Can a bad round of golf be good for your health?
An expert physiotherapist’s guide to warm-up routines, superstitions and reaching peak performance
By David Bevan
Despite having a passion primarily for Cricket, growing up in north-east Scotland gave me only two real sporting choices - football and golf. I got the bug for the latter aged eleven and have been an avid player and follower of the sport ever since. During this time I have been inspired by the meteoric rise of Tiger Woods with his almost scientific approach to the game and his global dominance. Despite his recent slump in form following chronic back pain, the mantle has been taken over by young guns such as McIlroy, Spieth and DeChambeau to name but a few.
The ever-increasing average drive distances and the resultant shortening of some of the world’s most iconic courses is often cited as a result of club design and manufacture. This may be the case, yet my opinion is that an increased awareness of healthy living and strength conditioning must also play its part. But as a weekend amateur golfer, what can we do to improve our game? And to paraphrase a famous quote, is it all just a waste of a good walk?
Is being worse at golf better for you?
There is growing evidence of the health benefits of golf physically, mentally and in disease prevention. The days of stereotyping golf as merely a sedentary lifestyle choice have long gone. Playing golf, despite its inaccurate reputation, has been found by research as a form of moderate intensity aerobic exercise. This places it somewhere between walking regularly and having a good cycle. Indeed, extrapolating further would suggest the worse you are (i.e. the further you walk) the healthier the sport is for you (good news for most of us!).
The good news doesn’t only relate to calories burned but is seen far beyond in long-term disease prevention and even mortality. There are currently approximately 55 million golfers playing around the world, although this is five times smaller than the numbers playing Soccer. There is a much higher percentage of golfers playing in their middle to late ages compared to soccer equivalents (not everyone is Zlatan Ibrahimovic, but there are a few Tom Watsons about). This high number of participants in later life could be one of the reasons why golfers have a 36 to 68 per cent reduction in hip fractures, 30 to 40 per cent reduction in type two diabetes and 20 to 30 per cent reduction in breast and colon cancers (it is fair to state this also could be linked to the higher than average socioeconomic group seen in golf clubs). However, current available evidence suggests regularly playing golf results in significantly lower mortality rates.
Is golf a mind game?
Studies have found activities that foster social interaction, promote self and group identity, and provide support during bereavement or illness (such as golf) may lead to improvements in mental health. Further research is required to investigate firm links to mental health and well-being.
Injury in golf is an interesting topic. If you were to look at the two major professional tours, the injuries that occur most seem to be lower back, shoulder and elbow related. However, these must be seen in the context of athletes that play and train for a living. Considering amateur golfers (who play one to three times weekly, when the sun’s shining) the likelihood is that back pain is still up there in the list of most complained about. However, other problems such as hip and knee pain are increasingly common (believe me, I hear about them every time I play at my local club).
It is important to understand that although golf may be aggravating these problems, there may be another underlying cause. We need to look at what is done or not done away from the fairways (i.e. work life and everyday life).
Keeping you on the course
There is a large amount of research being conducted in the rehabilitation world on the best ways to manage long term degenerative pain and dysfunction (back, hip or knee related). Prescribing periods of relative “off-load” and then gradual “re-load” are likely to be the answer and is increasingly becoming evidential. I am very much a believer that more harm is inadvertently inflicted by making patients wary of exercise, instead of empowering someone to embrace movement in the right way. It’s not unheard of that professional and amateur golfers are routinely told that every time he/she lifts a club or makes a putt, your pelvis is at risk of “slipping-out”. Not only is that based on no credible evidence, it is placing the worst “swing thought” into an already vulnerable mind. Let’s stop this now.
Warm-ups, injury and performance
We have all seen Mr Jimenez’s legendary warm-up routine and his accompanying cigar. So do warm-ups actually prevent injury and aid performance? In most sports, including golf, there is a surprising lack of evidence that support warm-ups and downs as a means to prevent injury. There may however be a link with the prevention of delayed onset of muscle soreness. But even this link is currently tenuous.
However, as clinicians and indeed as players, we know that the extent of shoulder turn is essential to efficient swing mechanics (without it you can lose distance and possibly overload structures such as the lower back). With good clinical reasoning, I am a strong advocate of spinal exercises to maintain or improve mobility and therefore performance; these can be fitted in to your weekly exercise routine.
Although there is also a general lack of evidence focusing on warm-up routines enhancing golf performance, there is considerable evidence suggesting the avoidance of static, sustained stretching. The golf swing requires large rotational forces around the hips, trunk and arms, which are generated by an explosive “stretch-shortening” of muscles and tendons. Statically stretching these muscles (rather than dynamically) only elongates them and therefore compromises the power generated by the stretch shortening mechanism.
This was shown in 2012 when members of the European Tour Performance Institute conducted interesting research that implemented a dynamic warm-up routine before playing (using a resistance band) and found significant improvements in performance variables such as drive accuracy, drive distance and club head speed (using a launch monitor). The opposite result was seen with static stretching.
Superstitions and the future of golf
So going back to Miguel Angel and his warm-up routine … why does it work for him? Often it is about getting the mind in check before you play, therefore getting into a movement or stretch routine can aid this process. It can also be almost part of a superstitious routine. If you know you haven’t “warmed up”, you are psychologically destined to blob the first few holes.
Golf is one of the world’s oldest sports and critics would say (albeit tongue in cheek) it’s played by some of the world’s oldest people. However, despite recent figures suggesting dwindling participation numbers, it still attracts millions of players young and old to its fairways every year. Society is experiencing an epidemic explosion of sedentary living, lifestyle-related disease, chronic joint pain and mental health disease, which could all be interrelated.
Therefore, I am an advocate of sports such as golf that get you out in the fresh air with friends, socialising or competing. This in turn helps buck the trend of declining health and well-being in our society.
Senior Lower Limb Physiotherapist, Circle Reading Hospital
20th July 2017