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How to Train the Female Golfer

Working with female golfers during hormonal fluctuations

In today’s competitive coaching environment, being aware that the female athlete needs a comprehensive supportive training program that optimizes her performance potential throughout hormonal fluctuations is a must. This article reviews the potential effects of the female steroid hormone fluctuation during menses (menstrual cycle) on golf performance. Though the focus is on golf efficiency, the concept of training during menses is transferrable to many other sports. These days the adeptness of trainers able to craft skillfully designed strength and conditioning programs will enable their female athletes to remain competitive contenders on the green.

At some point in your personal training career you will meet female clients who need golf specific strength and conditioning programming to optimize their golf game. While the unique physiology of the female golfer during menses requires a tailored training approach that is different from the male golfer, historically most trainers have overlooked this need. On the global stage of sports combined with the women’s movement and the depth of digital communicated the gap in the training mindset of golf coaches and trainers between sexes has become more distinctive.

The implementation of a golf evaluation is very similar in certain respects to other sports assessments yet notability different due to the game of golf. The challenge for the trainer seems to be that of time and knowledge. Most professionals may believe it takes too long to evaluate each client and some professionals lack the education in the specificity in the area of golf movement, so they eliminate it completely and train golf like any other sport. To play great golf male or female the trainer needs to help the athlete to practicing hard, develop mental toughness, focus, strength, endurance, stamina, power, range of motion, and balance. There are no differences when training and assessing golf athletes with the exception of female hormonal fluctuations. The one question typically not asked by trainers (male and female) is where are you in your cycle? This critical piece of information can make or break your female golfers conditioning program, possible injury and performance on or off the green.

The female athlete in general, during her reproductive years, is hit with a complex and ever-changing state of fluctuating steroid hormones, whether it is the endogenous variety found in estradiol and progesterone of the regular menstrual cycle or the exogenous synthetic hormones of the oral contraceptives. Estrogens and progestins have individual, interactive and sometimes opposing physiological actions with potential underlying outcomes for the female athlete.

The subject of hormonal fluctuations during menstrual cycle and its negative affect on exercise training and performance capacity has been research and discussed yet not rigorously implemented as a critical component of a women’s golf focused training program. The distinguishing factor between males and females is the difference in dominant sex hormones. The three major sex hormones made by the ovaries are the sex hormone estrogen and progesterone and the male sex hormone testosterone. In fact, testosterone is made by the female adrenal glands throughout her life, although levels decline with age. During reproductive years, these hormones are critical to the pregnancy process, maintaining a healthy menstrual cycle and other aspects of the women’s body, health, and state of mind.

Women’s golf has grown extensively in recent years, however gender-specific physiology has rarely been considered. The female reproductive hormones, which rise and fall throughout the menstrual cycle, affect cardiovascular, respiratory, thermoregulatory and metabolic parameters, which impact exercise physiology and golf performance. Therefore, the main aim of this article is to discuss, types of hormones involved in the menstrual cycle, potential effects of the menstrual cycle phase on golf performance strength and conditioning and considerations when planning a golf strength and conditioning program.

The professionalism and interest in female golf has grown over the last decade, which has lead to an expediential rise in the interest of “how to train the female golfer.” Even with the increasing surge of research surrounding female golfers, gender-specific aspects of physiology, particularly the stages of the menstrual cycle and its effects on the physical performance, capacity and other factors continue to be treated as a little ink in an abyss.

OVERVIEW

The Broader Structure of Menses

The menstrual phase is the first stage of the menstrual cycle defined by the onset of the period, shedding of the uterine lining, and low levels of estrogen and progesterone. With the onset of the menstrual phase, the follicular phase (FP)/ proliferative phase starts on the first day of a female’s period with no overlap and ends with ovulation. The follicular phase/proliferative phase is characterized by low luteinizing hormone (LH) follicle stimulating hormone (FSH), progesterone and slowly increasing levels of estrogens as the proliferative is initiated and the uterine lining builds back up again. Then around mid-cycle (day 14) the ovulation phase occurs, which is characterized by a spike in levels of estrogen and luteinizing hormone. This coincides with the release of the egg and conveys this is the time when females can become pregnant. Ovulation is followed by the luteal phase (LF) occurring between ovulation and before the start of menstruation as the female body prepares for a possible pregnancy. During the Luteal phase (high hormone) both estrogen and progesterone levels peak and then drop. The secretory phase is when the uterine lining starts to produce chemicals that will either support an early pregnancy or will prepare the lining to break down and shed if the pregnancy doesn’t occur. A critical aspect when coaching/training the female golfer is to understand how physiology is affected by the various phases of the menstrual cycle.

STAGE ONE OF THE MENTRUAL CYCLE Day 1-5

The menstrual phase is the first stage of the menstrual cycle signified by a female getting her period. The length of each stage (the menstrual phase can last from 3-7 days) can vary from woman to woman and can shift over time.

What the trainer needs to know when tailoring strength and conditioning to the female golfer during the menstrual cycle:

. Due to hormone fluctuation, modify weight training to every second day during the   follicular phase.

. Implement restorative exercise and stretching

. Walk don’t run

. Avoid heavy lifting due to laxity in joints

. Avoid gymnastic or inversions in exercise

. Modify exercises due to the laxity of joints

Program exercise consideration:

>Use a basic squat with your athlete using a wide plié stance and assuring the knee tracks with the second toe while using a moderate barbell or kettle bell.

>Utilize a Theraband around your athlete’s thigh to activate her gluteus medius, while using a medicine ball for a front raise or overhead press.

>Have your athlete utilize isometric split squat with weight 50/50 front to back. If she can’t…STOP…don’t ruin her motor program or her belief in herself.

Factoid: Remember the goal is to assure your athlete doesn’t damage her knees due to increased laxity in her knee joints.

Your female athlete may come to practice/training with symptoms like:

. Cramps

. Sensitive breast tissue

. Abdominal fullness (bloating)

. Emotional mood swings

. Agitation

. Headaches

. Fatigue

. Joint pain

The Follicular Phase/Proliferative Phase (Ovaries) Day 1-13

The follicular phase starts with the first day of a female’s period and ends with the onset of ovulation. The follicular phase can be broken down into two sub phases; the early follicular phase (FP), characterized with low concentrations of the hormone estrogen and progesterone; and mid FP where estrogen is higher independently from progesterone.

Prior to menstruation or during the early follicular phase is suggested to be optimal for golf training due to the lower hormonal levels. At this phase you can do anything you want using barbells, weights, and cables. Some studies suggest resistance training during the follicular phase will result in more strength gains than just training in the luteal phase.

What the trainer needs to know:

. Be proactive about programming an appropriate warm up and recovery.

. Early in the follicular phase, due to higher pain tolerance and perceived higher energy levels, the female golfer is primed to perform high-intensity workouts.

. Focus on increasing the repetitions, sets, or weight for the exercises in your program.

. During the late follicular phase, due to higher estrogen levels this might be the optimal time to initiate strength conditioning. Increase the number of days per week when planning resistance training.

Program exercise consideration:

>Incorporate foundational-functional movement pattern that engage the whole body in a variety of different stimulating ways, movements that involve coordinating your upper and lower body with areas that alternate from being stable to moving and back again. Consider incorporating exercises like squats, front lunge – back lunge, Bosu squats for balance, power cleans, clean and jerk and split lunge or split jerk.

Towards the second phase of the follicular cycle be careful not introduce too much power due to an overlapping surge in hormones.  Exercises to modify are type of balance exercises, leg press, medicine ball squat throws, squat jump, and barbell curl.

Factoid: Avoid exercises that require your athlete to exert a maximal force in as short a time as possible, as in accelerating, jumping and throwing.

Ovulatory Phase (Interlude) Day 14

Ovulation occurs day 14 to 18 and initiates the transition between the follicular phase and the luteal phase. Once the ovulation phase is complete the luteal phase is initiated prompting the female body to prepare for your next period.

During ovulation females feel amazing as they become flooded with estrogen and progesterone. Yet, exercises should be modified to prevent laxity injury of the joints. This time represents the perfect storm to potentially rip, tear, or strain a ligament. Why? Because your athlete is being subjected to:

            >Higher body temperature

            >Laxity in joints

            >Instability/balance issues

            >Poor concentration

What the trainer needs to know:

. No jump squats or jump squat – push press type exercises due to laxity issues.

. Put extra effort into pre and post workouts, warm-ups and consider recovery supplements and rest, as your athlete’s muscles are more vulnerable to injury. 

. This could be the time your athlete could achieve their personal best in strength performance. There is no change in strength, yet, mobility is compromised due to ligamentous laxity and decreased neuromuscular performance (Hewett 2000; Lathinghouse and Trimble 2000).

. During the ovulation phase, there is evidence for higher risk of injury. The trainer should assure the athlete’s joints are stabilized and all movement patterns are modified due to the continuum of joints laxity.

Program exercise considerations:

>Exercises that may work well include Bosu squats, ball on the wall squats, Jefferson squats, isometric split lunge and slow temp movements. Try implementing a bar instead of free weights due to the athlete challenged stability/balance and lack of concentration.

STAGE TWO OF THE MENSTRUAL CYCLE

Luteal Phase/Secretory Phase (Ovary) Day 15-28

Your athlete’s levels of progesterone and estrogen has dropped, the endometrium breaks down and shed triggering the onset of bleeding which marks day 1 and a new cycle begins (Fritz MA, McLachlan RI, Cohen NL, Dahl KD, Brenner WJ, Soules MR. 1992).

What the trainer needs to know:

. Due to hormonal fluctuations, increases in body temperature and breathing efficiency, stamina becomes disrupted. The trainer should limit training to once per day during the luteal phase.

. The female body is now burning fat rather than carbs or glycogen

(A polysaccharide which forms glucose on hydrolysis, stored primarily in the cells of the liver and skeletal muscle). To make the most of this phase focuses on having your female athlete perform moderate cardiovascular training to maximize fat burn.

. Water retention and other pre-menstrual symptoms can make high intensity workout feel much more taxing. Body mass might be higher due to fluid retention.

. The process of sweating is delayed yet occurs only after a higher body temperature   has been reached when involved the sport activity.

. This is not the time for high intensity training. Move towards more body/resistance-based exercises, such as yoga or Pilates. The trainer can suggest that their athlete cross train with a bike ride, a trail run, or take a soothing swim.

. Reduce the number of resistance sessions, weights, repetitions and sets. During this phase, the trainer can add weights and cables as long as they are moderate in intensity.

. The introduction of new and different movement patterns will help curb your athlete’s expectations, judgement and criticisms of their athleticism.

. Be aware of your athlete’s energy level and modify, modify and modify. This is the time when female will feel least motivated, feeling sluggish. The trainer should encourage a structured scheduled routine. In this phase, the trainer is not just a coach but is a cheerleader encouraging the female athlete to stay the course.

Secretory Phase (Uterus)

Think of the secretory phase as a transition process. This phase is the final phase of the uterine cycle and it corresponds to the luteal phase of the ovarian cycle.

Premenstrual Phase (PMS) Day 24-28

The late luteal phase is the point at which women are most likely to have symptoms of PMS. It should be noted that 25-50% of women suffer from PMS and it is common in women in their 30’s.

A recent study in the Human Kinetics Journal indicated that approximately 75 percent of athletes experience negative side effects due to menses. Premenstrual syndrome (PMS) gives expression to emotional, behavioral and physical symptoms. To date, experts are unsure what causes PMS yet it is believed that changes in hormone levels and the neurotransmitter serotonin could play a role in the development of symptoms. The symptoms of PMS can be severe enough to force an athlete to miss days of practice and exercise. However, getting appropriate regular exercise is often recommended as a step that the female golfer can take to alleviate the symptoms associated with PMS.

FACTOID: A more severe form of PMS known as premenstrual dysphoric disorder (PMDD) that presents the athlete with many additional disabling symptoms, such as panic attacks, feelings of despair, binge eating and lack of interest in daily activities, alongside the physical symptoms of PMS.    

What the trainer needs to know:

. Getting regular exercise is often recommended as a step that the female athlete can take to alleviate PMS syndrome.

. Trainer should focus on nothing that requires fine balance or single leg.

. The trainer’s exercise selection should focus on movements like cable deadlifts or seated deadlifts always coming back to neutral. Isometric split lunge patterns, hip extensions using a resist-a-ball.

. Pre-menstrual syndrome can interfere with training and performance 7-10 days leading up to menses (not just during menses). The athlete is dealing with swelling, bloating and tender breasts.

. Keep it simple. No ball slams, chest thrust or throwing motions.

The female athlete may experience emotional and behavioral signs and symptoms such as:

  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration
  • Change in libido
  • Insomnia
  • Irritability

Physical signs and symptoms

  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain related to fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhea
  • Alcohol intolerance
  • Lower level of energy

Exactly what causes premenstrual syndrome is unknown but factors that contribute to this condition:

> Cyclic changes in hormones/hormonal fluctuations.

> Chemical changes in the brain/fluctuation in serotonin levels, a brain chemical (neurotransmitter) thought to play a critical role in mood states. Insufficient amounts of serotonin may contribute to bouts of depression, fatigue, food cravings and sleep problems.

> Depression/undiagnosed depression, though depression alone doesn’t cause all of the symptoms.

Considerations That Effect Program Design for the Female Golfer/Athlete

Menstrual Cramps (dysmenorrhea)

Menstrual cramps referred to as dysmenorrhea occurs in females who experience pain before and during menstruation. This condition affects the female uterus or pelvic organ and is expressed as a painful cramping sensation in the pelvis during menses and occurs in 60-93% of adolescent females.

Trainer’s need to be aware that the pelvic cramping associated with dysmenorrhea may start prior to the onset of menses and continue 1-3 days accompanied by addition symptoms such as sweating, headaches, nausea, vomiting, diarrhea, and abnormal heart rate (tachycardia).

Oxygen Consumption

Progesterone stimulates ventilation independently, which can increase a female’s perception of physical exertion. And the factors of strength and other conditioning is typically link to the perception of breathing capacity and ability to physically and mentally perform. The trainer should note that breathing is greater during the luteal phase (when progesterone concentration is highest) making women feel more winded during workouts than during workout in the follicular phase.

Trainer need to be aware that this increased effort to breath during the luteal phase may also increase the oxygen demand of breathing during the cycle of training since the muscles responsible for the work need oxygen. The more oxygen being used by breathing muscles means less oxygen is available for other muscles involved in the exercise process (Allsen PE, Parsons P, Bryce GR., 1977).

Body Temperature
Body temperature changes rhythmically throughout the menstrual cycle, peaking during the luteal phase in response to the surge in progesterone. A higher body temperature during the luteal phase makes it harder to work out in the heat, because you don’t begin sweating to dissipate heat until you have reached a higher body temperature. And the female athlete has a decreased ability to dilate the small blood vessels under the skin, impacting the ability to release heat.

The trainer needs to be aware that the athlete’s ableness to engage in long, intense workouts or tournaments in the heat, such as the Women’s PGA Championship or 18 holes of golf, can be more difficult during the luteal phase of the menstrual cycle.

Metabolism
Menstrual-phase variations in golf performance may be a consequence of changes to exercise metabolism stimulated by the fluctuations in estrogen and progesterone concentrations. The mounting increase in these hormones between menstrual phases and the ratio of estrogen to progesterone concentration appear to be factors determining an effect on metabolism.

Trainer’s need to be aware that research suggests that estrogen may improve endurance performance by altering the body’s facility to metabolize carbohydrate, fat, protein and use of progesterone. Additional studies show that estrogen promotes both the availability of glucose and uptake of glucose into slow-twitch muscle fibers, providing the fuel during short-duration exercise.

ADDITIONAL FACTORS AFFECTING THE ATHLETE

Muscular Considerations

The effects of the menstrual cycle on golf strength and conditioning

When reviewing studies using hormone verification and electrical stimulation to ensure maximal neural activation, the current acquisition of published work implies that the fluctuations of reproductive hormones in females throughout the menstrual cycle don’t affect factors necessary for muscle contractions. Research also indicates that generally there are no changes over the menstrual cycle in the consumption of maximal oxygen consumption (VO2max), bodyweight, plasma volume, lactate response, hemoglobin concentration, heart rate and ventilation. Yet the jury is still out on that of prolonged exercise performance. Regardless of these statements, the effects are real and vary from female to female surrounding the factors of:

Hypermobility

Estrogen, Progesterone and Relaxin fluctuate considerably during the menstrual cycle and are said to increase ligamentous laxity and decreased neuromuscular performance (Hewett 2000; Lathinghouse and Trimble 2000)

Factoid: In women relaxin is secreted into the circulation by the corpus luteum in the ovary in both pregnant and nonpregnant females. Relaxin levels in the circulation peak within 14 days of ovulation, during the second half of the menstrual cycle and decline in the absence of pregnancy resulting in menstruation.

Decrease in power occurs in the female golfer during the golf swing due to ligament laxity and the influence of the hormone relaxin. Being too flexible can alter optimal golf alignment (swing path), which is critical to the development of club head speed.

The Q angle

This is the angle that is formed by the intersection of a line drawn from the ASIS to the central patella and a second line drawn from the central patellar to the tibial tubercle. The normal Q angle in women is 17 degrees. Women usually have a higher Q angle due to their naturally wider pelvis. This measurement of pelvic width is thought to contribute to sports injury risk in women (Hewett 2007/ Wojtys et al. 2002). Any alteration that increases the Q angle is thought to increase the lateral forces imposed on the patella. Female golfers should work on reducing their Q angle. Conditioning exercises should be performed which focus on restoring optimal muscular balance by improving flexibility of the typically tight muscles and strengthening the weaker ones. It is beneficial to strengthen the gluteal muscles and the vastus medialis. Weaknesses in the glut muscle and external rotators of the hip prevent proper stabilization of the thighbone. During the golf swing, the repetitive stress applied to the lower back, pelvis, hip, knee and ankle may produce injuries in the female golfer especially those with abnormal Q angles.

Knee Valgus

In the female golfer if there is a tendency for the hip to move into adduction and internal rotation, referred to as knee valgus, (knock kneed posture) express with feet rolling inward flattening the main arch on the inside of the foot. For a golfer, knee valgus may hamper the golf swing and detract from swing efficiency. To understand this concept try swinging a golf club with your knees bent slightly towards each other. You will notice your swing efficiency will dissipate due to the stressors applied to both the knees and the hip as you go through the motion of a golf swing (Knee Valgus and the Golf Swing, A Precursor to Injury? GoIFIT, Bob Forman.)

The H2O Factor

Hydration is critical to the female athlete. Fluid levels will change throughout the menstrual cycle and can have an impact on the ability to exercise, especially in the heat. But why is it important to maintain hydration? The brain is made up of 85% water and is a top priority in the area of blood flow. The human body is composed of 60-70% water. Just 1-2% loss of water can affect your thinking.  Insufficient water can affect short and long-term memory, reaction time, the joints synovial fluid, and the ability to make clear decisions on the golf course.

Factoid: Take your body weight divide it in half and that will give you the ounces of water per day you will need. For example:

110 lbs. women divide by 2 = 55 fluid ounces per day (6.875 cups)

Timing of water intake is also important during a sport like golf. In the morning the body awakes in a dehydrated state try:

> 25 % first thing in the morning

> 55% throughout the day

> 25% before dinner or after dinner

This fluid redistributes throughout the athlete’s body during the luteal phase creates a drop in plasma volume, which can compromise the amount of oxygen delivered to the muscles. This drop reduces sweat rate, and since sweat helps the body cool down, it can also result in an increase in body temperature. Due to these changes, the female golfer should be more aware of her hydration level and fluid intake during the mid-luteal phase, especially if in hot and humid environments.

What the trainer needs to know:

. Consider saving the higher –intensity workouts until the luteal phase is over.

. If you are trainer your golfer for an event, decrease training endurance, instead plan shorter workouts during he menstrual phase.

. Due to the fluctuation of steroid hormones during the female menstrual cycle, be aware of your athlete’s moods each day.

. Consider having your athlete take a step back and give her body more recovery time if she displays the symptoms of PMS (fatigue, irritability and moodiness).

Program Essentials Thinking

The menstrual cycle in female physiology doesn’t have to impede training goals. Just like life with its ebbs and flow, the female body and hormones go through cycles, which can be assessed and modified to meet most training needs. While every woman is uniquely engineered when it comes to how she feels and expresses herself during the menstrual cycle, as trainers we can use physical science to help formulate an appropriate cardio, strength, and conditioning program augmented with range of motion and balance exercises. When optimizing training around the menstrual cycle, the trainer should consider adapting the golfer’s training/competition schedule around her cycles, especially if in hot and humid conditions. The shifts in fluid, body temperature, and metabolism can make it more challenging for athlete to undertake big training efforts and ensure adequate recovery in the luteal phase.

Conclusion

There is evidence that due to the fluctuating nature of hormones throughout the menstrual cycle, a female’s maximal strength, muscle mass and performance many vary over the duration of each phase of menstruation. It is important to note that some research has indicated that fluctuating hormones don’t have influence on a female’s performance or strength. In retrospective surveys on the menstrual cycle and performance found from 37 to 63% athletes didn’t report any cycle ‘phase’ detriment, while 13 to 29% reported an improvement during menstruation. And the best performances were generally in the immediate postmenstrual days, with the worst performances during the premenstrual phase and the first few days of menstrual flow. However, this type of study has an inherent built-in bias, limited by the lack of substantiation of each phase. In addition, these variances in studies may be due to the variability of hormone levels in females, the time of day, specific muscles tested, and preexisting tolerance to exercise. In addition, every female’s response to the menstrual cycle varies female-to-female, month-to-month and decade-to-decade.

The pattern of hormonal changes during the menstrual cycle can vary greatly due to other factors such as to much exercise, high physical and mental stress, poor diet, and low body fat, all leading to potential hormonal imbalance and an irregular cycle to the absence of the menstrual cycle. Many of the studies associated premenstrual symptoms with decreased performance linked to an increase in traumatic musculoskeletal injuries during premenstrual ad menstrual period. Other adverse effects found during the premenstrual phase were those of neuromuscular coordination, manual dexterity, judgement and reaction time.

Results in early studies are particularly difficult to interpret due to the small number of female’s studies, wide range of fitness levels, and variability in the definition of cycle and phases. In terms of documentation of menses and the menstrual cycle, the newer hormonal measurement techniques such as the levels of urinary luteinizing hormone (LH) to detect ovulation or salivary progesterone, should make it easier in the future to effectively measure or prevent the methodological difficulty incurred in early studies. As a final note, it behooves researches who are using the female athlete as subjects in future studies to standardize the menstrual cycle phases in which they are testing, in order to eliminate any possible confounding effects due to hormonal variation.

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