INTRODUCTION
Traditionally, performance enhancement within the sport of golf has been primarily focused on improving technology (86). More recently however, especially in more elite settings, a greater emphasis has been placed on developing strength, flexibility, and balance to enhance swing mechanics, optimize performance, and reduce injuries (22). Recent scientific investigations have provided empirical evidence, demonstrating positive improvements in performance measures, such as club head speed (CHS), after strength and power training interventions (17,60,76). However, information regarding the practical application of appropriate strength and conditioning programming is limited. The purpose of this review is to provide an evidence-based description of the biomechanical requirements, physiological demands, and reported injury epidemiology associated with the sport of golf. Following this, considerations and guidelines for the implementation of appropriate strength and conditioning programs will be provided.
BIOMECHANICAL, PHYSIOLOGICAL, AND INJURY NEEDS ANALYSIS FOR GOLF
BIOMECHANICAL ANALYSIS OF THE GOLF SWING
Maximal displacement during a golf shot is primarily a function of angular club head velocity and the characteristics of the arm-club lever at the point of impact with the ball (37). It should be considered that the latter is largely determined by the anthropometrics of each individual, whereas angular velocity of the club head is further affected by factors such as ground reaction forces and transfer of body weight, the sequential summation of forces, and utilization of eccentric-concentric coupling (37). The role of the strength and conditioning coach will focus predominantly on increasing the production of angular club head velocity through the development of a player's ability to generate larger ground reaction forces and speed of movement, in addition to the promotion of safe and efficient deceleration of force through increases in strength.
The golf swing can be divided into the following sections: (a) set up, involving largely isometric actions (6), (b) the backswing, used to allow the correct positioning of the club head to instigate an accurate and powerful downswing where agonist muscles and joint structures responsible for generating power in the downswing are preloaded, or put on stretch (37), (c) the downswing, where the purpose is to return the club head to the ball at the correct angle with maximum angular velocity, and finally, (d) the follow through, which is characterized largely by eccentric muscle actions (39).
In the golf drive, a range of involved musculature has been identified as significant contributors to the production of the requisite torque, including the hip and knee extensors, hip abductors and adductors (8), spinal extensors and abdominals (58), and shoulder internal rotators (39). Specifically, the downswing action involves a kinetic chain sequence, where the larger, more proximal body segments initiate the movement (right hip extensors and abductors, and the left adductor magnus in right handed golfers), followed by the trunk, shoulders, and finally the hands and wrists (55). This suggests a sequential order (proximal to distal) of torque generation, which results in the achievement of maximal CHS (68).
Although it is beyond the scope of this article to discuss in great depth the complexity of the golf swing, it is reasonable to suggest that based on the available literature, appropriate training programs should include whole-body dynamic movements to develop strength and power. In addition, placing an emphasis on ground up force generation sequencing will have a greater transfer of training effect than isolated uniarticular approaches. For the reader interested in a more extensive analysis of the biomechanics of the golf swing, previously published literature (33,37,51) is recommended.
INJURY ANALYSIS
Despite golf appearing less physically demanding than other sports, it should be considered that the golf swing is a complex series of integrated motions, involving a range of muscles and joints, where significant forces of up to 8 times bodyweight can be experienced (36). Additionally, in excess of 2,000 swing repetitions are often performed by the tournament professional during practice and competition each week (58,74). Subsequently, injury risk is an inherent part of the sport, and thus, strength and conditioning coaches should be cognizant of the anatomical sites most affected, and the frequency with which they occur.
Based on epidemiological data, professional golfers seem to incur more injuries than amateurs (31), most commonly in the back, followed by the wrist and shoulders (31,47). Conversely, amateur players are more likely to experience an injury to the elbow, followed by the back and shoulder (7,31); however, these findings are not consistent across all investigations (24,48). Specifically, lower-back injuries have been reported to account for 23.7–34.5% (24,47,48), and up to 52% (29) of all injuries sustained by amateur and professional golfers. This is likely because of the high magnitude of forces and ranges of motion experienced in this region due to the mechanics of the swing. For example, axial twisting alone has been determined as an injury risk factor (45), in addition to other swing characteristics, such as downward compression, side to side bending, sliding, and back to front shearing (36).
Adequate levels of symmetry and postural endurance of the trunk musculature are also key aspects in the prevention of spinal injuries (49). Confounding this, correlations between incidences of back pain and a range of strength, flexibility, and endurance tests were measured in a group of elite youth golfers, reporting that asymmetry on a side bridge endurance test provided the strongest relationship (r = 0.59) (21). Given the asymmetrical nature of the golf swing, the side bridge endurance test, which challenges the quadratus lumborum and muscles of the anterolateral trunk wall, may be considered appropriate to detect exaggerated unilateral differences in trunk muscle endurance (49). This has important implications for the identification and prevention of injury, as in instances where a left side bridge endurance test was greater than the right by 12.5 seconds, there was an increased chance of low back injury (21). However, the reader should also be cognizant of the fact that because of the repetitive asymmetrical nature of the golf swing, side to side differences are to be expected; the achievement of symmetry may not be possible, and approaches to manage such factors are likely more achievable.
Therefore, because of the inherent risk of lower-back injuries in golfers of all levels, regular screening of muscle imbalances and postural endurance is recommended. In addition, with the primary injury mechanism reported as overuse because of high volume practice and competitions (47,51), adequate mobility, muscular stability, and strength should be deemed essential to withstand repetitive loading, through both concentric and eccentric muscle actions. As such, the implementation of individualized strength and conditioning programs should be considered essential for the prevention of injury.
PHYSIOLOGICAL ANALYSIS
Despite the common misconception that there is a high requirement for aerobic fitness in golf, average oxygen uptake (V[Combining Dot Above]O2) has been reported at 22.4 mL·min−1·kg−1 (64), with V[Combining Dot Above]O2max levels ranging from 35 to 46 mL·kg−1·min−1 (16,53). These values correspond to normative data previously reported (nonathletes age, 20–29: men = 43–52, and women = 33–42 mL·kg−1·min−1) (88). Additionally, lactate responses of 0.8–1.1 (mmol/L) have been recorded after the completion of 18 holes, which are indicative of typical resting levels (80). Furthermore, Murase et al. (53) concluded that during a round of golf, players functioned at a mean exercise intensity of just 35–41% V[Combining Dot Above]O2max, demonstrating minimal aerobic requirements. With golf imposing a relatively low cardiorespiratory demand, it is of no surprise that reported V[Combining Dot Above]O2max values for golfers are lower than other more demanding endurance-based sports (88). Compounding the previously held misconception that golf relies heavily on aerobic capacity, research has proven that continuous aerobic training leads to reductions in strength, power, and rate of force development (RFD) in anaerobic sports performers (10,20). Therefore, it is suggested that aerobic conditioning should not be viewed as the primary training focus for golf, but instead training prescription should be directed toward the development of explosive, anaerobic physical qualities to enhance a player's ability to generate high levels of ground reaction force and angular velocity of the club head. In addition, it is essential to promote and develop adequate levels of flexibility, muscle balance, strength, and tissue tolerance to ensure players are able to attenuate force effectively because of the high volume, repetitive nature of practice and competition.
Although repeated exposure to practice and competition may bring about adaptive changes in elite players compared with nonelite individuals, for example, greater rotational velocities because of superior swing mechanics (54), levels of grip strength (14), and muscle mass in the dominant arm (15), the physical characteristics of proficient golfers are still relatively unknown. In a profile of a range of golfers, Sell et al. (63) reported that lower handicap players (HCP 0) had significantly greater static balance, hip, torso, and shoulder strength and flexibility than golfers with higher handicaps (HCP 10–20). Further to this, Read et al. (59) identified moderate relationships between field-based measures of strength and power and golf CHS in physically untrained single figure handicap (5.8 ± 2.2) golfers. Significant correlations were reported between a seated and standing medicine ball throw (r = 0.67 and r = 0.63, respectively), countermovement jump (CMJ) peak power (r = 0.54) and height (r = 0.44) and squat jump peak power (r = 0.53) and height (r = 0.50), suggesting that rotational power, upper-body strength, and lower-body strength and power are significant contributors to the development of CHS.
Therefore, based on the profiling assessments above, it could be suggested that elite golfers possess unique physical characteristics that can be further enhanced by undertaking golf-specific training programs including strength, flexibility, and power training (17,43). Accordingly, because of the fact that recent research has focussed on the development of anaerobic qualities, the following subsections highlight the available literature in relation to physical performance and golf-related measures, to determine key considerations for those responsible for the strength and conditioning provision of golfers.
PHYSICAL CONDITIONING AND GOLF
EFFECTIVENESS OF STRENGTH AND CONDITIONING INTERVENTIONS ON GOLF PERFORMANCE
A meta-analysis conducted by Smith et al. (66) reviewed a range of golf-specific intervention studies where strength, flexibility, and core stability conditioning (3–4 times-per-week for 8 weeks) were implemented with subjects ranging from 16 to 70 years old. The findings noted an average increase in club head velocity (4.2%) and enhanced driving distances (5.6%) across all studies. Of note, the examined literature generally focused on specific areas such as whole-body stability, flexibility, and strength development as well as targeted approaches for the shoulder, torso, and hip. In addition, the work of Smith et al. (66) reported considerable variation in training and assessment methods, including strength assessments (i.e., isometric, isokinetic, isoinertial), muscular endurance measures, and power tests. Consequently, this may raise issues surrounding interpretation of the results (77), with suggestions that isometric and isokinetic testing methodologies to assess performance are inappropriate because of the poor relationship with dynamic athletic activities (3,90). This highlights a clear need for a standardized testing battery specific to golf as suggested by Read et al. (60).
It has also been reported recently that acute enhancements in CHS are possible through the use of a postactivation potentiation intervention (60). The mean CHS of 3 swings was recorded with (experimental) and without (control) 3 preceding CMJs. An increase in CHS of 2.25 mph (effect size, 0.16; p < 0.05) 1 minute after the CMJ intervention was recorded. Speculatively, this may form part of a preshot routine on holes requiring maximal driving distances. However, caution should be applied as changes in driving accuracy were not measured, and also not all the participants displayed improvements after the intervention. It was further highlighted that the management of fatigue and recognizing between-subject variability may be critical so that potentiation effects are not masked.
In addition to increases in CHS after targeted physical conditioning, Lennon (42) reported significant improvements in a range of performance measures, particularly grip and leg strength, and increased effectiveness in a 5 iron skill test, following a 4 times-per-week, 8-week strength and flexibility intervention. The researchers summarized that as a result of greater physical performance, players were able to optimize rotational abilities and club head control. For a further review of the effectiveness of strength and conditioning interventions on measures of golf performance, see the Table.
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Table-a: The effectiveness of strength and conditioning interventions on measures of golf performance
Table-b: The effectiveness of strength and conditioning interventions on measures of golf performance
STRENGTH AND POWER CONSIDERATIONS FOR THE DEVELOPMENT OF INCREASED CLUB HEAD SPEED
Power, a key component of the golf swing, is largely dependent on the ability to exert high levels of force, indicating the importance of strength development (62,70). It has been reported that without reasonable levels of overall body strength, golfers are unable to generate sufficient muscular torques (68). With optimal force generation sequencing in the golf swing initiated from the legs (27), the ability to generate large ground reaction forces is essential in developing CHS, as evidenced by significant correlations (r = 0.59–0.82) between leg power and driving distances (84). Furthermore, Hellstrom (32) reported moderate significant correlations between a range of performance measures and CHS, with 1 repetition maximum back squat (r = 0.54) and vertical jump peak power (r = 0.61) displaying the most significant relationships. These results suggest that physical factors such as whole-body dynamic strength and power are important for the generation of CHS and should be considered by golfers and strength and conditioning coaches as key qualities to train in order to enhance golf drive performance. Of note, a possible limitation of this study was the exclusion of a trunk rotational exercise within the test battery, which is a movement pattern inherent to the golf swing (56). The importance of trunk rotary strength and power has been determined previously with significant correlations (r = 0.54) reported between rotational power and CHS (30). However, caution should be applied when interpreting these findings, as isolated measures of trunk rotational strength have been unable to distinguish between elite and recreational players (44), highlighting the importance of the sequential torque production in the golf swing, initiated from the legs as stated previously (27). As such, a medicine ball rotational hip toss has been suggested as an appropriate power test and exercise for golfers, which sequentially involves the leg, trunk, and arm musculature, correlating significantly (r = 0.63) with CHS (59).
PROGRAMMING CONSIDERATIONS
TRAINING GOLFERS FOR STRENGTH AND POWER DEVELOPMENT
To enhance power in the golf swing, strength and power development should target whole-body, multijoint exercises that promote force transfer along the kinetic chain. However, there is often a consensus for training the “core” in isolation to generate high levels of force in rotational sports. This may not be the optimal approach, as exercises that elicit repeated simultaneous flexion and rotations in the lower-back (lumbar spine) increase the chance of spinal injury (12). It has been reported that the core is never a power generator, as power is generated in the hips and transmitted through a stable core (50). This is evident in a range of other sports involving high levels of trunk rotation such as boxing and baseball in which a definite synchronization between leg, trunk, and arm actions plays a major role in increasing the force of a strike (23,65). Thus, training for the enhancement of CHS should emphasize anti-motion control to reduce spinal torques (50), with strength and power development targeting the extremities. Consequently, traditional movements such as deadlifting, squatting, and lunging, which provide a strong training foundation from which to develop sequential kinetic chain linking should be included as part of fundamental exercise prescription.
Although foundational movements (squatting, deadlifting, and lunging) should form the basis of training prescription, it should be considered that these exercises are performed predominantly in the sagittal plane. Thus, it will be important to consider the addition of transverse plane exercises to provide optimal transfer, enhancing sport specificity (67). One such approach is to incorporate projectiles into the training plan (e.g., medicine balls), which have been shown to provide an effective means for developing rotational power (73), further enhancing kinematic sequencing (69) and movement velocity (18). Such exercises are optimally performed through a closed kinetic chain sequence, allowing the initiation of force through the larger, stronger muscles of the lower body and then transferred toward the ball, allowing for maximal velocity in the target direction (4). Additionally, and of particular importance, medicine ball training does not involve a deceleration component, subsequently enhancing their effectiveness for the development of power through the full range of movement. However, despite their effective application, it should be noted that projectile exercises are viewed as a supplemental component of the physical development programs of golfers, as strength and conditioning coaches should avoid simply overloading mimicked movement patterns, but focus more on developing appropriate neuromuscular adaptations that can then be used effectively by the golf professional or coach.
Of further consideration, isolated upper-body training methods may not be suitable for optimizing CHS. Supporting this, force generation sequencing along the kinetic chain has been examined in the shot put, with high performance levels involving a shift from the shoulder to the leg muscles (83), that is, the development of more optimal sequencing. Interestingly, recent findings have identified that physically untrained golfers may over use upper-body mechanics (as evidenced by significant correlations between an isolated concentric upper-body–seated medicine ball throw, r = 0.67), and weaker relationships with the legs (r = 0.54 and r = 0.53 for countermovement and squat jump peak power, respectively) (59). However, at present, this concept is speculative and requires further investigation including direct measurement during the golf swing.
THE IMPORTANCE OF RATE OF FORCE DEVELOPMENT
Rate of force development may be defined as the change in force development divided by the change in time (72), that is, the ability to develop force within a limited time frame, represented by an individual's ability to accelerate objects (62). It has been suggested that maximum force takes 0.25–0.4 s to develop (2,92), but may require up to 0.6–0.8 s (19). Therefore, time available to develop peak force is not sufficient for most athletes, with a range of athletic movements occurring within 0.25 s (71) to 0.3 s (93). This “critical” window of force application is evident in the golf swing, with reports indicating that the time from downswing to impact is approximately 290 ms for male professional players (52). It is hypothesized that if the time available for force development is <0.3 s, training should focus on improving RFD (2).
Because of the initial forceful muscular contraction from the lower limbs and hips, and the fact that elite players transfer more of their weight at a faster rate throughout the entire downswing phase (55), RFD should be considered essential in enhancing CHS and is developed through increases in efferent neural drive, in particular, an increased firing frequency of motor units (1). Subsequently, exercises such as ballistics (rapid acceleration against a resistance in the form of the body or an object) (91) are recommended. In addition, if a player possesses the appropriate orthopedic profile and has established sound movement competency in a range of fundamental movements, weightlifting derivatives, because of reported high power outputs (28) and short execution times (i.e., the second pull in the clean and snatch has been recorded as 0.2 s) (35) could be considered for inclusion to further promote increases in RFD.
APPLICATION OF THE STRETCH SHORTENING CYCLE AND THE X-FACTOR STRETCH
Within the available literature, the contribution of the X-factor stretch has provided ambiguous results (33). Defined as the relative rotation of the shoulders with respect to the hips at the top of the backswing (13), the maximal increase of pelvic-upper torso separation during the transition between the backswing and downswing has been proposed to elicit increases in elastic energy as a result of a stretch reflex (i.e., activation of the stretch shortening cycle [SSC]), enhancing rotational velocities in more distal limb segments (13). However, it has been suggested that the enhanced striking distances associated with the X-factor stretch may be because of increases in force, attributable to eccentric activation of the musculature of the lower body and torso before the downswing (8,55). In addition, the subsequent performance augmentation derived from prestretching a muscle greatly reduced the time frame between the eccentric and concentric actions, with a point of diminishing returns, whereby, once the eccentric loading (stretch phase) reaches a critical threshold, the subsequent concentric contraction exhibits no further increase (79). This is likely because the time frame between the eccentric contraction and the propulsive concentric contraction (i.e., the amortization phase) is too great, with reports that the half-life of the SSC is 0.85 seconds, and that by 1 second the benefits diminished by 55% (89). With average backswing durations for elite players recorded at 0.80 seconds (52), this suggests slower rates of stretch occur, thus negating neural influences. However, caution should be applied in interpreting these findings as further investigations are required to determine in more detail the underpinning mechanisms during the rotational stretch between the pelvis and upper torso.
In a recent review by Read et al. (59), multiple regression analysis demonstrated that concentric dominant exercises, namely, the squat jump and seated medicine ball throw were the greatest predictors of CHS (R2 = 49%). Based on these results, the authors suggested that the golf swing may not reflect fast stretch SSC activity (<250 ms), which is dependent on large contributions from stretch reflex properties and elastic energy reutilization (11), but rather slow-SSC activity (>250 ms), which takes advantage of an increased time for cross-bridge formation (82). Speculatively, it was proposed that the back swing merely allows increases in force production through the eccentric action, providing an increase in impulse (force × time), compared with a downswing without a prestretch, as supported by Newton et al. (54). Therefore, it is reasonable to suggest that increasing the magnitude of initial ground reaction forces in the downswing, as developed through appropriate resistance training protocols, may be more pertinent to the production of higher CHS values. In addition, supplementary medicine ball training should be included to increase velocity and further optimize transfer of force in the transverse plane.
FLEXIBILITY CONSIDERATIONS
In the execution of the golf swing, players repeatedly achieve movements and joint angles indicative of high levels of mobility and stability. Suboptimal movement mechanics may lead to a range of compensations, increasing injury risk, reducing exercise economy, and creating inconsistencies in swing technique. To promote competent swing mechanics, avoidance of jerky and unnecessary movements is considered essential (37).
Flexibility levels of lower handicap players have been characterized by increased shoulder abduction (17,76) and greater range of movement in right shoulder extension, external rotation, left shoulder extension, right hip extension, left hip flexion, and right torso rotation (63). The reported flexibility characteristics are likely because of repeated exposure to the golf swing, as it has been reported that golfers, like other athletes, will exhibit adaptive changes in response to the specific demands of the sport (81). Speculatively, increasing flexibility will allow a longer backswing and subsequent impulse, the net product of (force × time) enhancing swing speed. However, this has not been confirmed within the literature and requires further investigation.
Although it should be considered that flexibility is a critical component in the optimization of golf performance and CHS, this notion is not well supported in the literature. Keogh et al. (40) reported that although golfers exhibited high levels of flexibility across all assessed joints, no flexibility measures were significantly correlated with CHS. In support of this, Doan et al. (17) noted no significant relationships between CHS and rotational trunk flexibility. However, strength and conditioning practitioners should interpret these findings with caution. In addition, allowing for optimal joint positioning, greater mobility, and strength throughout the range of movement may also help minimize the potential for injury (44). Additionally, the methodology in the range of research for flexibility assessment should be scrutinized when interpreting the findings. For example, assessment of lower-back and hamstring flexibility has been examined in golfers from a range of abilities through a sit and reach test with greater range of motion displayed in lower handicap players (41). The sit and reach test, used primarily to assess hamstring and low-back flexibility in the sagittal plane, clearly does not replicate the principal of specificity (90). Furthermore, questionable validity and reliability of this test is present, with particular inaccuracies in the measurement of lower-back flexibility (38).
It is also important to address the issue of previously held misconceptions regarding reductions in flexibility after resistance training. Although few studies have examined the effects of resistance training on flexibility, previous research has demonstrated that reductions in flexibility do not occur (46,87), and there is a range of evidence to suggest that, provided weight training is performed using the full range of motion, flexibility will not be negatively affected (9), and may even be increased (9,57). Furthermore, increases in joint range of motion have been reported through the use of resistance training without the addition of flexibility training (78). Therefore, previously held misconceptions that weight training negatively affects flexibility are largely unfounded. However, it should be considered that the above research was not conducted with golfers; caution should be applied when interpreting these findings. Furthermore, it is recommended that resistance training exercises should avoid the inclusion of protocols designed to elicit significant gains in hypertrophy and overutilization of isolated single joint movements, and instead focus on exercises that are multijoint in nature and are performed through full ranges of motion to minimize the risk of unwanted losses in flexibility.
SUMMARY
This article has highlighted the key literature examining the biomechanical, physiological, injury epidemiology, and subsequent physical development strategies for the enhancement of golf performance. In an attempt to dispel myths surrounding various training approaches, the importance of developing strength and power generated in a ground up approach using strength and power training modalities has been suggested as key components of a holistic training program. In addition, the importance of including anti-rotation exercises to reduce injury risk and aid in spinal motion control has been discussed. Furthermore, it is suggested that targeted rotational training emphasizing force production from the extremities, transferring through a stable torso is implemented through the use of a variety of rotational medicine ball throws.
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