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Improving performance in golf: current research and implications from a clinical perspective

ABSTRACT

Golf, a global sport enjoyed by people of all ages and abilities, involves relatively long periods of low intensity exercise interspersed with short bursts of high intensity activity. To meet the physical demands of full swing shots and the mental and physical demands of putting and walking the course, it is frequently recommended that golfers undertake golf-specific exercise programs. Biomechanics, motor learning, and motor control research has increased the understanding of the physical requirements of the game, and using this knowledge, exercise programs aimed at improving golf performance have been developed. However, while it is generally accepted that an exercise program can improve a golfer's physical measurements and some golf performance variables, translating the findings from research into clinical practice to optimise an individual golfer's performance remains challenging. This paper discusses how biomechanical and motor control research has informed current practice and discusses how emerging sophisticated tools and research designs may better assist golfers improve their performance.

golf swing; kinematics; exercise programs; movement variability; biomechanics

Introduction

The inclusion of golf in the 2016 Summer Olympic Games for the first time since 1904 is an indicator of the increasing globalisation of the sport. It is estimated that worldwide between 55 and 80 million people from at least 136 countries play golf1 3, with the more avid golfers playing more than once a week, every week of the year. The vast majority of people who play golf are amateur golfers, with only a very small proportion being considered elite amateurs and fewer still are professional golfers. Irrespective of whether a golfer is an amateur or a professional, the goal is the same - to complete a round of golf in as few strokes (shots) as possible and, from a longevity perspective, continue to enjoy the game as pain and injury free as possible.

The game of golf

Golf is a sport that involves a relatively long duration of low intensity activity interspersed with short bursts of high intensity activity. Golf courses vary in length and terrain, so a round of 18 holes can take between 3.5 and 6 hours to play and, if the players are walking, results in a low moderate intensity form of aerobic exercise4 Magnusson ML, Bishop JB, Hasselquist L, Spratt KF, Szpalski M, Pope MH. Range of motion and motion patterns in patients with low back pain before and after rehabilitation. Spine (Phila Pa 1976). 1998;23(23):2631-9. http://dx.doi.org/10.1097/00007632 199812010 00019. PMid:9854763.
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, 5 Parkkari J, Natri A, Kannus P, Mänttäri A, Laukkanen R, Haapasalo H., et al. A controlled trial of the health benefits of regular walking on a golf course. Am J Med. 2000;109(2):102-8. http://dx.doi.org/S0002 9343(00)00455 1.
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. However, as much as 60% of the time taken to play a round of golf is spent preparing and performing swings, and of this time, 25% is spent putting on the green6 Derksen JC, van Riel MP, Snijders CJ. A new method for continuous recording of trunk postures while playing golf. J Appl Biomech. 1996;12:116-29.. In contrast to the relatively low intensity demand of the rest of the game, a full swing action requires a rapid expenditure of energy. For example, professional golfers perform a swing with a driver in 1.09 seconds7 McTeigue M, Lamb SR, Mottram R, Pirozzolo F. Spine and hip motion analysis during the golf swing. In: Farrally MR , Cochran AJ, editors. Science and Golf II: Proceedings of the World Scientific Congress of Golf; 1994 July 4-8; London: E &FN Spon; 1994. p. 50-8., with the club head reaching speeds of more than 160 km/hour8 Egret CI, Vincent O, Weber J, Dujardin FH, Chollet D. Analysis of 3D kinematics concerning three different clubs in golf swing. Int J Sports Med. 2003;24(6):465-70. http://dx.doi.org/10.1055/s 2003 41175. PMid:12905097.
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. Overall muscle activity when using a 5 iron reaches 90% of maximal voluntary contraction (MVC) for amateurs and 80% for professionals9 Hosea TM, Gatt CJ, Galli KM, Langrana NA, Zawadsky JP. Biomechanical analysis of the golfer's back. In: Cochran AJ, editor. Science and Golf: Proceedings of the World Scientific Congress of Golf. London: Chapman and Hall, 1990. p. 43-8., and golfers perform an average of 30 40 swings every round with these high levels of intensity1010  Wells GD, Elmi M, Thomas S. Physiological correlates of golf performance. J Strength Cond Res. 2009;23(3):74150. http://dx.doi.org/10.1519/JSC.0b013e3181a07970. PMid:19387406.
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. In contrast to full swings, the putting stroke requires minimal body movement but involves the greatest degree of sustained trunk inclination and sagittal flexion compared with shots with other clubs6 Derksen JC, van Riel MP, Snijders CJ. A new method for continuous recording of trunk postures while playing golf. J Appl Biomech. 1996;12:116-29.. It has been suggested that, particularly when practised for prolonged periods, putting may challenge a golfer's postural endurance1111  Evans K, Refshauge KM, Adams RD, Barrett R. Swing kinematics in skilled male golfers following putting practice. J Orthop Sports Phys Ther. 2008;38(7):425-33. http://dx.doi.org/10.2519/jospt.2008.2617.
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, 1212  Horan SA, Evans K, Morris NR, Kavanagh JJ. Swing kinematics of male and female skilled golfers following prolonged putting practice. J Sports Sci. 2014;32(9):810-6. http://dx.doi.org/10.1080/02640414.2013.848999. PMid:24480046.
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. Researchers and clinicians wanting to optimise performance and prevent golf injury have hypothesised that specific golf exercise programs are necessary to meet the physical demands of both full swing shots and the potential fatigue associated with putting or walking1313  Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf. Am J Sports Med. 2003;31(3):438-43. PMID:12750140. , 1414  Smith MF. The role of physiology in the development of golf performance. Sports Med. 2010;40(8):635-55. http://dx.doi.org/10.2165/11532920 000000000 00000. PMid:20632736.
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.

Biomechanical investigations of the golf swing

The landmark work of Cochran and Stobbs1515  Cochran AJ, Stobbs J. The search for the perfect swing. Chicago: Triumph Books; 1996.in 1968 employed high-speed filming techniques to examine the components of the golf swing, ball aerodynamics, and equipment dynamics. Since then, there has been a vast range of biomechanical studies that have examined the highly complex, multi joint movements involved in the golf swing. Researchers have used 2D and 3D methods, including high speed video1616  Bradshaw EJ, Keogh JW, Hume PA, Maulder PS, Nortje J, Marnewick M. The effect of biological movement variability on the performance of the golf swing in high and lowhandicapped players. Res Q Exerc Sport. 2009;80(2):185-96. http://dx.doi.org/10.1080/02701367.2009.10599552. PMid:19650383.
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, optoelectronic1212  Horan SA, Evans K, Morris NR, Kavanagh JJ. Swing kinematics of male and female skilled golfers following prolonged putting practice. J Sports Sci. 2014;32(9):810-6. http://dx.doi.org/10.1080/02640414.2013.848999. PMid:24480046.
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, 1717  Beak SH, Choi A, Choi SW, Oh SE, Mun JH, Yang H, et al. Upper torso and pelvis linear velocity during the downswing of elite golfers. Biomed Eng Online. 2013;12(1):13. http://dx.doi.org/10.1186/1475 925X 12 13. PMid:23398693.
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18  Joyce C, Burnett A, Cochrane J, Ball K. Three dimensional trunk kinematics in golf: between club differences and relationships to clubhead speed. Sports Biomech. 2013;12(2):108-20. http://dx.doi.org/10.1080/14763141.2012.728244. PMid:23898684.
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- 1919  Myers J, Lephart S, Tsai YS, Sell T, Smoliga J, Jolly J. The role of upper torso and pelvis rotation in driving performance during the golf swing. J Sports Sci. 2008;26(2):181-8. http://dx.doi.org/10.1080/02640410701373543. PMid:17852693.
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and electromagnetic motion tracking systems2020  Tinmark F, Hellstrom J, Halvorsen K, Thorstensson A. Elite golfers' kinematic sequence in full swing and partial swing shots. Sports Biomech. 2010;9(4):236-44. http://dx.doi.org/10.1080/14763141.2010.535842.
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, 2121  Neal RJ, Lumsden RG, Holland M, Mason B. Segment interactions: sequencing and timing in the downswing. In: Crews D, Lutz R, editors. Science and Golf V: Proceedings of the World Scientific Congress of Golf; 2008 Mar 24-28; Phoenix: Energy in Motion Inc.; 2008. p. 21-9., computer modelling2222  Nesbit SM, McGinnis RS. Kinetic constrained optimization of the golf swing hub path. J Sports Sci Med. 2014;13(4):859-73. PMID:25435779., force plates2323  Ball K, Best R. Centre of pressure patterns in the golf swing: individual based analysis. Sports Biomech. 2012;11(2):175-89. http://dx.doi.org/10.1080/14763141.2012.673007. PMid:22900399.
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24  Foxworth JL, Millar AL, Long BL, Way M, Vellucci MW, Vogler JD. Hip joint torques during the golf swing of young and senior healthy males. J Orthop Sports Phys Ther. 2013;43(9):660-5. http://dx.doi.org/10.2519/jospt.2013.4417. PMid:23886577.
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- 2525  McNally MP, Yontz N, Chaudhari AM. Lower extremity work is associated with club head velocity during the golf swing in experienced golfers. Int J Sports Med. 2014;35(9):785-8. http://dx.doi.org/10.1055/s 0034 1367010. PMid:24577856.
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, wireless inertial sensors2626  Lai DTH, Hetchl M, Wei XC, Ball K, Mclaughlin P. On the difference in swing arm kinematics between low handicap golfers and non golfers using wireless inertial sensors. Procedia Eng. 2011;13:219-25. http://dx.doi.org/10.1016/j.proeng.2011.05.076.
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, and electromyography27 31 to gain insight into and quantify the fundamental elements of the swing. The majority of studies have been conducted in laboratory settings and most have employed indirect measures of golf performance such as club head velocity (CHV) and ball launch characteristics1818  Joyce C, Burnett A, Cochrane J, Ball K. Three dimensional trunk kinematics in golf: between club differences and relationships to clubhead speed. Sports Biomech. 2013;12(2):108-20. http://dx.doi.org/10.1080/14763141.2012.728244. PMid:23898684.
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, 2323  Ball K, Best R. Centre of pressure patterns in the golf swing: individual based analysis. Sports Biomech. 2012;11(2):175-89. http://dx.doi.org/10.1080/14763141.2012.673007. PMid:22900399.
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, 3232  Brown SJ, Nevill AM, Monk SA, Otto SR, Selbie WS, Wallace ES. Determination of the swing technique characteristics and performance outcome relationship in golf driving for low handicap female golfers. J Sports Sci. 2011;29(14):1483-91. http://dx.doi.org/10.1080/02640414.2011.605161. PMid:21988676.
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, 3333  Myers J, Lephart S, Tsai YS, Sell T, Smoliga J, Jolly J. The role of upper torso and pelvis rotation in driving performance during the golf swing. J Sports Sci. 2008;26(2):181-8. http://dx.doi.org/10.1080/02640410701373543. PMid:17852693.
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. Laboratory based studies have clear advantages, including ease of standardisation, greater environmental control, and the degree of accuracy possible with some indoor motion analysis systems. On the other hand, swinging a golf club indoors surrounded by expensive equipment may not reflect what happens on the golf course, and there is concern that the indirect measures of performance used in laboratory conditions may provide incomplete information about actual golf performance. Some studies have been conducted outdoors and on golf courses6 Derksen JC, van Riel MP, Snijders CJ. A new method for continuous recording of trunk postures while playing golf. J Appl Biomech. 1996;12:116-29. , 3434  Evans K, Horan SA, Neal RJ, Barrett RS, Mills PM. Repeatability of three dimensional thorax and pelvis kinematics in the golf swing measured using a field based motion capture system. Sports Biomech. 2012;11(2):262-72. http://dx.doi.org/10.1080/14763141.2012.654502. PMid:22900406.
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; however, more research is needed to examine how golfers perform their swing on the course, over a round of golf, and under competition conditions and how these findings relate to what occurs in laboratory settings. Not only will these types of studies provide ecologically valid biomechanical information, but they will also provide more specific information about the physical demands of the sport and how environmental or other factors, such as pressure or fatigue, affect golf performance.

Due to the importance of the full swing, particularly in driving performance3232  Brown SJ, Nevill AM, Monk SA, Otto SR, Selbie WS, Wallace ES. Determination of the swing technique characteristics and performance outcome relationship in golf driving for low handicap female golfers. J Sports Sci. 2011;29(14):1483-91. http://dx.doi.org/10.1080/02640414.2011.605161. PMid:21988676.
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, and perhaps because of the fact that this stroke could be considered as having the most repeatable intention to hit the ball as far and straight as possible most kinematic studies have concentrated on full swing kinematics. In spite of the golf swing being dynamic by nature, many of these studies have measured parameters (e.g. segmental orientation) at discrete time points during the swing, such as address, top of backswing, ball contact. Collectively, findings have provided valuable insights into, for example, the magnitude of thorax and pelvis movement when high CHV are produced7 McTeigue M, Lamb SR, Mottram R, Pirozzolo F. Spine and hip motion analysis during the golf swing. In: Farrally MR , Cochran AJ, editors. Science and Golf II: Proceedings of the World Scientific Congress of Golf; 1994 July 4-8; London: E &FN Spon; 1994. p. 50-8. , 3535  Burden AM, Grimshaw PN, Wallace ES. Hip and shoulder rotations during the golf swing of sub 10 handicap players. J Sports Sci. 1998;16(2):165-76. http://dx.doi.org/10.1080/026404198366876. PMid:9531005.
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, 3636  Cheetham PJ, Martin PE, Mottram RE, St. Laurent BF. The importance of stretching the "X Factor" in the downswing of golf: the "X factor stretch". In: Thomas PR, editor. Optimising performance in golf. Brisbane: Australian Academic Press; 2001. p. 192-99., differences in segmental angular velocities between skilled and less skilled golfers3737  Healy A, Moran KA, Dickson J, Hurley C, Smeaton AF, O'Connor NE, et al. Analysis of the 5 iron golf swing when hitting for maximum distance. J Sports Sci. 2011;29(10):1079-88. http://dx.doi.org/10.1080/02640414.2011.576693. PMid:21678149.
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, 3838  Zheng N, Barrentine SW, Fleisig GS, Andrews JR. Swing kinematics for male and female pro golfers. Int J Sports Med. 2008;29(12):965-70. http://dx.doi.org/10.1055/s20081038732. PMid:18563677.
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, and the importance of the magnitude, sequencing, and timing of segmental motion3535  Burden AM, Grimshaw PN, Wallace ES. Hip and shoulder rotations during the golf swing of sub 10 handicap players. J Sports Sci. 1998;16(2):165-76. http://dx.doi.org/10.1080/026404198366876. PMid:9531005.
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, 3939  Horan SA, Evans K, Morris NR, Kavanagh JJ. Thorax and pelvis kinematics during the downswing of male and female skilled golfers. J Biomech. 2010;43(8):1456-62. http://dx.doi.org/10.1016/j.jbiomech.2010.02.005. PMid:20185139.
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, 4040  Horan SA, Kavanagh JJ. The control of upper body segment speed and velocity during the golf swing. Sports Biomech. 2012;11(2):165-74. http://dx.doi.org/10.1080/14763141.2011.638390. PMid:22900398.
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. The results have helped inform research investigating physical characteristics required for skilled golf performance.

With the increasing awareness of the importance of movement variability in skilled performance41 43, there has been growing interest in investigating the complex segment and intersegmental coordination that occurs during the full swing44 47. Movement variability can be described as the normal variations that occur in motor performance across multiple repetitions of a task4848  Stergiou N, Decker LM. Human movement variability, nonlinear dynamics, and pathology: is there a connection? Hum Mov Sci. 2011;30(5):869-88. http://dx.doi.org/10.1016/j.humov.2011.06.002. PMid:21802756.
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. Historically, movement variability observed in skilled sporting tasks was considered "noise" or error and therefore undesirable. It is now recognised that variability has a functional role and does not necessarily result in outcome variability4141  Bartlett R, Wheat J, Robins M. Is movement variability important for sports biomechanists? Sports Biomech. 2007;6(2):224-43. http://dx.doi.org/10.1080/14763140701322994. PMid:17892098.
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, 4545  Glazier P. Movement variability in the golf swing: theoretical, methodological, and practical issues. Res Q Exerc Sport. 2011;82(2):157-61. PMID:21699094. , 4949  Davids K, Glazier P. Deconstructing neurobiological coordination: the role of the biomechanics motor control nexus. Exerc Sport Sci Rev. 2010;38(2):86-90. http://dx.doi.org/10.1097/JES.0b013e3181d4968b. PMid:20335740.
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. That is, there is greater understanding of the large number of constraints that interact to shape movement behaviours during sporting endeavours, including body properties, environmental conditions, and tasks, and that highly skilled performers demonstrate the necessary flexibility and adaptability to operate proficiently in a variety of learning and performance contexts4242  Davids K, Button C, Bennett SJ. Dynamics of skill acquisition: a constraints led approach. Champaign: Human Kinetics; 2008. , 5050  Seifert L, Komar J, Barbosa T, Toussaint H, Millet G, Davids K. Coordination pattern variability provides functional adaptations to constraints in swimming performance. Sports Med. 2014;44(10):1333-45. http://dx.doi.org/10.1007/s40279 014 0210 x. PMid:24895244.
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.

Movement variability in the downswing of skilled male and female golfers was investigated by Horan et al.5151  Horan SA, Evans K, Kavanagh JJ. Movement variability in the golf swing of male and female skilled golfers. Med Sci Sports Exerc. 2011;43(8):1474-83. http://dx.doi.org/10.1249/MSS.0b013e318210fe03. PMid:21266926.
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. Despite variability in the kinematics of the thorax and pelvis as well as variability in thorax pelvis coupling at the midpoint of the downswing and at ball contact, both males and females achieved highly consistent club and hand trajectories at ball contact. Interestingly, females were found to have greater variability in thorax pelvis coupling than males. While physiological measures were not directly measured, the differences may have been due to differences in factors such as strength or flexibility or that male and female golfers adopted different motor control strategies to achieve consistent performance. Gender related differences in golf swing kinematics have been observed by other authors3838  Zheng N, Barrentine SW, Fleisig GS, Andrews JR. Swing kinematics for male and female pro golfers. Int J Sports Med. 2008;29(12):965-70. http://dx.doi.org/10.1055/s20081038732. PMid:18563677.
http://dx.doi.org/10.1055/s 2008 1038732...
, 3939  Horan SA, Evans K, Morris NR, Kavanagh JJ. Thorax and pelvis kinematics during the downswing of male and female skilled golfers. J Biomech. 2010;43(8):1456-62. http://dx.doi.org/10.1016/j.jbiomech.2010.02.005. PMid:20185139.
http://dx.doi.org/10.1016/j.jbiomech.201...
, 5252  Egret CI, Nicolle B, Dujardin FH, Weber J, Chollet D. Kinematic analysis of the golf swing in men and women experienced golfers. Int J Sports Med. 2006;27(6):463-7. http://dx.doi.org/10.1055/s 2005 865818. PMid:16767611.
http://dx.doi.org/10.1055/s 2005 865818...
supporting the notion that a number of characteristics will influence a golfer's pattern of movement and coordinative strategies.

The concept that movement variability in individual segmental trajectories during a specific task may not be detrimental to outcome performance as long as the critical 'end point parameters' (in the case of the golf swing, club head parameters at ball contact) remain consistent4949  Davids K, Glazier P. Deconstructing neurobiological coordination: the role of the biomechanics motor control nexus. Exerc Sport Sci Rev. 2010;38(2):86-90. http://dx.doi.org/10.1097/JES.0b013e3181d4968b. PMid:20335740.
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, 5353  Whiteside D, Elliott BC, Lay B, Reid M. Coordination and variability in the elite female tennis serve. J Sports Sci. 2015;33(7):675-86. http://dx.doi.org/10.1080/02640414.2014.962569. PMid:25358037.
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was supported more recently by Tucker et al.5454  Tucker CB, Anderson R, Kenny IC. Is outcome related to movement variability in golf? Sports Biomech. 2013;12(4):343-54. http://dx.doi.org/10.1080/14763141.2013.784350. PMid:24466647.
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. These authors found that a group of highly skilled golfers maintained consistency of ball speed despite variability in movement of individual body segments during the swing. Variability of movement of the individual body segments are integrated to produce a reduced variability in the club head trajectory, which in turn results in an even smaller variability in the club head on contact with the ball. Additionally, Tucker et al.5454  Tucker CB, Anderson R, Kenny IC. Is outcome related to movement variability in golf? Sports Biomech. 2013;12(4):343-54. http://dx.doi.org/10.1080/14763141.2013.784350. PMid:24466647.
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found that movement variability was highly individual-specific with different golfers adopting different performance strategies to preserve shot outcome. Taken collectively, emerging evidence supports the notions of 1) inter player variability, i.e. that individual golfers have individualised swing patterns that are different from the patterns of other golfers (Figure 1), and 2) intra player variability, i.e. that within their own swing pattern, each individual has variation in the contributions from the many different components (Figure 2).

Figure 1.
Full swing by two golfers demonstrating between individual variations. From left: address position, top of backswing, impact, and follow through.

Figure 2
The 3D trajectory of the club head of one golfer performing multiple swings demonstrating within individual variation. The width and colour of the pathway indicate the magnitude and direction of variability. The width at the point of impact is narrower indicating considerably less variability than the backswing and downswing that precede it.

Clinical implications

Golf has been described as one of the most complex, technically demanding and high precision sports that exist5555  Ferdinands RED, Kwon YH. Golf. Sports Biomech. 2012;11(2):125-6. http://dx.doi.org/10.1080/14763141.2012.696400. PMid:22900395.
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. Clinicians that work with golfers should consider that inter golfer and intra golfer variability in swing performance will be affected by task, environment, and organism constraints, all of which interact to determine the patterns of motion that are observed when a golfer swings a club4545  Glazier P. Movement variability in the golf swing: theoretical, methodological, and practical issues. Res Q Exerc Sport. 2011;82(2):157-61. PMID:21699094.. Despite an increased understanding of the swing from both biomechanics and neuroscience research, the best way to optimise both swing and outcome performance for an individual golfer remains elusive. From a physical therapist's perspective, optimising performance in golf requires knowledge of not only the technical and physical requirements of the sport, but also how these domains are interrelated with the fields of psychology, motor learning, and motor control. While recognising the importance of a multimodal approach to optimising golf performance, the following sections focus on the physical requirements of golf and evidence pertaining to whether exercise programs can help golfers improve their performance.

Physical requirements of the golf swing

Highly skilled golfers tend to have different physical characteristics than less proficient golfers5656  Sell TC, Tsai YS, Smoliga JM, Myers JB, Lephart SM. Strength, flexibility, and balance characteristics of highly proficient golfers. J Strength Cond Res. 2007;21(4):1166-71. http://dx.doi.org/10.1519/R 21826.1. PMid:18076270.
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and factors such age, gender, and history of injury also influence a golfer's performance on physical tests as well as swing parameters3939  Horan SA, Evans K, Morris NR, Kavanagh JJ. Thorax and pelvis kinematics during the downswing of male and female skilled golfers. J Biomech. 2010;43(8):1456-62. http://dx.doi.org/10.1016/j.jbiomech.2010.02.005. PMid:20185139.
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, 5757  Lindsay D, Horton J. Comparison of spine motion in elite golfers with and without low back pain. J Sports Sci. 2002;20(8):599-605. http://dx.doi.org/10.1080/026404102320183158. PMid:12190279.
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, 5858  Tsai YS, Sell TC, Smoliga JM, Myers JB, Learman KE, Lephart SM. A comparison of physical characteristics and swing mechanics between golfers with and without a history of low back pain. J Orthop Sports Phys Ther. 2010;40(7):430-8. http://dx.doi.org/10.2519/jospt.2010.3152. PMid:20592479.
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. Nevertheless, a combination of mobility, stability, strength, and cardiovascular fitness is frequently recommended for optimal 'golf fitness'1414  Smith MF. The role of physiology in the development of golf performance. Sports Med. 2010;40(8):635-55. http://dx.doi.org/10.2165/11532920 000000000 00000. PMid:20632736.
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, 5959  Hellström J. Competitive elite golf: a review of the relationships between playing results, technique and physique. Sports Med. 2009;39(9):723-41. http://dx.doi.org/10.2165/11315200 000000000 00000. PMid:19691363.
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. Kinematic studies have highlighted the importance of adequate flexibility, particularly in the trunk, hips, and shoulders, to achieve the body positions required to optimise CHV5252  Egret CI, Nicolle B, Dujardin FH, Weber J, Chollet D. Kinematic analysis of the golf swing in men and women experienced golfers. Int J Sports Med. 2006;27(6):463-7. http://dx.doi.org/10.1055/s 2005 865818. PMid:16767611.
http://dx.doi.org/10.1055/s 2005 865818...
, 5656  Sell TC, Tsai YS, Smoliga JM, Myers JB, Lephart SM. Strength, flexibility, and balance characteristics of highly proficient golfers. J Strength Cond Res. 2007;21(4):1166-71. http://dx.doi.org/10.1519/R 21826.1. PMid:18076270.
http://dx.doi.org/10.1519/R 21826.1...
, 6060  Nesbit SM, Serrano M. Work and power analysis of the golf swing. J Sports Sci Med. 2005;4(4):520-33. PMID:24627666.. For example, reported averages for torso rotation during the backswing for a driver range from 78° to 109° with the pelvis rotating to a lesser extent of between 37° and 64°7 McTeigue M, Lamb SR, Mottram R, Pirozzolo F. Spine and hip motion analysis during the golf swing. In: Farrally MR , Cochran AJ, editors. Science and Golf II: Proceedings of the World Scientific Congress of Golf; 1994 July 4-8; London: E &FN Spon; 1994. p. 50-8. , 3535  Burden AM, Grimshaw PN, Wallace ES. Hip and shoulder rotations during the golf swing of sub 10 handicap players. J Sports Sci. 1998;16(2):165-76. http://dx.doi.org/10.1080/026404198366876. PMid:9531005.
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, 5252  Egret CI, Nicolle B, Dujardin FH, Weber J, Chollet D. Kinematic analysis of the golf swing in men and women experienced golfers. Int J Sports Med. 2006;27(6):463-7. http://dx.doi.org/10.1055/s 2005 865818. PMid:16767611.
http://dx.doi.org/10.1055/s 2005 865818...
. EMG studies have sought to identify the muscle groups important for golf performance28,29,61 64 and several reviews have been published on this topic6565  Marta S, Silva L, Castro MA, Pezarat-Correia P, Cabri J. Electromyography variables during the golf swing: a literature review. J Electromyogr Kinesiol. 2012;22(6):803-13. http://dx.doi.org/10.1016/j.jelekin.2012.04.002. PMid:22542769.
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, 6666  McHardy A, Pollard H. Muscle activity during the golf swing. Br J Sports Med. 2005;39:799-804. http://dx.doi.org/10.1136/bjsm.2005.020271.
http://dx.doi.org/10.1136/bjsm.2005.0202...
. From the collated data, it is apparent that the trunk extensors, hip extensors, and the abdominal muscles all play an important role in producing a powerful efficient golf swing. The efficient transfer of energy from the lower body to the muscle groups of the chest and arms and eventually the hands and club the "bottom up phenomenon"6060  Nesbit SM, Serrano M. Work and power analysis of the golf swing. J Sports Sci Med. 2005;4(4):520-33. PMID:24627666. is important for producing high CHV, but similarly to swing kinematics, a number of kinetic variables measured during the swing are also highly individual-specific2222  Nesbit SM, McGinnis RS. Kinetic constrained optimization of the golf swing hub path. J Sports Sci Med. 2014;13(4):859-73. PMID:25435779..

Golfers spend many hours practising. Professional golfers can perform up to 300 swings in a single practice session and hit over 2000 shots per week6767  Jobe FW, Pink MM. Shoulder pain in golf. Clin Sports Med. 1996;15(1):55-63. PMID:8903709. , 6868  Thériault G, Lachance P. Golf injuries. An overview. Sports Med. 1998;26(1):43-57. http://dx.doi.org/10.2165/00007256199826010 00004. PMid:9739540.
http://dx.doi.org/10.2165/00007256199826...
. To ensure a golfer can meet both the physical and mental demands of playing tournament golf and avoid the detrimental effects that fatigue has been shown to have on performance1111  Evans K, Refshauge KM, Adams RD, Barrett R. Swing kinematics in skilled male golfers following putting practice. J Orthop Sports Phys Ther. 2008;38(7):425-33. http://dx.doi.org/10.2519/jospt.2008.2617.
http://dx.doi.org/10.2519/jospt.2008.261...
, 6969  Mathers JF, Grealy MA. Motor control strategies and the effects of fatigue on golf putting performance. Front Psychol. 2014;4:1005. http://dx.doi.org/10.3389/fpsyg.2013.01005. PMid:24454298.
http://dx.doi.org/10.3389/fpsyg.2013.010...
, exercises aimed at improving a golfer's cardiovascular fitness have also been advocated1414  Smith MF. The role of physiology in the development of golf performance. Sports Med. 2010;40(8):635-55. http://dx.doi.org/10.2165/11532920 000000000 00000. PMid:20632736.
http://dx.doi.org/10.2165/11532920 00000...
.

In summary, playing golf has very specific physical requirements that have led many researchers, coaches, and clinicians to suggest that physical preparation programs should be undertaken by golfers of all ages and abilities in order to improve performance and prevent golf related injury. This paper will not focus on the latter but on findings from studies that have investigated whether exercise programs can improve golf performance.

Exercise programs to improve golf performance

Golf-specific exercises have been advocated for many years, with early attempts being largely idiosyncratic and based on personal experience and opinion. For example, three-time Open Championship winner Sir Henry Cotton in 1948 said:

Let me add, that, as far as I know, no data on this subject of specific golf muscle-building has ever been given, and I have had to grope my way along according to my own ideas and following my own observations, endeavouring to build up my golfing muscles to the best of my ability7070  70. Cotton H. This game of golf. London: Country Life; 1948. .

Cotton's statement reflects the predominant understanding of human performance in the 1940's: increased muscular strength should result in improved performance. A golf specific exercise program would therefore be designed to target the specific muscles used in the sport. In their review of strength and conditioning programs for improving fitness in golfers, Smith et al.7171  Smith CJ, Callister R, Lubans DR. A systematic review of strength and conditioning programmes designed to improve fitness characteristics in golfers. J Sports Sci. 2011;29(9):933-43. http://dx.doi.org/10.1080/02640414.2011.571273. PMid:21547836.
http://dx.doi.org/10.1080/02640414.2011....
defined golf-specific exercises as those that activate muscles groups that are used in golf in comparable patterns of motor coordination, in similar planes and ranges of movements, with similar speeds, and similar loads on postural muscles. In addition to load, this definition adds coordination, pattern specificity, and speed to the idea of what makes exercises golf-specific. Interestingly, Smith et al.7171  Smith CJ, Callister R, Lubans DR. A systematic review of strength and conditioning programmes designed to improve fitness characteristics in golfers. J Sports Sci. 2011;29(9):933-43. http://dx.doi.org/10.1080/02640414.2011.571273. PMid:21547836.
http://dx.doi.org/10.1080/02640414.2011....
concluded that the majority of studies included in their review involved reasonably generic exercise programs that did not fulfil the criteria for being golf-specific. The exercises employed ranged from free weights and medicine ball plyometric training in young male golfers (age: 29±7.4 yrs, handicap: 5.5±3.7)7272  Fletcher IM, Hartwell M. Effect of an 8 week combined weights and plyometrics training program on golf drive performance. J Strength Cond Res. 2004;18(1):59-62. PMID:14971982. to strength and flexibility exercises in older recreational golfers (age: 65.1±6.2 yrs of all skill levels)7373  Thompson CJ, Osness WH. Effects of an 8 week multimodal exercise program on strength, flexibility, and golf performance in 55 to 79 year old men. J Aging Phys Act. 2004;12(2):144-56. PMID:15223883. to a proprioceptive neuromuscular facilitation stretching program in golfers aged between 47 and 82 years with handicaps ranging from 8 to 347474  Jones D. The effects of proprioceptive neuromuscular facilitation flexibility training on the clubhead speed of recreational golfers. In: Farrally MR, Cochran AJ, editors. Science and Golf III: Proceedings of the World Scientific Congress of Golf; 1998 July 20-24. St. Leeds: Human Kinetics; 1999, p. 46-50.. Despite the fact that several of the studies reviewed by Smith et al.7171  Smith CJ, Callister R, Lubans DR. A systematic review of strength and conditioning programmes designed to improve fitness characteristics in golfers. J Sports Sci. 2011;29(9):933-43. http://dx.doi.org/10.1080/02640414.2011.571273. PMid:21547836.
http://dx.doi.org/10.1080/02640414.2011....
had low methodological scores, it is nevertheless interesting to see that, seemingly irrespective of the type of exercise approach, the duration of the program, the age or skill of the golfer, the majority of studies reported improvements in at least some of the fitness (e.g. muscular strength, flexibility) and golf performance variables (e.g. club head speed, driving distance) that were measured.

Since Smith et al.'s7171  Smith CJ, Callister R, Lubans DR. A systematic review of strength and conditioning programmes designed to improve fitness characteristics in golfers. J Sports Sci. 2011;29(9):933-43. http://dx.doi.org/10.1080/02640414.2011.571273. PMid:21547836.
http://dx.doi.org/10.1080/02640414.2011....
2011 review, as well as that of Torres Ronda et al.7575  Torres Ronda L, Sánchez-Medina L, González-Badillo JJ. Muscle strength and golf performance: a critical review. J Sports Sci Med. 2011;10(1):9-18. PMID:24149290., further studies have investigated the effects of different exercise approaches on parameters, such as club head speed, ball spin, and swing kinematic variables, thought to relate to golf performance. These studies have again been diverse in terms of the exercises prescribed (e.g. 'isolated core training'7676  Weston M, Coleman NJ, Spears IR. The effect of isolated core training on selected measures of golf swing performance. Med Sci Sports Exerc. 2013;45(12):2292-7. http://dx.doi.org/10.1249/MSS.0b013e31829bc7af. PMid:23698248.
http://dx.doi.org/10.1249/MSS.0b013e3182...
, plyometric training7777  Bull M, Bridge M. The effect of an 8 week plyometric exercise program on golf swing kinematics. IJGS. 2012;1(1):42-53. , combination of maximal strength, plyometric and golf-specific exercises7878  Alvarez M, Sedano S, Cuadrado G, Redondo JC. Effects of an 18 week strength training program on low handicap golfers' performance. J Strength Cond Res. 2012;26(4):1110-21. http://dx.doi.org/10.1519/JSC.0b013e31822dfa7d. PMid:21881530.
http://dx.doi.org/10.1519/JSC.0b013e3182...
, different warm up programs7979  Tilley NR, Macfarlane A. Effects of different warm up programs on golf performance in elite male golfers. Int J Sports Phys Ther. 2012;7(4):388-95. PMID:23936749.); duration of the program (range 6 weeks8080  Lamberth J, Hale BD, Knight A, Boyd J, Luczak T. Effectiveness of a six week strength and functional training program on golf performance. International Journal of Golf Science. 2013;2:33-42. to 18 weeks7878  Alvarez M, Sedano S, Cuadrado G, Redondo JC. Effects of an 18 week strength training program on low handicap golfers' performance. J Strength Cond Res. 2012;26(4):1110-21. http://dx.doi.org/10.1519/JSC.0b013e31822dfa7d. PMid:21881530.
http://dx.doi.org/10.1519/JSC.0b013e3182...
); age and skill level of the golfers (e.g. ~24 years with handicap <58080  Lamberth J, Hale BD, Knight A, Boyd J, Luczak T. Effectiveness of a six week strength and functional training program on golf performance. International Journal of Golf Science. 2013;2:33-42. vs ~47 years with a mean handicap of 11.2±6.17878  Alvarez M, Sedano S, Cuadrado G, Redondo JC. Effects of an 18 week strength training program on low handicap golfers' performance. J Strength Cond Res. 2012;26(4):1110-21. http://dx.doi.org/10.1519/JSC.0b013e31822dfa7d. PMid:21881530.
http://dx.doi.org/10.1519/JSC.0b013e3182...
); effect sizes; and methodological quality. Similar to previous work, direct measures of golf performance (e.g. strokes per round, performance during tournaments) are lacking. Overall, the results support the notion that it is more important that a golfer do some form of exercise rather than no exercise, irrespective of what particular type of exercise is undertaken.

Lessons from other areas of clinical research

Interestingly, the conclusion that exercise (generally) has a beneficial effect for golfers, regardless of the type of exercise, is similar to findings in other areas of sports research8181  Girold S, Maurin D, Dugué B, Chatard JC, Millet G. Effects of dry land vs. resisted and assisted sprint exercises on swimming sprint performances. J Strength Cond Res. 2007;21(2):599-605. PMID:17530963. , 8282  Mihalik JP, Libby JJ, Battaglini CL, McMurray RG. Comparing short term complex and compound training programs on vertical jump height and power output. J Strength Cond Res. 2008;22(1):47-53. http://dx.doi.org/10.1519/JSC.0b013e31815eee9e. PMid:18296955.
http://dx.doi.org/10.1519/JSC.0b013e3181...
but most notably the low back pain (LBP) field. Historically, most reviews of exercise therapy for patients with LBP conclude that when different types of exercise are compared directly, exercise in general is effective83 85. That is, there does not appear to be one form of exercise that is superior to another for patients with LBP. What the studies do not tell us, however, by reporting group means, is whether one program is better for a given individual and if so, which one. More recently, studies comparing interventions based on subgrouping of patients and development of clinical prediction rules have been conducted with the aim of more specifically tailoring interventions based on a set of patient characteristics. However, it has proven extremely challenging to develop theoretical and practical frameworks that consider enough of a patient's biological as well as psychosocial characteristics to determine effective treatment strategies8686  Huijnen IPJ, Rusu AC, Scholich S, Meloto CB, Diatchenko L. Subgrouping of low back pain patients for targeting treatments: evidence from genetic, psychological, and activity related behavioral approaches. Clin J Pain. 2015;31(2):123-32. http://dx.doi.org/10.1097/AJP.0000000000000100. PMid:24681821.
http://dx.doi.org/10.1097/AJP.0000000000...
. Nevertheless, there is preliminary evidence supporting the notion that patients who receive a more individualised treatment approach achieve better outcomes8787  Asenlöf P, Denison E, Lindberg P. Individually tailored treatment targeting motor behavior, cognition, and disability: 2 experimental single case studies of patients with recurrent and persistent musculoskeletal pain in primary health care. Phys Ther. 2005;85(10):1061-77. PMID:16180955..

To date, when studies of the effects of exercise programs on golf performance have subgrouped participants, the grouping criteria have been according to handicap, age, or gender. Grouping a golfer based on handicap intuitively makes the most sense - skilled golfers have more consistent swing kinematics than unskilled golfers and therefore any changes post intervention are more likely to be as a result of the intervention than due to measurement error. However, one only has to look at the player anthropometrics of the Ladies Professional Golf Association's (LPGA) Top 10 female golfers to recognise that even the best players in the world are reasonably heterogeneous.

Where to from here?

There is still much to understand about how to assist golfers improve their game and avoid injury. It will be important to ensure the validity of the measurements that are being made, consider more sophisticated measures or methods of analysis, and ensure that the outcomes being considered are true indicators of the desired outcomes. Perhaps most importantly, however, is to use measures that reflect the dynamic nature of golf and are capable of taking into consideration individual variation in strategies and responses.

New tools such as a variety of wearable sensors, marker-less motion tracking, and wide field-of-view electromagnetic tracking systems are becoming available that can assist to improve our understanding of the biomechanics and by enabling studies to be carried out on the golf course instead of the laboratory. Alternatively, if laboratory studies continue to be used, it will be important to cross validate the methodologies to ensure what occurs in the lab actually reflects what occurs on the course. Similarly, it will be important to determine how the surrogate measures of performance typically used in the lab relate to performance on the course.

The systems that are currently used in most biomechanics laboratories are able to determine location of points on the body and ground reaction forces at rates of hundreds or even thousands of samples per second and create a 3D reconstruction of the entire movement pattern through time. In spite of the dazzling complexity and accuracy of the data, much of the analyses use simplified variables such as maximum or minimum values of locations, angles, speeds, or accelerations or the values of these parameters at predetermined time points during the swing. One of a relatively small number of studies that evaluated data across the time course of the swing was that of Tucker et al.5454  Tucker CB, Anderson R, Kenny IC. Is outcome related to movement variability in golf? Sports Biomech. 2013;12(4):343-54. http://dx.doi.org/10.1080/14763141.2013.784350. PMid:24466647.
http://dx.doi.org/10.1080/14763141.2013....
. The authors recorded the locations of 14 points on the golfer's body and club at 400 Hz for 10 swings by each of 16 golfers. For each normalised time point for each marker, a virtual three dimensional ellipsoid was constructed that would contain the mean location +/ one standard deviation of the position of that marker through the swing. Not only does this type of methodology enable the swings of different individuals to be compared in ways that were not previously possible, but it also enables investigators to evaluate the relative impact of different body locations and/or time points on performance.

As more is understood about individual variation, it may be possible to develop and assess the efficacy of individualised programs for individual golfers. Instead of the more common study design, which compares two (or more) groups and have every member of the group receiving the same intervention, individualised programs could be assessed using a parallel group design. For example, the intervention in one group can be individualised according to an algorithm while the other intervention uses a set protocol8787  Asenlöf P, Denison E, Lindberg P. Individually tailored treatment targeting motor behavior, cognition, and disability: 2 experimental single case studies of patients with recurrent and persistent musculoskeletal pain in primary health care. Phys Ther. 2005;85(10):1061-77. PMID:16180955.. Perhaps more appropriate, however, to evaluate individual treatment responses would be the use of so called "n of one trials"8888  Senn S. Individual therapy: New dawn or false dawn? Drug Inf J. 2001;35(4):1479-94. http://dx.doi.org/10.1177/009286150103500443.
http://dx.doi.org/10.1177/00928615010350...
. The power of this design comes from each intervention option being trialled more than once in a multiple crossover design (e.g. as a minimum - an ABAB or ABBA sequence). One type of intervention being consistently superior in more than one comparison provides much stronger evidence for it being actually superior. An advantage of n of one trials is that they are also available to the therapist in clinical practice. Consider for example if two exercise programs have demonstrated benefits, but in a head to head comparison neither is superior.

One interpretation of the evidence would be to select one and only change the program if the outcomes were 'very poor'8989  Herbert R, Jamtvedt G, Mead J, Hagen KB. Outcome measures measure outcomes, not effects of intervention. Aust J Physiother. 2005;51(1):3-4. http://dx.doi.org/10.1016/S0004-9514(05)70047-7. PMid:15748119.
http://dx.doi.org/10.1016/S0004 9514(05)...
. However, by applying an n of one design in clinical practice, the therapist no longer has to rely on average results but can determine which of the options is better for each individual golfer at a given time.

Conclusions

Despite the growing body of research investigating the golf swing, much remains unknown and translating the findings from the biomechanical, physiological, motor learning, and motor control research into clinical practice, where the aim is to assist golfers improve their performance and prevent injury, remains challenging. It is generally well accepted that, in order to improve performance, a multimodal approach is required and both researchers and clinicians need to consider the aforementioned inter related dimensions in order to help optimise golf performance. There are general principles of exercise that are likely to be of benefit to all golfers, and the study designs employed to date have provided a wealth of information and should inform current and future practice. However, more sophisticated tools and designs are available that are capable of expanding our knowledge of golf and practice, thereby potentially increasing our ability to assist our clients improve their golf performance.

Acknowledgements

The authors wish to thank Dr Catherine Tucker and colleagues for allowing use of this image which illustrates some of the findings from their research.

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Publication Dates

  • Publication in this collection
    06 Oct 2015
  • Date of issue
    Sep-Oct 2015

History

  • Received
    17 Mar 2015
  • Reviewed
    12 June 2015
  • Accepted
    25 June 2015
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