Pete Draovitch, ATC, PT, CSCS Ralph Simpson, PT, OCS, CMPT, ATC
Training and conditioning programs for golfers vary tremendously, based upon the person’s goals and skill levels. However, each program, regardless of its objectives or time constraints, must be designed considering injury prevention, enhanced performance and neuromuscular system patterning. Based upon physical examination shortcomings, the program should incorporate sport specific muscular strength, functional flexibility, dynamic postural balance and/or segmental sequencing. Sport specific muscular strengthening activities may use different forms of resistance ranging from body weight to resistive tubing to traditional weight training equipment. Many times, prior to beginning a strength training program, much of the time is spent trying to activate the muscles we are trying to functionally engage. Functional flexibility activities can utilize different forms of stretching, including static stretching, Proprioceptive Neuromuscular Training (PNF) and Active Release Techniques (ART). Dynamic Postural Balance activities can be implemented in either challenged or unchallenged environments, with the eyes open or closed or on level or uneven surfaces.
Segmental sequencing, in the author’s opinion, may be the most important skill and fitness factor for developing an improved skill level. Since the golf swing is an appropriately timed coiling and uncoiling process, inability to properly sequence those segments may result in loss of power or compensatory movement patterns. The golf score of a tour level player can vary as much as 20% – 40% between rounds, or even between front and back nines. However, barring injury or muscular fatigue or different effort level, an individual’s strength and flexibility should not vary that much from day to day. Therefore, the only explanation for the large variance has to be the sequencing changes which occur from round to round, nine to nine or even shot to shot.
Most recreational golfers are not willing to spend long hours improving their fitness levels. In today’s busy world, professional and personal commitments, a recreational golfer’s program should include time limited total body strengthening, flexibility, balance and neuromuscular training. Strength training is encouraged twice a week whereas flexibility, balance and segmental sequencing exercises are recommended 4-5 times per week.
Although kinetic linking or proper weight shifting and timing play a huge role in performance little time is usually spent talking about ways to address it. Therefore the next section is a more focused look just at this component.
Optimum athletic performance requires coordination, balance, and timed weight-shifts of the various segments of the body. Few skills reflect this as well as the golf swing. Several neurological systems provide the feedback necessary for a person to accurately move body segments and contract and relax muscles in the smooth ballet of sporting movements. As humans, we all have the same basic anatomical
elements yet some are able to use their particular neurological senses in a more effective manner in sport. “Gifted athlete” we often call them; they excel at sports because they are able to move in repetitive patterns of highly coordinated, sequenced movements. They are somehow able to integrate information from these systems better than others. Although it is beyond the scope of this article to provide an exhaustive discussion of these systems and their pathways, some dialogue of this neuroanatomy and neurophysiology will be necessary if we are to better understand how to apply training theories to improve performance.
Three subsystems of the central nervous system (CNS) control our ability to maintain balance and equilibrium: the somatosensory system, the vestibular system, and the visual system.1 Although higher CNS centers (cerebral cortex and brain stem) are very much involved, this article will primarily concern itself with the somatosensory system.
The somatosensory system may most simply be described as a system providing information concerning the orientation of body parts to one another and to the supporting surface for the purpose of maintaining postural equilibrium.2,3 In other words; it controls how we move our center of gravity and body parts in relation to our environment. It includes cells or organs called proprioceptors and tactile sensors. Proprioceptors are receptors spread throughout our muscles, ligaments, joints, and connective tissues that tell us not only where our body parts are in relation to each other and the outside world but also how fast and where they may be moving. The tactile organs detect such things as touch, pressure, and vibration and also influence balance and movement.4
Mechanoreceptors are specialized proprioceptors that live either within joint ligaments or capsules (articular) or within muscles and tendons (muscular). They may be either fast or slowly adapting. Overlap exists between the two as they function to provide seamless control of joint stability via muscle tone changes. Articular mechanoreceptors are of four types: “The function of the slow adapting/non-adapting type I receptors is to continuously transmit impulses as long as the stimulus is present. This keeps the brain aware of the body and its surroundings. They allow the CNS to know the status of muscle contraction and load on tissues at each moment of both static and dynamic activities. The fast adapting receptors (type II) fire only when the strength of the stimulus being applied changes. They react strongly while a change is actually taking place and the impulses are directly related to the rate at which change takes place. These receptors are movement and rate detectors. The type III receptors are completely inactive in immobile joints. They are found in ligaments and are thought to measure tension. They become active at the extreme ranges of motion. Type IV receptors are free nerve endings found throughout the body. Most detect pain, but some detect crude touch, pressure, and tactile sensations.” 6,7
Muscular mechanoreceptors are called Golgi tendon organs (GTOs) and muscle spindles. The GTOs, located where tendon blends to muscle, send information about muscle tension or changes in tension to the CNS and spinal cord. The spindles, however, are located within the muscle belly and transmit information regarding rate and magnitude of muscle length change.4,7 The muscle spindles are unique in that they have nerve attachments (innervations) that not only perceive stimulus (afferent) but also cause a motor response (efferent). These motor efferents (also called gamma efferents) adjust the tension of small muscle fibers (intrafusal) within the spindle itself altering its sensitivity to the larger muscle’s current state of tone. Large muscle movement is initiated when it receives signals from alpha motor neurons thus changing its current tone. But since the gamma system may be stimulated by joint and cutaneous mechanoreceptors as well as the brainstem 8,9, it follows that proprioceptor activation in functional movements help increase excitation of the spindles which in turn cause a greater recruitment of motor units and a stronger contraction.11
The last groups of proprioceptors explored are tactile sense organs; they also have the ability to influence movement and posture. Spread throughout the skin as cutaneous receptors as well as in deeper layers, these organs are also either slow or fast adapting. Of particularly importance, are those of the plantar surface of the feet. They have been shown to supply the CNS with information regarding weight distribution upon each foot as well as between the feet. Not only are they an important source of input on static position and body sway, they play a “significant role during dynamic and functional movements as well.” 4 p.40-41 These cutaneous receptors provide information that blend with the receptors of muscles and joints to further the overlapping system of neurological input guiding movement and balance.
So what does all this mean for golf training and why is it important? For one thing, models have shown that by increasing a person’s strength 5%, we can get about a 1.7% increase in club head speed. Improving or adding proper weight shifting can give us up to a 14% increase in club speed….immediately 36. It stands to reason then that if we can influence an athlete’s ability to segmentally sequence then we can improve performance significantly within a much shorter time frame than is needed for strength changes. For specificity we use a weight bearing golf-like stance when ever possible with this approach. Strength gain from more tradition resistance training is automatically integrated into this segmental sequencing training as well further enhancing performance. An important by-product is an improvement in striking consistency as accuracy improves after training. 37
The development of this methodology grew out of experience with the best golfers in the world and can rapidly enhance input from these somatosensory components enabling people to learn athletic movements faster as well as improve existing motor skills. Additionally, the process provides a platform for enhanced rehabilitation and strengthening. The program is an elastic resistance-based application that targets the mentioned motor learning and neurological systems. Type I, II, and even III
mechanoreceptors are targeted as are weight-bearing tactile receptors. The sport-specific swing planes trigger the type III cells at the end of the pattern further educating the sensory system as to exact positions. Protocol rotation patterns tend to load limbs and feet in a certain order, stimulating the cutaneous receptors of the foot as well as muscular mechanoreceptors of the lower leg. During rapid movements, this input from the legs give us our most sensitive means of feeling postural sway.4 This approach encourages loading of the legs in functional patterns at different times as weight shifts are progressively trained. This results in massive sensorimotor input 6,9 and raises the level of excitability and contractility of the nervous system, speeding the rate of muscle shortening.13 In other words, movements and muscle contractions become more responsive and quicker. The importance of this becomes evident when we think of a typical force/time graph. In golf, for instance, typically .20 seconds are required from a full, take-away position to reach impact14 yet absolute maximum force usually requires .60 to .80 seconds in any explosive move.13 So, the goal with late stage training is to create more power faster. By focusing on the trunk, hips, and legs the we’re in a great position to do this.19 This approach, using an optimal combination of open and closed chain maneuvers 10 p. 372, loads the joints of the spine and lower extremity in sport-specific patterns; a requirement for any exercise designed to enhance neuromuscular control of joints or movement patterns.10 p.369 Because these patterns first require the athlete to control his center of gravity and individual body segments against resistance in an “iso-econ-centric” (eccentric and concentric contractions punctuated by an isometric hold) fashion and then move those same components with the assistance of the tension, balance is continually challenged and control improved. This sort of training will enhance the “responsiveness and sensitivity of mechanoreceptors, thereby increasing proprioceptive input to the CNS.” 10 p. 369 Since these inputs and effects are mediated via the nervous system rapid changes may take place. As has been shown, more input means a better ability to move the body in a coordinated fashion. “Feel” is enhanced. “The most rapid approach to skill in golf is very consciously to develop a feeling for things that should be done.” 36 Your body is learning to move more optimally. The resistance, endurance, and flexibility portions of your program provide a foundation upon which you employ this skill of movement. Developing better sequencing won’t do you much good at the end of the day if you’ve fatigued by the 11th hole and can no longer hold postures the game requires or if muscular fatigue leads to back pain.
Adding sequential sequencing moves like the assisted take-away and accelerated swing after resistance training helps to re-synchronize weight shifts while using the new found strength, power, or range of motion gained by a more traditional program.
The 15-minute exercise program, adapted from Complete Conditioning for Golf, Human Kinetics Publishers, Draovitch and Westcott, can fit anyone’s busy schedule.
The 15-Minute Workout
Instant Replay® Swing Training
Assisted Take-Away: Set up with tubing attached to door below the bottom hinge or with pulley system near the floor. Make a shoulder loop in the free end of the tubing and reach through it with your right arm (right handed golfer) and turn in a circle to your left until your right shoulder points at the door attachment. Now the tubing is wrapped around your body from the right shoulder and exits your body from the right side.
Perform assisted back swings now focusing on your core: cutters and “tightest jeans in the world”. Do Not Swing Completely Through.....only back swing then stop and reset for another rep. Perform 10-15 individual reps...set up in a stance between each rep.
Opposite Side Take-Away: (optional; to be used for balanced range of spinal motion as necessary) Face the wall/door attachment and loop the Instant Replay over your left shoulder; turn to the right in a full circle until your left shoulder is pointed at the wall or door attachment. Now perform left handed back swings but Do Not swing through. Only practice the take away move.
Accelerated Swing: Use the same set up as in opposite side take-away but change your swing thoughts and grip to a right-handed golfer. Now perform full swings holding your finish position in a balanced form. Be sure that when you are in your finish position there is NO MORE TENSION within the Instant Replay; it should hang limp. Focus on your core during the entire swing. You will be very close to the door/wall attachment. Start at 1⁄2 speed and build to reach full speed by rep 5. Perform 10-15 reps.
A complete neuromuscular training program can also be performed using the Instant Replay®. This neuromuscular training device has benefited players of all levels, age and physical make-ups. Combining the Instant Replay® with a generalized exercise programs is certain to provide results.
Many variables must be manipulated to insure that fitness and practice time are appropriately adjusted. Time of the season must be considered, such as pre-season, in-season and off-season. Time of the week determines how much of a workload you should be undertaking. Is it an off day, an early playing day or a late playing day? During the season practice takes precedent. Volume versus intensity are the 2 variables which must be manipulated to insure you are optimizing your fitness potential and limiting over training or physical breakdown. Since golfers may hit 500-1000 balls during a usual practice session,
sometimes it is smart to do a totally unloaded, non weight-bearing workout, such as trunk stability in a non weight-bearing position or aquatic therapy. Current health status also should dictate the level of the program. Sometimes it may be more beneficial to do isometric training versus dynamic isotonic programs. In conclusion, it is important to recognize, more than ever before, that anyone interested in competing at their maximum level must now participate in some type of training and conditioning program. What was once the exception is now the rule.
1. Rozzi, S., Yuktanandana, P., Pincivero, D., Lephart, S., Role of Fatigue on Proprioception and Neuromuscular Control. In Proprioception and Neuromuscular Control in Joint Stability, Lephart, S., Fu, F., (Eds.) p. 378. Champaign, IL: Human Kinetics, 2000.
2. Flores, A. Objective Measures of Standing Balance. Neurology Report-Am Phys Ther Assoc 16: 17-21, 1992.
3. Nasher, L., Practical Biomechanics and Physiology of Balance. In Handbook of Balance Function and Testing, Jacobsen, G., Newman, C.,
2. Kartush, J., (Eds.), 261-79. St. Louis: Mosby Year Book, 1993.
3. Riemann, B., Guskiewicz, KM., Contribution of the Peripheral Somatosensory System to Balance and Postural Equilibrium. InProprioception and Neuromuscular Control in Joint Stability, Lephart, S., Fu, F., (Eds.) p.39-40. Champaign, IL: Human Kinetics, 2000.
4. Martin, J., Jessel, T., Modality Coding in the Somatic Sensory System. Princ Neural Sci pp.340-52, 1991.
5. Lyons, C., Review of Proprioception and its Role in Low Back Pain. In The North American Institute of Orthopaedic Manual TherapyNewsletter. Vol. VII, Issue 1, Winter 2002.
6. Berry, M., Bannister, LH., Standring, S., (Eds.) Nervous System. In Gray’s Anatomy 38th Ed. pp. 964-969. London: Churchill Livingstone,1999.
7. Vander, AJ., Sherman, JH., Luciano, DS., Control of Body Movement. In Human Physiology: The Mechanisms of Body Function. Pp.539-42. New York: McGraw-Hill 1975.
8. Johansson, H., Sjolander, P., Neurophysiology of Joints. In Mechanics of Human Joints, Wright, V., Radin, EL., (Eds.), 243-90. New York:Marcel Dekker, 1993.
9. Irrgang, JJ., Neri, R., The Rational for Open and Closed Kinetic Chain Activities for Restoration of Proprioception and NeuromuscularControl Following Injury. In Proprioception and Neuromuscular Control in Joint Stability, Lephart, S., Fu, F., (Eds.) p.365-9 Champaign,IL: Human Kinetics, 2000.
10. Lephart, SM., Riemann, BL., Fu. FH., Introduction to the Sensorimotor System. In Proprioception and Neuromuscular Control in JointStability, Lephart, S., Fu, FH., (Eds.) p. xvii -xx. Champaign, IL: Human Kinetics, 2000.
11. Harris, RT., Dudley, G., Neuromuscular Anatomy and Adaptations to Conditioning. In Essentials of Strength Training and Conditioning,Baechle, TR., Earle, RW., (Eds.) p. 20. Champaign, IL: Human Kinetics, 2000.
12. Plisk, SS., Speed, Agility, and Speed-Endurance Development. In Essentials of Strength Training and Conditioning, Baechle, TR., Earle,RW., (Eds.) pp. 472-74. Champaign, IL: 2000.
13. Stover, C., Wiren, G., Topaz, S., The Modern Golf Swing and Stress Syndromes. Phys Sportsmed. 4(9): 43, 1976.
14. Lephart, S., et al. The Role of Proprioception in the Management and Rehabilitation of Athletic Injuries. J Sports Med. 1997 25(1): 130-7.
15. Garrett Jr., WE., Kirkendall, DT., Motor Learning, Motor Control, and Knee Injuries. In Proprioception and Neuromuscular Control inJoint Stability, Lephart, S., Fu, F., (Eds.) p. 53-7. Champaign, IL: Human Kinetics, 2000.
16. Barrack, R., Munn, B., Effects of Knee Ligament Injury and Reconstruction on Proprioception. In Proprioception and NeuromuscularControl in Joint Stability, Lephart, S., Fu, F., (Eds.) pp. 197-211. Champaign, IL: Human Kinetics, 2000.
17. Freeman, M.A.R., Instability of the Foot after Injuries to the Lateral Ligament of the Ankle. J Bone Joint Surg 47B: 669-77, 1965.
18. Leadbetter, D., The Golf Swing. Lexington, MA: Stephen Greene Press, 1990.
19. Brumagne, S., et al: The Role of Paraspinal Muscle Spindles in Lumbosacral Position Sense in Individuals With and Without Low BackPain. Spine 25(8): 989-994, 2000.
20. Bogduk, N., Twomey, L., Nerves of the Lumbar Spine. In Clinical Anatomy of the Lumbar Spine. p. 118. Melbourne, Aust.: ChurchillLivingstone, 1991.
21. Evans, C., Oldreive, W., A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance ofTransversus Abdominis, J Man Manip Ther, vol. 8, #4, pp. 162-74, 2000.
22. Shumway-Cook, A., Woollocott, MH. Motor Control: Theory and Practical Application 2nd ed., p.29. Philadelphia, PA: LippincottWilliams and Wilkins, 2001.
23. Ibid. p.36.
24. Panjabi, MM., The Stabilizing System of the Spine. Part 1. Function, Dysfunction, Adaptation, and Enhancement. J Spine Disorders; 5(4): 383-9, 1992.
25. Richardson, C., Jull, G., Hodges, P., Hides, J., Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. p. 14-9. London, UK: Churchill Livingstone, 1999.
26. Ibid. p.3-164.
27. Ibid. p. 163-4
28. Ibid. p. 53-4
29. Tesh, KM., Shaw Dunn, J., Evans, JH. The Abdominal Muscles and Vertebral Stability. Spine; 12(2): 501-8, 1987.
30. Kay, AG. An Extensive Literature Review of the Lumbar Multifidus: Biomechanics. J Man Manip Ther; Vol 9, #1 pp. 17-39, 2001.
31. Danneels, LA. Vanderstraeten, GG., Cambier, DC., Witvrouw, EE., Bourgois, J., Dankaerts, W., DeCuyper, HJ., Effects of Three DifferentTraining Modalities on the Cross Sectional Area of the Lumbar Multifidus Muscle in Patients with Chronic Low Back Pain, Br J SportsMed., Vol 35(3): 186-191, 2001.
32. Farfan, HF., Reorientation in the Surgical Approach to Degenerative Lumbar Intervertebral Joint Disease, Orthop Clin North Am. 8(9);1977.
33. Farfan, HF., Biomechanics of the Spine in Sports. In Spine in Sports, Watkins, R., (Ed.) p. 20, St. Louis, MO: Mosby, 1996.
35. Watkins, RG. Uppal, SS., Perry, J., Pink, M., Dinsay, JM., Dynamic Electromyographic Analysis of Trunk Musculature in Professional Golfers, Am J Sports Med, 24(4): 535-40, 1996.
36. Jorgensen, T., The Physics of Golf, 2nd ed., Springer-Verlag, 1999.
37. Unpublished data. Simpson, R., McGee, S., Las Vegas Instant Replay testing 2002