswing here:

Whilst the movement looks similar to the golf swing the direction of force is completely altered. In the case of the cable backswing, the weight of the cable stack is pulling you down and forward towards it, you must therefore activate the muscles to resist this, this doesn’t happen in the swing normally. The golf swing requires almost every muscle your body to be utilised in a specific sequence, in specific ranges of motion, and in correct tension relationships to all the other muscles. Altering the direction of force, causes your body to change the entire sequence and balance of the movement in order to achieve a similar outward appearance.

 5.Time constraint and intensity specific

Let us also consider speed and intensity for a moment as I believe this to be one the biggest failings in the weighted swings, cable machine or dumbbell swings and bosu/stability ball swings that might traditionally be considered golf-specific. The golf swing is a high speed movement, it therefore stands to reason we should train with the goal of developing speed. Additionally adding resistance (particularly via a cable which ensures smooth movement and equal resistance throughout) to the movement alters the velocity of the movement, research has shown in almost all speed based sports that swinging weighted implements decreases speed.

The reason they do

In a word, posture! When you train in the same posture as your goal activity, the forces (namely gravity) acting on your joints and muscles will be replicated. This can obviously be advantageous for sports specific training, the problem is that most of these exercises will contravene one, two, three or more of the rules above. One area I have found this idea to be usable is t-spine mobility drills – once you have gone through an appropriate progression i.e. from lying to kneeling positions before moving into standing – drills like the one below serve to develop the ability to utilise t-spine mobility in a position similar to the golf swing.

A Closing thought

if you are using a drill like this to improve a specific part of your technique/ motor pattern with your swing coach or something then absolutely all for it. RNT band drills for example can be really helpful in teaching correct shoulder/hip turn  or kinematic sequence in the golf swing. However, if your using drills like these in the gym in the hope it will improve your mobility, strength, power, you won’t have much success and when it comes things like rotational mechanics and lower back pain it may even be detrimental.

 

Why golfers still need the bench press

Today’s post is a guest post from Bobby Dattero. Bobby is Co-Owner and Sports Performance Coach at Evolution Sports Performance in Easton, MA, USA. He holds a Master’s degree in strength and conditioning, is a Certified Strength and Conditioning Specialist and TPI certified. You can catch more of him at his blog or on twitter.

The fitness industry is often guilty of very all or nothing thinking, this leads to different people in the industry often stating seemingly completely contradictory or opposing things, this I’m sure can be really confusing and a little disconcerting.

But why does this happen?

Training is not black and white. As Dan John is a fan of saying “everything works until it doesn’t”. There is no such thing as a bad exercise only a bad fit for that particular person at that particular time.

Training for golf is no different. You can get conflicting opinions on methods or programs. Some of this also stems from controversial headlines used to grab a reader’s attention (which hopefully this did).

Unfortunately, this is the way things go. It is much easier to write an article that asks you to “throw out your bench press” than it is to say that “all upper body exercises are pretty much OK to do unless you have an individual reason not to.” There is nothing that’s going to grab your attention with that second example.

This is why it is essential to look at the whole picture and when designing fitness programs and making choices regarding exercise selection.

So, let’s get to that old staple of the weight room,  the bench press. There are a few reasons why someone might not want to bench press.

  1. If you have a shoulder injury bench pressing may be painful. Never train in pain
  2. The scapulae are not allowed to move freely in the bench press so it’s “bad”
  3. The exercise is often loaded too heavy which results in missed reps and a lack of progress
  4. Stability is created by the bench and not the user
  5. Some gyms are small and cannot fit racks and bench presses in them

With the exception of point 1, I don’t buy into these reasons. If someone has a physical reason why the bench press is not a good fit for them, I have no problem eliminating it from their program.

A combination of points 2 to 4 is oftentimes rephrased with regards golf fitness as “golf is played on our feet so we should train on our feet, its functional.” This is has lead to exercises like the cable press gaining huge popularity amongst golfers. Now, someone can work their pushing strength while on their feet.

The body needs a variety of stimuli to adapt and develop all the facets of fitness required to play the game of golf. The bench press can be one of the best means to build upper body strength and, well, the cable press isn’t perfect either.

“When appropriately programmed and loaded the bench press is one of the best exercises for developing upper body strength”

The Bench Press can be Progressively Overloaded

Progressive overload is a term used to mean that over time we must continually add stress to the body in order to adapt to training. If the training load never increases then progress will cease. Training load includes sets, reps, and weight.

The bench press’s best advantage is that it can be loaded extremely well. We get to use both hands to push against the bar and the bench provides support for us. It basically isolates pushing.

A cable press is limited by stability. You can only load the cable press as much as you can avoid being pulled back by it. This makes progressive overload a challenge.

Take myself for example. I weigh 68kg/150lbs. It is really hard for me to hold the cable resistance in place without getting controlled by the machine. The press is not as hard as getting in position for the movement. A standard bench press is only limited by how strong I am. It will be easier to gain strength with a bench press than a cable press.

Forgive me because I do not have a research study handy, but strong people usually have a good bench press. That means something. If you want to be strong, it isn’t wise to completely disregard its use.

As I’m sure you’re aware Rory McIlroy has added some significant muscle and strength to his golf game in recent years and the bench press has seemingly been a part of a what is doubtless and balanced program of pressing variations to help him get there

Bench Press and Shoulder Health

The bench press can expose shoulder issues and its disproportionate use can potentially cause them. If that is your main concern then you need to really take a look at the risk of the golf swing on the body. More shoulders are beat up because of the golf swing and daily life than through bench pressing and this article is not getting into backs, knees, and hips.

There are steps we can take to protect our shoulders for improved performance and long term health.

  • Monitor Volume – Volume can be problematic for joint health. I would like to see most golfers keep their bench press reps at 6 or less. We can get our volume elsewhere.
  • Add Pushups – Pushups allow the scapulae to move freely. This helps train rotator cuff health while improving push strength and core stability
  • Use the Cable Press – Just because the cable press has limitations does not mean to stop using it. Again, the scapulae move freely and we train core stability with the movement. It’s a win win.
  • Use DB’s and Neutral Grips – A neutral grip is more shoulder friendly than a pronated grip. Use that with DB’s or specialty bars to spare the shoulders.
  • Incorporate Posterior Shoulder Work – Add a lot of Y’s, T’s, external rotations, and breakaways to train the shoulder stabilizers. High reps/volume works well here.
  • Row/ Pull double: If you do 3 pushes in your program, try to have 6 pulls. This will give the shoulder and upper back the kind of strength it needs to fend off cranky shoulders.

I do not want to make this argument to make the cable press seem bad, because it is not. It should be in most programs. The core stability developed and pushing strength is definitely going to complement your training.

When appropriately programmed and loaded the bench press is one of the best exercises for developing upper body strength. Continue to use it if you want to hit the ball further and shoot lower scores.

 

Sort your neck for more shoulder turn

What golfers call shoulder turn is actually thoracic (a.k.a. upper back) rotation, however as the head remains still whilst the upper back turns our cervical spine (a.k.a. the neck) must be able to rotate too if you are going to achieve full shoulder turn in your backswing.

The neck also plays a vital role in how well the rest of your body functions.  As Dean Somerset says, along with the feet and the core, the neck is one of the major stability centres in the body. To generate power, you need mobility. To have mobility, you need stability. Proximal stability feeds distal mobility. Instability signals the brain and nervous system to put the brakes on power output because it feels threatened. A lack of stability is a threat to your nervous system.

If the deep core stabilizing system of your body (of which the deep neck flexors are a part) is unstable, your nervous system will simply recruit more superficial muscles to take over. Neck position, therefore, can play a HUGE role in not only arm movement but also hip mobility, in other words we talk a lot about fixing alignment from the bottom up (i.e. at the feet up) but fixing from the top down is also an important strategy.

In the case of the shoulder, every muscle that holds the shoulder to the body and keeps it from falling down, is held up by the neck. If the neck is in a forward head posture, muscles like the sternocleidomastoid, scalanes, levator scapulae, and upper traps will be all jacked up, which will alter the ability to move the arms around. One of the most common relationships is inhibition (weakness) of the deep neck flexors to facilitation (tightness) in the hamstrings. Lack of stability in the neck causes a reflex compensation in the hamstrings to take over the job of the neck flexors. Neck alignment/ head position will also play a role in hip mobility due to the anatomical link to the spinal chord.

The deep neck flexors flex, side bend, and rotate the head as well as being a big part of the stability system we discussed. They do a ton of stuff. Assessing them is critical.

So, how can you determine if the deep neck flexors aren’t up to par?

The first test we like to utilise is a standing cervical rotation. Standing upright in good posture with the feet together turn the head to the left as far as you can and tilt it down, you should be able to touch your collar bone with your chin, then repeat on the other side.

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Take a close look and you’ll see in the first picture I’m quite able to touch as high on my collar bone and also my shoulder has shrugged up slightly in order to help me get my chin and collar bone too touch. These are the sort of things you need to look for and suggest your neck rotation may not be up to scratch.

Next up we use a supine neck flexion to test the activation of our deep neck flexors. Lying on your back place the base of your thumb at the top of your sternum and point your thumb. Pull your neck down to touch your thumb and hold for 20 seconds.

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Do you feel fatigue, soreness, discomfort, shaking, or the need to hold your breath during this exercise? If so that indicates the muscle may be inhibited and needs activation/strengthening.

So what can you do about it?

The key is to activate the neck flexors after releasing areas of your neck such as the sternocleidomastoid, scalanes, levator scapulae, and upper traps that have been prone to tightness and stiffness.

Sternocleidomastoid hands on SMR

Supine lacrosse ball deep neck flexor activation

The video is an abbreviated version just to give you an idea. The full exercise involves; holding ball under chin for 20 seconds. Next side bend right and left four times keeping control of the ball. Then rotate right and left four times maintaining control of the ball. Lastly do not hold your breath or clench your jaw.

So, If you’re in need of more shoulder turn check your neck function. If you find a weakness or lack of mobility put these exercises into action and I bet you’ll see an improvement.

Incidentally, this article came about from  question posted on twitter so if you want your questions answered pop over to twitter (follow us if you aren’t already!) and tweet it to us.

Does overspeed training increase my swing speed? What the research says

The idea that swinging an underweight club or bat, throwing an underweight ball or sprinting with reduced resistance, meaning you can therefore swing, throw or run faster, therefore leading to an increase in swing speed, has been around a while now. However the idea seems to have become really popular  in golf of late with SuperSpeed Golf leading the way.

reactive-stretch-cord-overspeed-accelerator

 Theory behind Overspeed Training

Overspeed training in general, affects the speed of the neuromuscular reaction that happens when the brain runs a motor pattern i.e. the golf swing. It’s well established in exercise science that there is a continuum of motor units and their associated muscle fibers based on various physiological factors (not just simply fast vs slow, but every option between), with the largest motor units typically being the most forceful and having the fastest contraction speed. Overspeed training is believed to improve velocity of movement by recruiting the fastest specific motor units used in a particular action. Put another way, the body has a “typical” response to any motor pattern that does not usually equate to its potential for efficiency and speed. When the body runs the motor pattern with a lighter implement (one that is lighter than the usual implement, but not too light as to cause the activation of a completely different motor pattern), the neuromuscular response to this motor pattern can happen significantly faster.  In a short number of reps, the body will develop a ‘memory’ of this new and increased speed of the neuromuscular response.  Essentially, we have tricked the body into resetting the typical speed of the motor pattern.

 The need for specificity

As you may have picked up from the above overspeed relies on the idea of specificity, meaning that the training must closely resemble the specific athletic action in order to lead to transferrable results. Take a look at the demo video below and notice that all the drills closely resemble the golf swing. For general training I’m not a fan exercises mimicking the golf swing as these exercises can’t be loaded progressively to drive strength improvement, however with overspeed training we are not after progressive overload by resistance but by velocity and specificity is paramount.

This also leads to the need idea of keeping the weights within about 12% is considered crucial (This value has been determined by the few studies done with baseball swings and throws, where they determined too great of a deviation from the standard weight actually led to velocity decrements rather than improvement). The thought is that more or less than that will lead to the training not translating to actual improved velocity in the action.

Single set response

Much like PAP training in the weight room, this effect if only occurs on a single use basis will fade gradually over about 20 minutes to an hour.  According to SuperSpeed, they have found that there must be a gradual increase in load during the training, in order to make this increase in response speed permanent (the reason for our 10% light and 5% heavy clubs in the set).  This load cycle repeated many times during the individual training session continues to alter the neuromuscular response speed in the body. SuperSpeed claim that with about 4-6 weeks of regular practice, we find that the player’s initial speed increase will become permanent, essentially representing a reprogramming of the ‘typical’ speed of the neuromuscular response to the motor pattern.

Effect on swing mechanics

According to SuperSpeed, their research on the effect on the biomechanics/ kinetic chain of the golf swing, have found significant increase in especially pelvic rotational speed in many players.  This directly results in more speed in the distal segments beyond the pelvis as well.  The more energy that is transferred in the first link of the chain multiplies greatly as the players gets to impact.  They posit that there are a few reasons for this increase: Improved Stability resulting directly from increased muscle activation from the non-dominant swings.  This allows for a stronger load and unload cycle in the lower body.  Increased Downswing Loading as a result of the step-change of direction swings, and general attempt by the player to get the club moving faster.  We find that not having the goal to hit the golf ball allows the player to “discover” the necessary sequencing elements of ground force interaction and lag. This can also lead to players seeing a significant improved in casting and early release in the golf swing.

What the research says

Currently there is no quality research with golf (although SuperSpeed tell me they currently have some underway, and rest assured we will bring you the result as soon as we have them), we must instead take what we have and see what results they’ve gotten. The idea of overspeed training originated in sprinting so there is a fair amount of research on how it affects sprint speed, however there probably isn’t too much carryover to golf. Baseball is the closest activity to golf that has been studied to any real extent and there are a few reasons the results from studies in baseball may apply well to golf:

  • Rotational sports have quite a bit in common, as they sometimes use similar musculature and often rely on the same kinetic chain pattern of muscle activation.
  • Baseball swings and throws rely on the same sequence as golf; generating force from the ground by the big muscles in the hips, glutes, and quads and transferring the force through a stable core into the upper body musculature and eventually out to the extremities to the ball.

Effects on Baseball bat velocity:

Sergo & Boatwright (1993)

Studied 24 collegiate baseball players and split them into three groups based on the bats they would use for practice swings. One group was a control and used a standard legal bat, one group used a heavier bat, and the final group used an underweight bat (overspeed).
They would end up swinging a bat 100 times a day, 3 times per week, for 6 weeks (1800 total swings) and found that all three groups had similar increases in bat velocity (about 8%). Concluded any bat swung that many times will increase velocity, with overspeed or overload having no additional benefit

DeRenne et al. (1995)

Incorporated the use of all three weights of bats seen above into a combined methods training, each individual would take 50 swings with a heavy bat, 50 with a light bat, then 50 with a standard. One group only performed practice swings (dry swings), another took these 150 swings during batting practice, and the final was the control who only used a standard bat. The addition of overspeed and overload in the dry swing and batting practice groups led to significant increases compared to baseline and the control (6-10% average increase). The biggest increases were with the batting practice group (10%) which might have to do with trying to impart maximal force on a ball in a sport specific manner rather than just practice swings with no ball involved

Effects of weighted balls on throwing velocity in baseball:

DeRenne, Ho, & Blitzblau. (1990)

Tested baseball pitchers on throwing velocity after training with underweight and overweight baseballs. Found significant increases when using a ball that was 20% heavier as well as 20% lighter in addition to regular practice with a standard ball.

Effects on swing mechanics and accuracy:

As you can imagine with research in this area being fairly new there wasn’t a lot to go on. One study on bowling in cricket (Petersen, Wilson, & Hopkins. 2004) that found decreased accuracy using underweight and overweight methods, but these decrements were nearly totally wiped out if they had properly matched their intervention and control groups for baseline velocities and skill.

The contention currently seems to be that if using a relatively small deviation from the standard weight, we probably will not see much loss in accuracy, if any at all, but I would like to see that incorporated into future studies just to be sure. In my opinion (and this is only my opinion) it is also certainly possible that it could have some benefits to sequencing as step drills and swings with the club held at the club head end have been used effectively by coaches to teach better release mechanics for a long time.

Conclusion (a.ka. the bit you skipped to anyway)

Baseball has shown an amount of support for the combination of specific overspeed and overload training in a sport that also relies on rotational power. Many golf specific results also report increased clubhead speed immediately after a training session with overspeed, which is going to happen due to maximal activation of the nervous system as well as loosening up the musculature specific to the golf swing. However as of yet, there has been no scientific evidence of long-term retention using overspeed-training devices in golfers, other than the case studies and testimonials of various golfers who are advertising for companies such as SuperSpeed Golf. Additionally no research exist to support it’s use to improve swing mechanics.

This is not to say definitely it doesn’t or doesn’t have a longer term effect simply that the research doesn’t exist to give a definitive answer yet. But we can say that it will have a short term affect for definite and the theory is grounded in well-established exercise science principles.

Finally, a few authors suggest that overspeed and overload training works more efficiently with those who have a pretty solid base of fitness and strength, meaning resistance training and other training methods could be more beneficial for the weaker athletes, at least at first. This would make sense, as it fits with the general thought process of power training for sports. So it maybe for optimal results the best idea is to combine overspeed training with resistance training and periodise both based on your needs and competitive season. Incidentally, I am a huge fan of opposite swings to develop speed and deceleration ability for golfers so this also needs to be built in to any overspeed training protocol in my opinion (SuperSpeed Golf protocols do a great job of this actually)

Hopefully this article has given you some background info on overspeed training and shown you some of the potential gains. If you’d like to add overspeed training to compliment your golf fitness training do take a look at SwingSpeed Golf as they’re making waves in the industry and more importantly are great people. Also if you do purchase be sure to use the code “strongergolf” at check out, that way you get a little discount and I get some money come way too so I can continue to write free articles for you guys. Win win!

This article was co-authored by myself and Alex Ehlert, Alex is former NCAA Division 1 Golfer who was able to gain 20 yards by becoming stronger and more athletic. He is now a Masters Student in Exercise Physiology and writes about optimising golf fitness using an evidence-based approach at his blogwww.golfathlete.blogspot.co.uk and can be contacted via twitter. Information for it was also kindly provided by SuperSpeed Golf.

 

Stretching is a waste of time

I spend most of my time working with clients who want more mobility, be it the ability to get a greater shoulder turn in the backswing or to turn more to ‘load the hips’ in the downswing. The flip side of this is that I spend most of my time working with golfers who spend far to long sitting, either at a desk 8-10 hours a day or on a plane/train/car traveling to the next tournament 2-3 days a week. Unsurprisingly, a fair few of them arrive on my client roster with the mobility of a clam, meaning even basic human movement patterns, such as the squat or hinge are challenging endeavours.

Seeing that part of my job is centred on optimising movement patterns and mobility, these clients expect me to help them improve in this area. However, what isn’t expected, indeed even resisted by some, is when I break down my ‘mobility’ methods, It’s often not what people expect. For most clients, there is very little to no static stretching whatsoever.

The response is pretty predictable – “how am I going to improve my mobility/flexibility if I don’t stretch?” Or “But I’m stretching everyday at the moment; surely I need to do more if I’m going to get better?” My response is to ask whether there religious stretching routine to date has actually improved their mobility. The answer is always No.

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No matter how much time a client spends stretching, they typically see only transient improvements in flexibility and negligible improvement in motor control when performing any movement using that new range of motion. Static stretching alone is not the answer. In fact, it barely provides any benefit at all.

As a result, I’ve dropped almost all static stretching from my programs in favour of some more advanced mobility methods I’ll discuss here.

Why stretching doesn’t work?

Well first off, muscles can’t actually be lengthened – There are various research studies that have looked at this exact topic. Secondly a single 20 second static stretch has been shown to noticeably reduce force output – hardly ideal if your about to go and do a strength training session or complete a high power output activity such as golf.

Most importantly however, tightness in the muscle is often just a symptom not the cause of the problem and therefore stretching is just a band aid for the symptoms and will not fix the cause in the long term. A muscle is tight because it’s protecting a perceived instability, compensating for another area, or is guarding against a perceived threat. So if your tight first you need to ask why said muscle is tight?

For most of us with tightness one or all of the factors above are also at play in limiting range of motion.  Stretching doesn’t address the cause of the muscle being tense in the first place. If the muscle is actually ‘tight’, static stretching should allow the muscle to become less tight, and those gains should be permanent if they are appropriate to the restriction. However, particularly in an area like the hips, that are designed to have a large range of motion before actual end range due to a bony block or capsular ending, the muscles are most likely hanging on to give stability to some other part of the body. Static stretching won’t fix the issue on a permanent basis, as you’ll simply return to being tight as a drum again to give you the stability to move.

You need to fix the stability issue, which is the cause. Not attack the tight muscle, which is just the symptom with static stretching.

As a quick aside: The hip joint can get to 170 degrees of flexion, and in some angles outside of the sagittal plane it can get to more than 200 degrees flexion. It can also extend to between 40-60 degrees, which adds up to way more than the necessary 180 degrees to do a split. This leaves soft tissue restrictions as the reason most people can’t hit the splits. Sure, some have structural issues with the shape of their hip joints, but that can’t be something that could account for the entire population.

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Bodybuilder, Flex Wheeler, used to hit the splits on stage, carb depleted and dehydrated while packing more muscle than 95% of the population, proving the concept of “muscle bound” reducing flexibility to be completely and utterly false.

Let’s look at the hip flexors as a specific example, a tight hip flexor is often the result of femur sliding forward (anterior glide), resulting in the glutes becoming stretched and weak (this is what’s meant by a capsular issue). Additionally, if a segment is unstable, so other areas become tense to try to provide the stability needed to move. In the case of the hip flexors, they attach to the spine, so If you core musculature responsible for stabilising the spine is weak, your hip flexors will try to stabilise your spine and they’ll stay tight to give stability.

There is huge interplay between the core and the hip. It’s not enough just to look at the hip in addressing your poor mobility. To echo the message of smart people such as Gray Cook, Charlie Weingroff , and Mike Robertson who have really made this stuff mainstream, we need proximal stability to have distal mobility. In other words, we need relative stability through the trunk to make full use of the range of motion available in joints such as the hips and shoulders.

Another example would be tight hamstrings – many people have hamstrings that feel permanently tight and couldn’t touch their toes if their life depends on it. Many of these golfers still cling to the idea that static stretching of the hamstrings is the answer, down this road lies nothing but frustration and wasted time!

These individuals typically display a pelvis that is anteriorly tilted, placing the hamstrings in a stretched position to start with, coupled with an inability to posteriorly shift weight back into the hips. If we can improve the lumbo-pelvic position and alignment, both statically and dynamically, we’ll improve that feeling of hamstring ‘tightness’.

If not stretching, then what should I do?

As I said earlier muscle, or any soft tissue for that matter, doesn’t have the physiological properties to permanently deform and lengthen. That leaves us with optimising adjacent players in gross movement patterns to improve the pattern itself, and create an illusion of muscles gaining length or suppleness. True mobility, therefore, is dependent on an athlete’s ability to create proper movement strategies.

Below is the plan of attack we use with our clients to get their mobility restrictions in the right direction:

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While many people think foam rolling or other SMR techniques are a method of stretching, they’re not. The muscle isn’t undergoing any kind of length change, but rather a neural down-regulation that reduces resting tone in prime movers, meaning you can move more easily and with a better chance of having balanced tension around the joint. It’s a testament to how resetting the neural tone of a tissue can help increase range of motion faster than simply stretching. Picking up that tight hamstrings example again, foam rolling/ SMR techniques hitting the glute, glute med, and adductors are often useful to reduce tension in these muscles and allow a more posterior pelvic tilt. Here’s a tact and floss SMR technique that I’ve found particularly effective:

But again, un-gluing a chronically tight area without restoring stability to the tissues it’s trying to help stabilise will only result in it getting tight again.

Dynamic mobilisation comes into play with the newly unlocked joints and tissues. The role of active mobility is to train the body to use the range of motion in the most effective way possible so that the likelihood of maintaining this new range is higher.

When doing any active mobility, focus on keeping the spine tense and the core active while sinking deep into the stretches, hold each for a single breath per rep, and continue on to the next one. Continuing our hamstring tightness example, modified quadruped rock backs, kneeling adductor mobilisations or kneeling posterior hip/glue mobilisations work well.

Lastly, we need to ensure this new range of motion sticks and is usable within functional movement patterns. This is where motor control and movement pattern correctives come into play.

For the those with tight hip flexors this is where exercises teaching core control and separation of hip extension from lumbar extension are really useful. For those with tight hamstrings we will now utilise toe touch correctives, to address the poor pattern. As shown in the video below elevating the toes and squeezing an airex pad placed between the legs is a good option as it encourages posterior weight shift and engages the glutes to encourage posterior pelvic tilt respectively. As with dynamic mobility be sure to keep the core tense and focus on breathing.

Closing thoughts

If you happen to be the individual with tight hamstrings and a poor toe touch pattern, used as an example here, you’re in luck as all you need to do is follow along with the exercises in these videos and let me know how much better your hamstrings feel and your toe touch is after a month or so. However, the point of this article really was to highlight the limitations of static stretching and show the system we use in our programs to develop mobility instead of stretching. For any mobility restriction you have targeted foam rolling/SMR, followed by dynamic mobilisation work and finally pattern correctives will do much more for you than mindlessly static stretching ever did.

If you would like to see more articles like this, covering how to deal with other specific mobility restrictions such as tight hip flexors, t-spine or shoulder mobility, let me know in the comments and if enough people ask for it we’ll get it written.

5 tips for in-season training

In-season training for golf seems to be a pretty confused area for most golfers with opinions and attitudes ranging from; “I just play during the season,” to fully periodised in-season programs, altering exercise selection, load,volume, etc, to just carrying on with normal training regardless.

In this article I aim to give you some actionable tips, but also explain why this first option isn’t a good idea, why the other two both have merit, and which may best apply to you, your schedule and your on course performance.

Tip 1: Still Train

Realistically, you should be looking to train twice per week. Indeed a 15 minute, one set, workout is better in the long run than a missed day of training. In-season training will allow you to:

  • Maintain the strength and power you built in the off-season (especially important if you travel to play or are lucky enough to live somewhere with a long summer, and thus have a long season)
  • Prevent the build up of asymmetries and muscle imbalances that could lead to injury/ will have to be dealt with later

Tip 2: Manage Fatigue

All stress is stress; physical, emotional, mental, money, spouse, whatever. Once the stress bucket is full, theres not much you can do other than take a break to fix the problem. If the golf season sees a significant increase in the amount of golf swings you are making, walking you are doing (and probably more stress!) we had better factor that in.

Keep training volume low – In my experience, lifting twice per week with a 3 to 6 rep range during the in-season is appropriate for most. The off-season is the time for 4 or 5 day programs and tons of reps. In-season is the time for maintaining strength and preventing injury.

By keeping overall volume low, you can ensure you feel fresh during your round and not slow or tired, 2 to 3 sets of 3 to 6 reps will be enough to achieve these goals.

That said, reducing volume is going to mean different things depending on the needs of the individual. For golfers that are weaker/have less training experience or are playing less frequently  a reduced training volume may only need to be minimal and occur the workout before there their round (a Thursday/Friday workout before a Saturday round for example), for stronger golfers and/or those with a busier competitive schedule it may be necessary to cut training volume for the whole in-season period.

Train light and fast – There comes a point where continuing to pile the plates on to the barbell is tough on the bodies recovery ability and max lifts sap mental and physical energy that could be best used elsewhere during the season. Again this one for the stronger guys and you can get away without it more the relatively weaker you are but, dynamic effort reps and low volume will maintain the strength you have built in the off-season but allow you to feel fresh and ready to go exiting the gym. As an added bonus this type of lifting more closely mimics the high speed muscle contractions you’ll be using in the golf swing. Adding bands is a great way to achieve this, and the trap bar deadlift against a band is one of my favourites.

Tip 3: Avoid Soreness

I can tell you from personal experience that swinging a golf club when sore, particularly in the chest and shoulders, is not fun!

Cut out the eccentric portion of the lift as much as possible – eccentric muscle contractions have been shown to be correlated with higher levels of delayed onset muscle soreness (DOMS). When working out during the season, we want to minimise eccentric work, the lowering portion of the lift, and maximise concentric work. This means no slow-tempo lifting and absolutely no negative sets.

You should complete the lowering portion of the lift as quickly as possible, whilst maintaining control, to limit the amount of time your muscles are under eccentric stress. Deadlifts (you can even drop the bar from lockout if you’re lucky enough to have a lifting platform), box squats and floor presses are great exercises that lend themselves well to this type of lifting.

Keep exercise variety low – After performing an exercise that produces soreness, the muscle will quickly adapt to reduce any damage from further exercise. As a result, not only is soreness reduced, but other side effects, such as swelling, reduced strength and reduced range of motion are also more quickly recovered from. This effect is known as the repeated bout effect, and is most specific to the muscles that have been worked. Therefore by picking the same exercise for each body part, and working the muscles in the same manner each time, we can make the most of the repeated bout effect to prevent soreness.

Tip 4: Reduce explosive rotational movements

Things like rotational med-ball throws are usually best left to the offseason. Firstly, golfers get plenty of explosive rotational work just playing their sport. Secondly, we know there is a link between high repetition of spinal rotation and back injury. So, at a time when the number of rotations we do is likely increasing, why add to that load in the gym? You are better off focusing on movements that groove good rotational mechanics and preserve anti-rotation strength to keep your spine healthy. T-spine mobilisations, split stance anti rotation scoop tosses and Pallof presses are my go to’s here.

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Tip 5: Mobility/corrective exercises for common trouble areas

It’s called strength and conditioning, but the truth is we could probably scrap the conditioning part with respect to golf and replace it with ‘mobility.’ All the eccentric stress of a greater volume of golf swings leads to significant losses in mobility. For those that couple this with walking the course for 3 to 5 rounds a week and travel long distances to tournaments (even if it is in a private jet), this tends to lead to missing out on basic functional movement patterns  like squatting and lunging.

The hips, low back and shoulders tend to get pretty chewed up in the golf swing, particularly during a long competitive season. Performing hip windscreen wipers and 90/90 stretches for the hips, corrective exercises like bird-dogs or glute bridges for lumbar and pelvic control and soft tissue work for the shoulders will help you preserve full range of motion and stay injury free throughout the season.

 

In-season training is incredibly challenging to manage correctly, as there are so many different stressors and variables in play depending on the individual. However, if you do your best to follow the tips outlined here, chances are you’ll be more successful than most!

P.S. If you want more information pertaining to your individual in-season needs then fill out the contact form below and we can arrange a Skype consultation to discuss it in more detail.

 

Strength Standards for Golfers

There has been a fair amount of controversy of late surrounding strength training for golfers, how strong a golfer needs to be, or indeed if a golfer needs to do any strength training at all (for the record I’m backing Rory in the Rory V’s Brandel charity boxing that will never happen, but definitely should!). This article is going to be my attempt answering those questions.

I am a strength guy (just in case the name of this blog didn’t give that away). I come from a powerlifting background and I firmly believe in the benefits of getting stronger, not just for golfers but for everyone.

Stronger means happier, more confident, more resilient injury, likely to live and be active for longer and research proves that!

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Why strength?

Besides the general health and fitness benefits listed above golf isn’t a sport that requires you to lift heavy loads or push 300lbs men out of your way, the golf club is light, so why do golfers need to be strong?

The most obvious benefit of improved strength and power is an increase in clubhead speed, which can be increased dramatically with proper training, countless research papers have shown this over the past 10, even 20 years.

Strength, is the mother of all physical adaptations. All other physical capacities, such as power, speed, mobility, balance, muscular endurance and coordination depend on force production within the physical environment. If strength improves, all other capacities improve with it, to varying degrees. With this being that case, strength training should form the heart, soul and major basis of your training programs for golf.

For example, biomechanical analysis of the golf swing has shown that the muscles of the legs initiate the downswing before the upper body reaches the top of the swing to allow for maximal clubhead speed at impact (referred to as the X-Factor stretch). Data also reveals that a rapid weight shift to the lead leg in the downswing creating forces of more than 180 percent of a golfer’s body weight at impact. These robust weight transfer dynamics and torque during the downswing emphasise the importance of leg strength.

Research has even shown than increasing strength improves putting performance. This is likely because stronger muscles helps improve fine motor control. In other words, because you are stronger, each swing is relatively less stressful, and the likelihood of making a mistake — or a small movement pattern error — is less likely.

Let’s not forget issues of injury prevention too, as research shows a comprehensive strength training program working all muscles and joints will help reduce the chances of injury by ensuring that you have a strong, stable musculoskeletal system.

As legendary strength coach Mark Rippetoe puts it “all other things being equal the stronger athlete always wins.”

How strong is strong enough?

The problem with Rippetoe quote above is that all other things being equal part. Golf is an incredibly high skill game with an almost infinite number of variables, additionally a properly executed golf swing demands very high movement capabilities.

While strength is important to build a foundation for the development of speed and power, it’s overvalued if you endlessly chase strength pr’s to the determinant of improving your ability to use it, i.e. relative strength, and movement. Don’t get me wrong, I’m not saying Maximum Strength isn’t important – It certainly is! It’s vital. Especially considering for professional/competitive golfers, the competitive golf season is a long one, whilst amateurs (and quite a few pros!) typically don’t have a lot of exposure to physical preparation for golf. Therefore, it is safe to say that most golfers live executing movements on the furthest end of the general-to-specific continuum. The greatest training affect according to the law of diminishing returns and largest portion of their workload should therefore be dedicated to work that falls on the other (general) end of that continuum. This is most easily identified as strength training type modalities.

That said, we are in the sport of golf not powerlifting, it is not the tool that’s important, it is that your body is working in a specific movement pattern, recruiting the correct muscles, and generating force when you need it.

The principle of specificity dictates that your body specifically adapts to the imposed demands, therefore maximising the carryover to your sport requires you train movements and patterns that are specific to the demands of your sport, in the case of golf explosive movements carried out in multiple planes of motion.

Focus should be on developing/maintaining a strength base, then improving relative strength and power in the movements you need for performance.

Strength Standards

First bear in mind, as I said earlier I’m a strength guy and have carried over some bias here for sure. But without further ado, let the fun start!

Below are the standards of strength I like to see from and what works for my clients. In my opinion if you are not able to complete these exercises at the prescribed weights you a leaving something on the table physically when it comes to force production for golf, swing speed and ultimately distance. (Of course, this doesn’t take into account movement quality, mobility and biomechanical efficiency)

  • Bulgarian split-squat 6-8 reps with 0.5 x BW in each hand

 

  • Chin-up 5 reps for men, 1 for women. And pull strength equal to push strength.

Your pull (i.e. the chin-up) strength should also equal your push strength, so if you can do a bench press with your bodyweight + 40lbs on the bar you should be able to do a chin-up with 40 lbs external loaded added to you.

  • 6-8 reps feet elevated push-up with 45lbs external resistance (this can be done with bands, chains or a weight plate) for men, 6-8 reps at bodyweight feet on floor for women.

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Note: This does assume a relatively normal bodyweight range for the persons height, if you are carrying some extra padding the external load recomendation will be lower.

  • 1.5 x bodyweight deadlift for 5 reps.

As I said earlier we are not powerlifters and as such we are not bound by rules on how certain exercises must be completed, we use what is most effective and safest. Oftentimes people don’t posses the adequate mobility to deadlift adequately from the floor, that being the case we modify the exercise to deadlift with the bar slightly elevated or using the high handles of a trap bar and that’s fine for our goals of increasing golf performance.

  • 120% height broad jump.

This isn’t technically a strength but a power test it maybe shouldn’t make it on this list. However, power is essentially your ability to demonstrate your strength quickly, and power is obviously of ultimate importance. From that point of view it’s important that as golfers we test our ability to develop power and have a standard to achieve. This also a test I love as it’s really easy to set-up, perform and measure…you can do it literally anywhere!

Conclusion

Strength will reach a point of diminishing returns in which in order to get stronger you will spend time in the gym accumulating training volume that for golf performance could be better spent focused on others of their game improvement.

That said I still firmly believe being stronger than you were makes you a better athlete and a better athlete is a better golfer. Everybody should be trying to get stronger, and at least part of their training should be focused to that end. How much of their training time or training year should be spent on that goal will however vary from golfer to golfer depending on their needs.

3 (or 4) Exercises to do everyday for better posture and better golf

There are some exercises I believe golfers can’t get enough of.

Why?

Because they help offset the toll that working on a computer (or even a mobile device) takes on your body and your golf swing.

Specifically, that toll is forward shoulder position, downwardly rotated scapular, a flexed thoracic spine and forward head position. This can lead to issues rotating and even controlling the club-face in the golf swing, as well as to neck, shoulder, and back pain.

All the hours you spending at your desk, surfing the internet on your laptop, texting and playing angry birds on your phone can’t be undone with a few hours a week in the gym.

You need to up your game, the more frequently you perform these exercises the better.

Now just hear me out before you complain too much about not having the time: The best part is these no-weight, no-sweat exercises anywhere, even in the living room during the adverts of your favourite TV show! (the videos below are actually filmed in my kitchen and conservatory just to prove the point).

Exercise 1. Forearm Wall Slides w/ Scapular Retraction

Stop what you’re doing right now, and sit slumped forward in a chair. Now with your arms crossed in front of you try and rotate your shoulders to the left and right just as you do in the golf swing, take note of how much rotation you are able to achieve.

Next imagine that there’s a string attached from the ceiling to your chest and that string is being tightened, pulling your chest closer towards the ceiling, extending your spine and making you sit up straight. Cross your arms again and rotate, you are able to get more range of motion right?

This exercise drives the thoracic extension essential for good rotation mechanics. As well as teaching good scapular position essential for overhead movements and that also has a potential affect on club-face position.

For best results, do 10 to 15 reps of this exercise up to three times a day. (It’s easy to do in your office, and a great warm up before you lift weights.) Those of you with shoulder issues will love how good it makes your cranky shoulders feel too.

2. Hip bridge w/ leg extension

It’s not just slumping that hurts your posture. Simply sitting can be harmful, too.

For instance, when you sit constantly, as most of us do, the hip flexors on the fronts of your hips become short and tight. What’s more, your glutes—actually forget how to contract. (After all, when you’re sitting they’re not being used for much of anything except padding for your hipbones.)

The combination of tight muscles on the front of your hips and weak muscles on your backside causes your pelvis to tilt forward. This puts more stress on your lumbar spine, which can lead to low-back pain.  According to Lance Gill and TPI lower back pain is the number 1 reason why people stop playing the game of golf.

From a technical stand point too the glutes are important, when we talk about hip/ lower body stability, the ability to rotate around a stable lower body in the backswing without swaying, or the ability to post onto a firm lead leg during the downswing we are essentially talking about the strength and ability to contract of the glutes.

Enter the hip bridge with leg extension. It strengthens your glutes and teaches them how to contract —which helps allow your pelvis to move back in its natural alignment. Do 5 to 6 reps for each leg, holding the top position of the exercise for 3 to 5 seconds.

Bonus exercise: For extra credit perform the couch stretch (so called because you actually use the couch to do it) for 15-30 second holds to stretch out those pesky hip flexors.

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3. Quadruped rotation/extension

Like wall slides, this is another great exercise for your upper body posture. This exercise helps mobilise your upper back by rotating at your thoracic spine, it as teaches the good rotational mechanics (rotating at the upper back not the lower back) that are vital in good swing mechanics and will also help protect that lower back from injury. Do 3 sets of 10 on each side once, twice or even 3 times a day

 

You’ll be amazed what a few minutes a day can do to improve your mobility and movement quality. As well as undo the damage to your posture, and golf swing, slumping 8 hours a day can cause. And because posture and state of mind are linked you’ll feel better, happier and more confident too. Now that’s what I call a win win!

 

Elbow Pain in Golfers: What to do

Today’s article is something a bit special! It’s a guest post from Sports Chiropractor and author Tom Feeney. Tom is a Sports Chiro specialising in myofascial release in Newcastle upon Tyne. He has treated Premiership, Olympic, NHL, and WWE athletes and the general public since 1997. His work has featured in The Telegraph, Athletics Weekly, Train Magazine, and 220 Triathlon, with his article on performance therapy for golfers being published on Stack and TPI.

In this article Tom takes a look at the research on Elbow pain in golfers and offers some practical solutions to get you pain free, back to the course and back to full training in the gym. I think you’ll really enjoy it so without further ado!

Tendon pain at the elbow is common in golfers. When on the inside it is called Golfer’s Elbow and when on the outside it is called Tennis Elbow. Some tips:

  1. Research shows Myofascial Release is better than standard therapies.
  2. Exercises help- try isometric (no movement) and eccentric (negatives) exercises.
  3. There is some inflammation in some tendon problems, ice may help after heavy use.
  4. MRI may be better than diagnostic ultrasound in identifying LE.
  5. Steroid injections don’t provide long-term benefit.

Should I ice it? The inflammation debate!  There may  be some swelling but in most cases ice is not needed.

Over the last few decades, LE stopped being considered a tendinitis because little evidence of inflammatory markers were found.  Tendinopathy became the new term of choice, but recent research found convincing evidence that the inflammatory response is a key component of chronic tendinopathies like LE.   My take: some inflammation is there, but it may be an important part of healing.  Only ice after heavy use.

What causes the pain?

In a nutshell, tendinosis involves too much tendon breakdown and not enough repair. When repetitive micro trauma damages cells, they create new collagen which is structurally different.

Is exercise the answer?

Exercises helped relieve pain in the short-term compared to no intervention 2011 study.

Exercises should progress from isometrics to eccentrics:

Isometric exercises involve putting a muscle and tendon under tension, but no movement. In some cases I give this exercise with the wrist and finger in varied positions.

Eccentric exercises with a band for LE are often helpful and easy to do.

Will it go away on its own?

2002 study found in 83% of cases of LE resolved at 52 weeks with no intervention.

Does manual therapy help?

Researchers compared Active Release Techniques (ART) and Myofascial Release to a control  group receiving therapeutic ultrasound, the release techniques were found to be much more effective. Two case reports  also found them effective. A recent study found myofascial release effective in treating plantar fasciitis, which is similar to tennis elbow.

What about injections?

Steroid injections were found to provide worse outcomes than placebo in a 2013 study.  “There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief” – 2014 review.

Are MRIs or ultrasound scans needed?

2014 review concluded, “power doppler ultrasonography and real-time sonoelastography (is) expensive, and …this technology did not significantly add to the sensitivity and specificity of Gray-scale Ultrasonography”.

There is evidence of MRI signs of oedema on the asymptomatic side of many LE patients. Thickening or partial tearing was not found on the asymptomatic side. Therefore if the non-painful side shows swelling, it may not be important for an MRI to find the sore side has swelling!

Conclusion

Combine manual therapy with an exercise program, before getting an injection.

 

You can find more from Tom at his website www.whitleybaychiropractic.co.uk