Dynamic Stretching and Golf Swing Performance

What We Do Not Know About Stretching in Healthy Athletes: A Scoping Review with Evidence Gap Map from 300 Trials

BACKGROUND

Stretching has garnered significant attention in sports sciences, resulting in numerous studies. However, there is no comprehensive overview on investigation of stretching in healthy athletes.

OBJECTIVES

To perform a systematic scoping review with an evidence gap map of stretching studies in healthy athletes, identify current gaps in the literature, and provide stakeholders with priorities for future research.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA-ScR guidelines were followed. We included studies comprising healthy athletes exposed to acute and/or chronic stretching interventions. Six databases were searched (CINAHL, EMBASE, PubMed, Scopus, SPORTDiscus, and Web of Science) until 1 January 2023. The relevant data were narratively synthesized; quantitative data summaries were provided for key data items. An evidence gap map was developed to offer an overview of the existing research and relevant gaps.

RESULTS

Of ~ 220,000 screened records, we included 300 trials involving 7080 athletes [mostly males (~ 65% versus ~ 20% female, and ~ 15% unreported) under 36 years of age; tiers 2 and 3 of the Participant Classification Framework] across 43 sports. Sports requiring extreme range of motion (e.g., gymnastics) were underrepresented. Most trials assessed the acute effects of stretching, with chronic effects being scrutinized in less than 20% of trials. Chronic interventions averaged 7.4 ± 5.1 weeks and never exceeded 6 months. Most trials (~ 85%) implemented stretching within the warm-up, with other application timings (e.g., post-exercise) being under-researched. Most trials examined static active stretching (62.3%), followed by dynamic stretching (38.3%) and proprioceptive neuromuscular facilitation (PNF) stretching (12.0%), with scarce research on alternative methods (e.g., ballistic stretching). Comparators were mostly limited to passive controls, with ~ 25% of trials including active controls (e.g., strength training). The lower limbs were primarily targeted by interventions (~ 75%). Reporting of dose was heterogeneous in style (e.g., 10 repetitions versus 10 s for dynamic stretching) and completeness of information (i.e., with disparities in the comprehensiveness of the provided information). Most trials (~ 90%) reported performance-related outcomes (mainly strength/power and range of motion); sport-specific outcomes were collected in less than 15% of trials. Biomechanical, physiological, and neural/psychological outcomes were assessed sparsely and heterogeneously; only five trials investigated injury-related outcomes.

CONCLUSIONS

There is room for improvement, with many areas of research on stretching being underexplored and others currently too heterogeneous for reliable comparisons between studies. There is limited representation of elite-level athletes (~ 5% tier 4 and no tier 5) and underpowered sample sizes (≤ 20 participants). Research was biased toward adult male athletes of sports not requiring extreme ranges of motion, and mostly assessed the acute effects of static active stretching and dynamic stretching during the warm-up. Dose-response relationships remain largely underexplored. Outcomes were mostly limited to general performance testing. Injury prevention and other effects of stretching remain poorly investigated. These relevant research gaps should be prioritized by funding policies.

REGISTRATION

OSF project ( https://osf.io/6auyj/ ) and registration ( https://osf.io/gu8ya ).

Immediate Effects of Foam Roller and Stretching to the Lead Hip on Golfers Swing: A Randomized Crossover Trial

Golfers with decreased range of motion (ROM) of their leading hip internal rotation (IR) have increased lumbar rotation ROM and load. This study investigated the effects of foam roller (FR) applied to their leading hip muscles combined with stretching to the leading hip together with lumbar rotation ROM during the golf swing. The study design was a crossover design. Subjects were allocated to one of two groups comprising FR and dynamic stretching (FR + DS) or practice swing. Motion analysis was used to evaluate hip and lumbar angles during the golf swing. Data were compared using analysis of variance with Bonferroni correction using paired t-test's post hoc. The association between lead hip IR angle and lumbar spine left rotation (Lrot) angle was investigated using correlation analysis. Lead hip IR ROM during the golf swing was significantly greater in the FR + DS group (p = 0.034). The FR + DS group showed a moderate negative correlation between lead hip IR ROM and lower lumbar spine Lrot ROM during the golf swing (r = -0.522). The application of FR + DS might be useful to increase lead hip IR angle during the golf swing. Moreover, the application of FR + DS improves lead hip IR angle and may decrease lumbar spine rotation.

Reliability of repeat golf club testing sessions with modified club moment of inertia

The moment of inertia of a golf club, quantified about an axis at the butt of the handle, normal to the swing plane, has the potential to influence both clubhead and ball velocity. The purpose of this study was to assess the reliability of clubhead and ball velocity with changes to moment of inertia over repeat testing sessions and, if reliable, to quantify the effect of modifying moment of inertia. Eleven skilled male golfers hit 20 golf shots with three golf clubs, each with a different moment of inertia achieved through adding mass inside the club shaft and repeated this protocol over three sessions. A commercially available launch monitor was used to measure both velocity variables. Test–retest reliability was assessed via (1) limits of agreement, to determine reliability from a change in magnitude perspective and (2) linear-weighted kappa, to determine reliability from a directional perspective. The effect of moment of inertia on clubhead and ball velocity was determined using one-way, repeated measures analysis of variance tests, with partial eta squared being used to quantify the size of the effect. Increasing golf club moment of inertia reliably decreased clubhead and ball velocity, with fair to substantial kappa results revealed between sessions. The magnitude of decrease in these velocities, however, could not be reliably quantified. Statistically, the influence of moment of inertia was considered large (η2 ≥ 0.662 and 0.404) and significant (p < 0.001 and ≤ 0.006) for both clubhead and ball velocity, respectively.

A Systematic Review of Golf Warm-ups: Behaviors, Injury, and Performance

Ehlert, A and Wilson, PB. A systematic review of golf warm-ups: behaviors, injury, and performance. J Strength Cond Res 33(12): 3444-3462, 2019-Previous literature has demonstrated that warm-ups have the potential to increase physical performance and reduce risk of injury. Warm-ups before golf may have a similar result, but a systematic evaluation of their effects in golf is currently lacking. Three electronic databases (PubMed, SPORTDiscus, and Web of Science) were systematically searched to address 3 primary research questions: (a) What are the current warm-up behaviors of golfers?; (b) Is there an association between warm-up behaviors and golf-related injury?; and (c) What are the effects of various warm-up protocols on measures of golf performance? Twenty-three studies (9 observational and 14 experimental) were identified that included data on warm-ups before golf participation. Overall, the current data suggest that many golfers either do not warm-up regularly or perform a warm-up that is short in duration. Studies on the association between warm-up behaviors and golf-related injury were mixed and inconclusive. Experimental studies suggest that a variety of warm-up methods may be beneficial for golf performance. Specifically, dynamic warm-ups and those with resistance exercise tended to enhance measures of performance, whereas static stretching was inferior to other methods and potentially detrimental to performance. Overall, the results of this systematic review suggest that various warm-up protocols (with the exception of static stretching) may enhance golf performance, but observational data suggest many golfers do not regularly perform them. More data are needed on the warm-up behaviors of competitive golfers, the impact of warm-up behaviors on golf-related injury, and to further identify effective warm-up methods for enhancing golf performance.

Acute effects of different warm-up protocols on highly skilled golfers' drive performance

Previous research has highlighted the positive effect that different warm-up protocols have on golf performance (e.g. Sorbie et al., 2016; Tilley & Macfarlane, 2012) with the design of warm-ups and programmes targeting and improving golf performance through the activation and development of specific muscle groups. This study aimed to examine the acute effects of two warm-up protocols on golf drive performance in comparison to a control condition. Using a randomised counterbalanced design over three testing sessions, twenty-three highly skilled golfers completed the control, dynamic and resistance-band warm-up conditions. Following each condition, a GC2 launch monitor was used to record ball velocity and other launch parameters of ten shots hit with the participants' own driver. A repeated-measures ANOVA found significant increases in ball velocity (η_p² = .217) between the control and both the dynamic and resistance-band warm-up conditions but no difference between these latter two, and a reduction in launch angle between control and dynamic conditions. The use of either a dynamic stretching or resistance-band warm-up can have acute benefits on ball velocity but golfers should liaise with a PGA Professional golf coach to effectively integrate this into their golf driving performance.

Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis

The calf muscles are one of the muscle groups that have the most need for adequate flexibility since they are deeply related to normal lower limb function. When the goal is to increase flexibility, the most commonly used technique is stretching. However, it remains unknown which stretching technique and parameters are the most effective to increase flexibility. Hence, the aim of the current review was to investigate the influence of chronic stretching on ankle dorsiflexion range of motion (DFROM) of healthy individuals. The search strategy included MEDLINE, PEDro, Cochrane CENTRAL, LILACS, and manual search from inception to February 2017. Randomized and controlled clinical trials that have analyzed the influence of chronic stretching on DFROM were included. On the other hand, studies with special populations (children, and people with any dysfunction/disease), and articles with no control group were excluded. Twenty studies were included out of 493 identified. The meta-analysis was performed according to the stretching technique used in the study. The results show that static stretching (5.17°; 95% CI: 4.39-5.95; I²: 0%) and proprioceptive neuromuscular facilitation (4.32°; 95% CI: 1.59-7.04; I²: 46%) are effective in increasing DFROM. Ballistic stretching did not show positive results to increase DFROM (3.77°; 95% CI: -0.03 to 7.56; I²: 46%). In conclusion, chronic stretching is an effective way of improving ankle mobility in healthy individuals, especially when it contains a static component.

The short-term effects of trigger point therapy, stretching and medicine ball exercises on accuracy and back swing hip turn in elite, male golfers - A randomised controlled trial

OBJECTIVES

This study aimed to compare the effect of myofascial trigger point therapy (MTPT) and stretching, MTPT and medicine ball exercises, and no intervention, on hip flexor length (HFL), golf swing biomechanics and performance in elite, male golfers.

DESIGN

Single blind, randomised controlled trial with two experimental groups (stretch group: MTPT and stretching; and the ball group: MTPT, a single stretch and medicine ball exercises) and one control group (no intervention).

SETTING

Professional golf academy.

PARTICIPANTS

One hundred, elite, male golfers aged 16-25 years.

MAIN OUTCOME MEASURES

HFL, 3D biomechanical analysis of the golf swing, club head speed (CHS), smash ratio, accuracy and distance at baseline and after the interventions.

RESULTS

Backswing hip turn (BSHT) improved in the ball group relative to the control group (p = 0.0248). Accuracy in the ball group and the stretch group improved relative to the control group (Fisher's exact = 0.016).

CONCLUSIONS

Other performance parameters such as: smash ratio, distance and CHS were not compromised by either intervention. This study advocates the use of MTPT combined with medicine ball exercises over MTPT combined with stretching in the treatment of golfers with shortened hip flexors - even immediately preceding a tournament.

A systematic review of the effects of upper body warm-up on performance and injury

PURPOSE

This systematic review was conducted to identify the impact of upper body warm-up on performance and injury prevention outcomes.

METHODS

Web of Science, MEDLINE, SPORTDiscus, PsycINFO and Cochrane databases were searched using terms related to upper extremity warm-up. Inclusion criteria were English language randomised controlled trials from peer-reviewed journals in which investigation of upper body warm-up on performance and injury prevention outcomes was a primary aim. Included studies were assessed for methodological quality using the PEDro scale. A wide variety of warm-up modes and outcomes precluded meta-analysis except for one group of studies. The majority of warm-ups were assessed as having 'positive', 'neutral', 'negative' or 'specific' effects on outcomes.

RESULTS

Thirty-one studies met the inclusion criteria with 21 rated as having 'good' methodological quality. The studies investigated a total of 25 warm-up modes and 43 outcome factors that could be grouped into eight mode and performance outcome categories. No studies of upper body warm-up effects on injury prevention were discovered.

CONCLUSIONS

Strong research-based evidence was found for the following: high-load dynamic warm-ups enhance power and strength performance; warm-up swings with a standard weight baseball bat are most effective for enhancing bat speed; short-duration static stretching warm-up has no effect on power outcomes; and passive heating/cooling is a largely ineffective warm-up mode. A clear knowledge gap in upper body warm-up literature is the lack of investigation of injury prevention outcomes.

An investigation into the effect of a pre-performance strategy on jump performance

The aim of this study was to explore the effect that different components, making up a commonly used pre-performance preparation strategy, have on jump height performance. Sixteen male collegiate athletes (age, 21.38 ± 0.52 years; height, 1.79 ± 0.07 m; and body mass, 75.1 ± 5.26 kg) performed a preparation strategy involving a cycle ergometer warm-up, followed by a dynamic stretch component, and finishing with heavy back squats. This intervention was repeated to test countermovement, squat or drop jump performance after each component of the preparation strategy, with electromyographic activity measured during each jump test. Significant increases (p < 0.05) in jump height and electromyographic activity were noted, with a stepwise increase in performance from pre- to post-warm-up, increased further by the dynamic stretch component and again increased after the back squat. It was also noted that the increases in performance, attributed to the stretch and lift components, were significantly greater (p < 0.05) than the increases in jump height associated with the active warm-up. It seems likely that the initial active warm-up raised core temperature, helping to increase the jump performance. The specific movements employed in the stretch and lift interventions seemed to potentiate the agonistic muscles involved in jumping, shown by increases in electromyographic activity in the prime movers for the jumps explored. This could be an example of postactivation potentiation, where muscles are primed to increase performance beyond changes linked to an active warm-up.

Upper body force production after a low-volume static and dynamic stretching

This study investigated the acute effect of a low-volume static and dynamic stretching on maximal isometric peak force (MIPF), time to maximal isometric force (TMIF), rate of force production (RFP) and average amplitude of the surface EMG (AvgEMG) of the main agonist muscles acting on the bench press maximum isometric force exercise. Thirty subjects were randomly divided into three groups: static stretch (SG: 22.8 ± 5.6 years, 176.6 ± 3.5 cm, 74.4 ± 5.9 kg), dynamic stretch (DG: 21.4 ± 3.9 years, 178.4 ± 7.2 cm, 71.7 ± 8.2 kg) and control group (CG: 20.4 ± 3.6 years, 179.8 ± 5.8 cm, 74.4 ± 9.8 kg). SG performed two 30-s repetitions and DG performed 10 repetitions of each of the two different exercises for the pectoralis major and triceps brachii. The MIPF, TMIF, RFP and AvgEMG of the pectoralis major (sternocostal part) and triceps brachii (long and lateral head) were measured before and immediately after the stretching protocols. A significant decrease in the MIPF from pre- to post-stretching was observed in both SG (p <0.001) and DG (p <0.05). No significant differences were found in the CG for all force parameters. No significant differences in the TMIF and RFP from pre- to post-stretching were found in the three groups. The SG showed a significant (p <0.05) decrease in the AvgEMG of the three muscles, whereas no significant differences were found for the DG and CG. These findings suggest that a low-volume static and dynamic stretching adversely affects efforts of muscle maximal strength of the upper limb muscles studied, but it does not seem to affect TMIF or RFP.

The effect of warm-ups incorporating different volumes of dynamic stretching on 10- and 20-m sprint performance in highly trained male athletes

Recently, athletes have transitioned from traditional static stretching during warm-ups to incorporating dynamic stretching routines. However, the optimal volume of dynamic drills is yet to be identified. The aim of this repeated-measures study was to examine varying volumes (1, 2, and 3 sets) of active dynamic stretching (ADS) in a warm-up on 10- and 20-m sprint performance. With a within-subject design, 16 highly trained male participants (age: 20.9 ± 1.3 years; height: 179.7 ± 5.7 cm; body mass: 72.7 ± 7.9 kg; % body fat: 10.9 ± 2.4) completed a 5-minute general running warm-up before performing 3 preintervention measures of 10- to 20-m sprint. The interventions included 1, 2, and 3 sets of active dynamic stretches of the lower-body musculature (gastrocnemius, gluteals, hamstrings, quadriceps, and hip flexors) performed approximately 14 times for each exercise while walking (ADS1, ADS2, and ADS3). The active dynamic warm-ups were randomly allocated before performing a sprint-specific warm-up. Five minutes separated the end of the warm-up and the 3 postintervention measures of 10- to 20-m sprints. There were no significant time, condition, and interaction effects over the 10-m sprint time. For the 0- to 20-m sprint time, a significant main effect for the pre-post measurement (F = 10.81; p < 0.002), the dynamic stretching condition (F = 6.23; p = 0.004) and an interaction effect (F = 41.19; p = 0.0001) were observed. A significant decrease in sprint time (improvement in sprint performance) post-ADS1 (2.56%, p = 0.001) and post-ADS2 (2.61%, p = 0.001) was observed. Conversely, the results indicated a significant increase in sprint time (sprint performance impairment) post-ADS3 condition (2.58%, p = 0.001). Data indicate that performing 1-2 sets of 20 m of active dynamic stretches in a warm-up can enhance 20-m sprint performance. The results delineated that 3 sets of ADS repetitions could induce acute fatigue and impair sprint performance within 5 minutes of the warm-up.

The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties

Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues.

An investigation into the possible physiological mechanisms associated with changes in performance related to acute responses to different preactivity stretch modalities

The aim of this study was to explore the potential mechanisms underlying performance changes linked to different warm-up stretch modalities. Twenty-one male collegiate-semiprofessional soccer players (age, 20.8 +/- 2.3 years) performed under 3 different warm-up conditions: a no-stretch warm-up (WU), a warm-up including static passive stretches (SPS), and a warm-up incorporating static dynamic stretches (SDS). Countermovement jump, drop jump, peak torque, heart rate, core temperature, movement kinematics, and electromyography (EMG) were recorded for each intervention. Significant increases (p < 0.001) in performance were recorded for the countermovement, drop jump, and peak torque measures when the SDS was compared with the WU and SPS trials. When mechanism data were analysed, heart rate was significantly higher (p < 0.001) in the SDS condition compared with the SPS and WU conditions (a pattern also shown with core temperature), whereas the WU condition heart rate was also significantly higher than the SPS condition heart rate. When EMG data were examined for the rectus femoris muscle, significantly greater (p < 0.01) muscle activity was observed in the SDS condition compared with the SPS condition. It seems the most likely mechanisms to explain the increase in performance in the SDS condition compared with the SPS condition are increased heart rate, greater muscle activity, and increased peak torque.

The effect of different dynamic stretch velocities on jump performance

Dynamic stretching has gained popularity, due to a number of studies showing an increase in high intensity performance compared to static stretch modalities. Twenty-four males (age mean 21 +/- 0.3 years) performed a standardised 10 min jogging warm-up followed by either; no stretching (NS), slow dynamic stretching at 50 b/min (SDS) or fast dynamic stretching at 100 b/min (FDS). Post-warm-up, squat, countermovement and depth jumps were performed. Heart rate, tympanic temperature, electromyography (EMG) and kinematic data (100 Hz) were collected during each jump. Results indicated that the FDS condition showed significantly greater jump height in all tests compared to the SDS and NS conditions. Further, the SDS trial resulted in significantly greater performance in the drop and squat jump compared to the NS condition. The reasons behind these performance changes are multi-faceted, but appear to be related to increases in heart rate and core temperature with slow dynamic stretches, while the greater increase in performance for the fast dynamic stretch intervention is linked to greater nervous system activation, shown by significant increases in EMG. In conclusion, a faster dynamic stretch component appears to prepare an athlete for a more optimum performance.

The influence of reduced hamstring length on patellofemoral joint stress during squatting in healthy male adults

Increased patellofemoral joint (PFJ) stress has been implicated in the development of PFJ pathologies. Previous studies have identified a relationship between reduced hamstring length and patellofemoral pain syndrome. Hamstring stretching is also recommended in the management thereof. However, the relationship between reduced hamstring length and PFJ stress has not been explored in vivo during activities that load the PFJ, such as squatting. The objective of this study was to determine if persons with reduced hamstring length demonstrate increased PFJ stress during squatting compared with individuals without reduced hamstring length. Eight participants with, and eight participants without, reduced hamstring length were assessed to determine their PFJ contact area using magnetic resonance imaging, and their PFJ reaction force during squatting using motion analysis. Data collected were entered into a biomechanical model to calculate medial, lateral and total PFJ stress. It was found that participants with reduced hamstring length had significantly greater total (393.39 Pa/kg vs. 213.01 Pa/kg) and lateral (311.23 Pa/kg vs. 142.55 Pa/kg) PFJ stress at 60 degrees knee flexion during squat descent and ascent (427.75 Pa/kg vs. 255.64 Pa/kg and 337.75 Pa/kg vs. 170.63 Pa/kg, respectively). This was due to significantly increased PFJ reaction force at 60 degrees knee flexion during squat descent (12.18 N/kg vs. 7.21 N/kg) and ascent (13.03 N/kg vs. 8.72 N/kg), and lower medial PFJ contact area at 60 degrees knee flexion (88 mm(2) vs. 160 mm(2)). The results of this study demonstrate a relationship between reduced hamstring length and increased PFJ stress during squatting due to increased PFJ reaction force and reduced medial PFJ contact area.