If you want to be proficient at golf, you will at least need desire, determination, hand-eye coordination and some talent. Also, selective short-term memory loss is a benefit to strong golfers -- don't forget that!

As for the actual game, you will need to develop sound fundamentals, shot-making skills, course management, a keen understanding of the mental aspect of golf, equipment and physical conditioning. These characteristics perfectly describe the modern-day golfer. Today's game features the availability of video analysis, Doppler radar and other technology to get equipment dialed in, but there is one piece of equipment that still gets neglected -- your body.

Enter the golf screen, which is a physical evaluation that could bring to the forefront any issues a golfer may encounter.

In order to understand what the body can and cannot do, we now incorporate a physical screen into our assessment of golfers. A physical screen is a musculoskeletal assessment of the body in order to identify and isolate physical limitations, which may lead to poor performance and possible injury. Along with a functional movement screen, it is important to include fundamental movements, looking at speed, power, and agility.

Golf instructors can teach you about every aspect of the swing, but what happens when you physically cannot get into those positions? Besides frustration, injury becomes increasingly likely.

I got into golf in my 20s. I would swing as hard as I could and naturally got into some bad habits. I would slide into my left side, which occasionally would cause hip pain. My golf instructor would constantly tell me that I was sliding into my left side and I need to focus on transferring my weight by turning. My coach was not wrong, but years later it became evident I was having pain and trouble turning because of poor internal hip rotation on my lead hip.

Unfortunately, physical screens were not widely used then. Had they been, my body could have been in much better shape back then as well as today.

The Titleist Performance Institute (TPI) brought body mechanics to the forefront for many of us in the golf industry. The idea of TPI was to create a team combining the golf, medical and fitness professionals to enhance performance and prevent injury. Besides the TPI golf-specific screen, you might also have have heard of a Functional Movement System (FMS), or Selective Functional Movement Assessment (SFMA). 

It can get a bit confusing trying to figure out what type of assessment you should have and who you should go to in order to be evaluated physically for golf. The TPI screen or FMS is used to evaluate people who do not have injuries, whereas the SFMA is used by physical therapists and other health practitioners for individuals with injuries. When finding someone to do your physical evaluation, look for someone who specializes in sports performance/biomechanics and has a solid foundation when it comes to the mechanics of the golf swing.   

Ideally, it would be great to find a medical professional with a sports performance background or one who specializes in golf. This type of medical professional would have each screening tool at their disposal and be able to evaluate for functional movement. And in the event there are limitations they would provide treatment. 

Whether you are an elite athlete or a weekend warrior, going through a functional assessment will help to maximize performance and prevent injuries.

Marc Beeber, PGA, MPT

Soft Tissue and the New, Old Healing Process

The so-called soft tissue injury is one of the great misnomers of medicine in that there is nothing soft about the pain they cause to the affected area of the muscles, tendons and ligaments. 

Soft tissue injuries typically occur in muscles because of increased tension that could be caused by overuse, imbalance or poor mechanics. Muscles that are attached to the skeletal system contract and relax in order to allow you to move. Problems begin to surface when these muscles fail to completely relax and then become stretched beyond their new limit -- this is referred to as a trigger point. The small fibers that make up the muscle could become damaged and torn, leading to pain, restriction of motion (ROM), weakness or asymmetries throughout the skeletal system.

There are two categories of soft tissue injuries: acute injuries and repetitive or overuse injuries. An acute injury is the result of a trauma and includes strains (muscles or tendons), sprains (ligaments) or contusions (due to impact), whereas injuries such as tendinitis and bursitis occur gradually over time from repetitive motions. We classify soft tissue injuries by Grades; Grade 1 (micro-tears of fibers), Grade 2 (partial tears) or Grade 3 (ruptures).

The majority of soft tissue injuries heal without complication in a predictable manner that covers three phases: inflammatory, proliferation (repair) and remodeling.

      1. The inflammatory process immediately follows acute trauma or repetitive chronic irritation and involves the body's response to damaged tissue, irritants, or pathogens. This phase may be accompanied by pain, redness, increase in temperature, swelling or loss of function. The result is fibroplasia or scar tissue formation, which occurs two to four days after the injury. The major component in scar tissue is collagen, from the Greek word meaning glue.

      2. During the proliferation or repair phase, the production of scar tissue increases rapidly over the first 21 days after the injury and this newly formed tissue will contract. The collagen in the scar tissue is less elastic than normal soft tissue, which could result in reduced range of motion (ROM). It is important throughout this period to employ appropriate stress and movement, thus creating a strong and flexible scar. It is in this repair phase when the most effective improvements can be made in relation to ROM.

      3. The remodeling phase lasts up to a year and scar tissue will continue to increase in strength. It is necessary to increase the load of the tissue so it strengthens, and more vigorous ROM interventions should be utilized if required.

The movement and ROM interventions are key to proper healing of soft tissue injuries because they ensure that the quality of the scar tissue will be strong and flexible. Poor scar tissue will cause weakening of soft tissue over time, and when stress is placed on a weakened muscle, tendon or ligament, it could continue to tear or eventually rupture and the cycle sadly continues.

Indeed, mobility is a requirement for tissue health and healing, as muscle activation around passive vessels (the lymphatic system/Venus return) is necessary to reduce swelling. This action pulls the deoxygenated blood and waste out of the body (Reinl 2014). Although some conditions require immobilization, mobilization and progressive tissue loading should be performed when directed by your physical therapist.

There is one more mind-blowing thing to mention about soft tissue care. Yes, medicine and methodology change over time. Take the idea of rest, ice, compression and elevation (RICE), which has been the accepted norm in caring for injuries over the past several decades. But what if we were wrong? Specifically, what if the application of ice to reduce inflammation proved to be counterproductive? "There can be inflammation without healing but there cannot be healing without inflammation," (Leadbetter 1989). If you disrupt the first phase, of inflammation, then you prevent the second and third phases from taking place and completing the healing process (Stovitz and Johnson 2003). 

Ice, anti-inflammatories and cortisone shots prevent the body's natural inflammatory response from fixing the problem. Or, as Gary Reinl (2014) put it, if you are using anti-inflammatories that means you believe the body's inflammatory response is a mistake. Otherwise, you would not be trying to prevent it.

Mind blown? Let your body do what it has been designed to do by powers much greater than us.

References:

Reinl, Gary. Iced!: The Illusionary Treatment Option. Place of Publication Not Identified: Gary Reinl, 2014. Print.

Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999

Leadbetter WB. An introduction to sports-induced soft -tissue inflammation. In: Leadbetter WB, Buckwalter JA, Gordon SL. Sports-Induced Inflammation: Clinical & Basic Science Concepts. Park Ridge, IL, Amer Acad Orth Surg.1989.

The Physician and Sportsmedicine: Volume 31: No.1 January 16, 2003 NDAIDs and Musculoskeletal Treatment What Is the Clinical Evidence? Steven D. Stovitz, MD; Robert J. Johnson, MD 

Can you shoulder the load out on the golf course? In today's vastly sedentary lifestyle, the answer is: Not likely. 

"Sit up straight!" our parents and grandparents would bark at us when we were kids. But they were mostly concerned with our general health and well-being -- they weren't exactly worried about the way our poor posture would eventually affect the way we could swing a golf club, but they should have been.

Many of us spend too much time hunched over while sitting at our computers or while looking at our mobile devices, a rounding of the shoulders is often the price we pay for the benefits of modern technology. Right now, for instance, think about your posture as you read this article. Are you sitting up straight? I didn't think so.

In golf, this is the beginning of condition known as C-posture. Not only is there curvature of the spine (kyphosis), but there also is a rounding of the shoulders, which along with overdevelopment of shoulder internal rotators, could limit shoulder mobility.

We tend to focus on the rotator cuff because the shoulders are highly susceptible to injury among golfers, ranking third behind the back and wrists (Mchardy, Pollard & Luo 2006). The rotator cuff is comprised of four small muscles, all located on the scapula.  All these muscles will contribute in their own way toward the stability and mobility of the shoulder.

Rotator Cuff Muscles:          Function

• Ifraspinatus External Rotation

• Teres Minor

• Subscapularis Internal Rotation

• Supraspinatus Abduction

Swinging a golf club requires 90 degrees of external rotation in both the lead and trail arm. Though it is possible to manufacture a swing with less than a 90 degree range of motion, the motion has to come from somewhere, often leading to alteration of the swing mechanics and placing an increased strain on surrounding joints.

Looking just off the cuff, you can see where tension caused by the internal rotators can create an imbalance with the external rotators, and mobility may be compromised.

Here is a look at muscles that are affected while in a C-posture.

Tight or Shortened Muscles:                         Weak or Inhibited Muscles:

• Pec Major & Minor                                       • Serratus Anterior

• Upper Trapezius & Levator Scapula            • Deep Neck Flexors & Lower Trapezius

• Latissimus Dorsi & Sternocleidomastoid       

In trying to remedy this problem, workouts often are focused on the weakness of the infraspinatus and teres minor (external rotators). Although the weakness certainly may be present, trying to strengthen these muscles without addressing the true problem of the tight and shortened internal rotators could create a bigger problem. Shifting the focus to releasing the tension of the internal rotators -- the subscapularis, pec major and latissimus dorsi -- will help bring balance and order back to the rotator cuff.

It is important to recognize the relationship between a rigid thoracic spine, which is associated with C-posture, and the shoulders. When the body is balanced, the scapula will remain attached to the thorax. When the thoracic spine lacks mobility, combined with weakness of the serratus anterior (shoulder stabilizer), scapular winging could occur to maintain the mobility of the shoulder.

So how can you help avoid this pattern all together? For one thing, Sit up Straight! Posture is important and creating new habits will take time.  Spending a little time with your physical therapist and golf performance specialist is a choice place to start. You can also perform some self-myofascial release exercises targeting some of the bigger muscles such as the latissimus dorsi with a foam roller and using a lacrosse ball to "attack" muscles such as the pec major.  Spending less time hunched over your computer and more time out on the golf course would be a good idea -- but only after you finish reading all of the information this website contains!

References:

Begelman, B. (2009, April 2). [C - Posture]. Retrieved February 9, 2017, from http://http://www.pilatesdigest.com/pilates-for-a-better-golf-swing/

Mchardy, A., Pollard, H., & Luo, K. (2006). Golf Injuries. Sports Medicine, 36(2), 171-187.

Sechrest, R. C., MD. (1998). [Muscles of the rotator cuff]. Retrieved February 9, 2017, from http://eorthopod.com/shoulder-anatomy/

Westerdal, M. (2016). [Thoracic and forward head flexion]. Retrieved February 9, 2017, from http://www.forwardheadposturefix.com/

MOTOR LEARNING:

External vs Internal Cues – Negative vs Positive Reinforcement

When I was young, my parents taught me it was important to be mindful of the things you say to others.

"Think before you speak," they would tell me.

That old adage, ingrained into my head over the years, has a great deal more relevance to me now than I had ever given it credit for. As I have grown older and gained more wisdom, I have found -- especially when working with athletes -- that the words we use and how we use them matter.

When developing athletes, what you say -- which is called "cueing" -- can elicit a positive or negative response. Through cueing, coaches can focus an athlete's attention either internally toward their own body movements, or externally toward the effects their movement has on the environment.  Researchers have found that performance movements in sports like golf, which require the generation of force or power, can be significantly increased by externally directed cues (Bredin, Dickson and Warburton 2013).

An example of the difference between an internal and external cue can be seen in the interaction between Chris Finn, physical therapist and strength and conditioning coach at Par4success Sports Performance, and an athlete he was coaching. In order to get the athlete to move her knees higher when running, Finn gave the external cue of "running through tall grass," and then the internal cue of practicing "high knees" while the athlete had her hands up against a wall.

As a coach, it is important to identify the goals you and your athlete are trying to achieve and keep cues simple.  When learning a new movement pattern it can be frustrating at times for both the coach and athlete, but everyone learns at their own pace and will respond to different cues based on their own personal experiences (Wulf 2010). Developing a relationship with the athlete will facilitate communication. Being patient and learning how to say the same thing several different ways until the desired outcome is achieved is the sign of a diligent, attentive coach.

Another manner in which coaches attempt to elicit a reaction from an athlete is through positive and negative reinforcement. Positive refers to a reinforcing stimulus that the coach wants the athlete to continue, whereas negative reinforcement occurs when trying to remove an adverse stimulus as a result of a behavior. Negative feedback is NOT a punishment, and is considered much more effective when changing an initial habit. But this effect wears off in the long run. Using a combination of both, whereby negative feedback gets you started and positive feedback maintains the progression, has been shown to be a more successful method (McLeod 2015).

As an example, consider a golfer who has been coming over the top of the ball. Negative feedback would be eliminating the yelling (adverse stimulus) from the member’s home you keep hitting. While positive feedback would entail a coach complimenting his athlete “great job not hitting the home on the first hole.” Ok, perhaps I need to work on that one.

Overall, it is more productive to be mindful of how we speak to each other (in all walks of life, really). But when dealing with an athlete specifically, it is of utmost importance to understand how the words you choose through external and internal cueing-- and the way you say them -- will influence an athlete and help or hinder their performance. 

Reference:

Bredin, S., Dickson, D., and Warburton, D., 2013. Effects of varying attentional focus on health-related physical fitness performance. Applied Physiology, Nutrition, and Metabolism. 38, pp. 161-168

McLeod, S., 2015. Skinner - Operant Conditioning. Retrieved from www.simplypsychology.org/operant- conditioning.html

Wulf, G. et al., 2010. Frequent External-Focus Feedback Enhances Motor Learning. Frontiers in Psychology, 1, pp. 190.

You can get more than just laughs from the movie "Happy Gilmore." Take the character Chubbs, for instance, who imparts the following words of wisdom: “It’s all in the hips, it’s all in the hips. … Just easin' the tension, baby. Just easin' the tension!”

Oh Chubbs, how right you are! It is always great to finish what you start, whatever it might be. Whether it is a homework assignment, the infamous honey-do list or, for the sake of this discussion, your golf swing. 

Before we actually get into the hips and, more importantly, their mobility, we need to mention their partner in crime -- the core. Though they are spoken about separately, there is a tremendous exchange between the hips and the core. The body is made up of areas of mobility and stability. The mobility of the hip is predicated upon optimal functioning and the stability of the core. These core stabilizers include the abdominals (in front) and the multifidus, erector spinae (in the back), among others, as seen in the illustration below:

                        (lower crossed syndrome)

Our increasingly sedentary lifestyle wreaks havoc on this part of our body in the same way it does our shoulders. Prolonged sitting will cause weakness in the abdominals and glutes, and tightness in lumbar extensors and hip flexors (iliopsoas). This results in an imbalance in the core and hip musculature. It is this imbalance that can create an anterior pelvic tilt, reducing the space in the acetabulum (where the head of the femur meets with the pelvis) and limiting hip mobility. 

So, how does this affect your golf swing? Well, stand up for a moment. Too much sitting is bad for you anyway. Rotate your shoulders to the right (backswing for a right-handed golfer), and you will notice your lead hip externally rotates (Average 40 degrees in the golf swing), while the trail hip internally rotates (Average 30 degrees) (Rose 2012). On the downswing, the opposite will occur, with internal rotation on the lead hip and external rotation on the trail leg. On the downswing, the external rotation of the hips in the trail leg, though important, can be compensated for by getting off of your right side and “showing your spikes.” 

So far, the restriction in hip mobility could reduce the ability to get us into strong golf positions, but the internal rotation of the lead hip (approximately 40 degrees) tends to open us up to the greatest threat of injury and impairs the ability to finish our swing. During set-up of the golf swing, we tend to keep the back foot neutral, or perpendicular to the target line, whereas on the lead foot we will tend to “open the foot up” and externally rotate it. Not only does this help with the transfer of weight, but it also reduces the amount of internal hip rotation required. 

If you would not mind standing up again, try pointing both feet inward toward each other. Now try to rotate back and then through to the finish. You should clearly note the difficulty. All too often I notice the lead foot in a neutral position at the start of the swing, and by sheer force of the motion the foot will rotate outward at the finish. 

Having proper hip mobility in the backswing and through to the finish is essential for creating speed and power. If you are having trouble getting to your finish in your golf swing, start with checking your set-up and be aware of how your posture can cause limitations in hip mobility. Heed the important advice from our fictional friend Chubbs: “It’s all in the hips."

Reference:

Admin. Lower Crossed Syndrome. Digital image. Assessment and Treatment of Muscle Imbalance - The Janda Approach. N.p., 26 Nov. 2011. Web. 13 Feb. 2017.

Rose, Greg, Dr. "Your Hips and Your Swing." Blog post. Mytpi.com. N.p., 1 Nov. 2012. Web. 13 Feb. 2017.

Happy Gilmore. Dir. Dennis Dugan. Perf. Adam Sandler. 1996. DVD.