If you’re a golfer, you know your hips are important for your form and swing. Golf hip pain or lack of motion may throw your game off, or even worse, require you to take time off from the course.
So, what should you do when you start to feel hip pain while you golf?
Or better, how can you prevent the issue from worsening the moment you start to feel hip tightness or tension?
While we often hear about pain in golfers’ wrists, elbows, or backs, there are many common reasons why golfers experience hip pain during and after golfing. Although we will focus mostly on hip pain and tightness here, issues in the hips are related to back pain, SI (sacroiliac pain), and knee pain. Determining the cause of golf hip pain can not only improve your swing but can help resolve pain all over the body.
Once you figure out the why, the solution is simple and you will be well on your way to treating it -- and even preventing future aches further down the line.
How your golf hip turn (rotation) can cause hip flexor tension
You’ve probably heard “it’s all in the hips” when it comes to the perfect golf swing.
But while a big golf hip turn is essential to help you get par, any repetitive motion can be challenging for your muscles to endure. And, if you have developed poor mechanics or tension in the hip flexors, that hip rotation will be even more taxing for your body.
Even as a low-impact sport, golf requires precision, stability, and targeted muscle use - particularly in your hip region. The muscles that help you rotate your hips while teeing off are located mostly in the back of your hip, mainly your piriformis and glute. Then there is a group of deep hip rotators that do the fine control of rotation.
Finally, the iliopsoas muscles or, more commonly, your hip flexors, have a double job. They must stabilize your spine, pelvis, and hip region while simultaneously allowing controlled motion in the hip joint.
The iliopsoas is a pair of large muscles (the psoas and iliacus) that sit side by side on each leg, running from your spine to your pelvis to your inner thigh. They are essential for walking, running, squatting, sitting, twisting your hips and golfing - anything you do, really.
But because they also help you bend forward at the hips and help hold you there, they are hidden under the surface doing a major load of the work. Add in the fact that these hip flexors can get overworked and feel tight after prolonged sitting, driving, running and cycling.
So, if you put the big picture of your life together, these sidekicks are likely to protest at some point.
In golf specifically, you are asking your muscles to repeatedly do one swift movement while simultaneously stabilizing your body. Over time, and without a proper release, the muscle complex may experience tension on and off the golf course.
They will begin to pull on your pelvic bone, causing a twisted core.
Your core is the foundation of your entire body.
So, any twist or weakness can contribute to problems throughout your body - such as low back pain, hip flexor pain, knee pain, and more. In addition, tightness in the hip flexors can significantly impact your range of motion in your hip. And limited hip rotation can lead to more strain on the back.
If the iliopsoas is tight while golfing, it can make that muscle weak and set the stage for injury in the back, hips, or tailbone region. Those muscles are pretty dang important for a healthy golf body!
Whether you’re an avid golfer, occasionally hit the green for just 9 holes, or spend your weekends at the driving range, you're requiring your iliopsoas to work overtime. Though the pivot motion in your hip during golf is more natural than those we might do in other sports or activities, the fact that you are repeatedly activating your iliopsoas over long periods of time can fatigue your muscles.
Common causes of hip pain after golf
First, before taking any action to reduce or treat any hip flexor tension, it’s important to get a proper diagnosis on the root cause of your golf hip pain. As a professional physical therapist, I often find my golfers are suffering from a fatigued iliacus or psoas muscle that refuses to release its grip on the pelvic bone and spine.
The reason hip flexors are such a big deal for golfers is that those two muscles affect the entire alignment of the body.
When they are tight, they pull on the pelvic bone and spine, affecting the mobility of the spine, making it so the hip ball doesn’t fit into the socket, limiting internal rotation at the hip, changing the alignment of the knee and kneecap. And decreasing the overall motion in your spine and lower body can impact your swing.
In addition, this poor alignment makes the muscles around the hip and spine weaker because they are not at their proper length, easily setting the stage for injury.
The fact is, you may not have developed hip tightness from golf, although that is quite common.
But your golf hobby may be causing that hip tightness to become more apparent.
Hip flexor tension is so common in our world full of stress, sitting in desks, and long commutes. Tension that may have developed due to your daily life could be trickling into your golf game without you even knowing it.
Hip pain can have different severity levels, and may even require medical treatment.
I’ll address some of the common hip issues that golfers suffer from here. If you think you may be suffering from any of these, it’s wise to seek out the advice of a professional and/or invest in an at-home solution, such as the Hip Hook to help keep your iliopsoas muscles relaxed and happy.
If you experience golf hip pain, the most common culprit is muscle strain. A muscle strain is when a muscle has a hard time doing what is asked of it and ends up with a micro tear in the belly of the muscle itself.
A strained muscle often holds tension as a way of protecting itself. That’s why you end up with tight and painful muscles when they are strained.
During a golf swing - due to the hinging forward at the hips and rotation with the swing - many golfers complain of pain or tension in the front or back of their hips, in the groin region, or along the outside of their hips.
This could be multiple things, ranging from a tight iliopsoas muscle to a strain or tear.
Pain in the front of the hip or groin is often linked to the iliopsoas or tensor fasciae latae (TFL) muscles. The TFL muscles internally rotate your hips and work alongside the iliopsoas. Both of these muscles are stinkers and are often left unaddressed when working on the hips.
Pain near the back of the hip can be the glutes, hamstrings, or even the psoas and iliacus where they attach to the spine and pelvic bones.
Sometimes people will feel pain on the iliac crest. This part of your hip is often confused with your lower back because it sits up so high. However, it can be strained when the iliacus and psoas muscles end up pulling tightly on your pelvic bone. This can cause an unnatural rotation or forward tilt of your pelvic bone, resulting in back and iliac crest pain.
The iliopsoas pair is responsible for both rotation and stabilization in the hips. When muscles become tight or overused, they become weak. So, you may feel like your muscles are weak or that you have poor balance when, in reality, the muscles are being overused or holding tension. Stiffness and hip flexor tension could be your first signs this is happening.
I see this over and over again. And, most often, a simple release of the tension in the iliacus muscle results in immediate strength gains.
Put simply, tight muscles are not working at their best. (And they’re pissed.)
In addition, tension in the hip flexors affects the rest of the hip and body, making other muscles weak. A prime example is the back muscles or glutes and hamstrings. These muscles are not at their ideal length when the hip flexors are pulling on the pelvis and spine. Muscles that are not at their ideal length become weak and when asked to do a tough task, they are much more likely to not be up for that challenge and become strained.
Although the mechanics of this area of the body seems complex, it’s actually quite simple. If your hip flexors (the ones that hold it all together, connecting your upper body to your lower body) are happy, the rest of the hip region is happy.
Tension in the hip flexors can result from golf, get worse with daily activities, and affect your swing, setting the stage for strain to occur in this region. But, when you address the cause (tight hip flexors), the rest of the hip has a chance to perform at it’s best.
Beyond muscle strain or tension, many golfers develop bursitis in one or both of their hips. Hip bursitis in golf is more common in your dominant (back) hip when swinging your golf clubs.
Hip bursitis, or trochanteric bursitis, affects the outer area of your upper leg and hip. The greater trochanter is a part of the femur (leg bone) that sticks out on the outside of your hip so that muscles can attach to the bone there.
All of the muscles that attach there are hip rotators.
The pain arises from the inflammation of the bursa in this location. A bursa is a fluid-filled sac that is designed to protect your tendons and ligaments from excessive friction. Overuse or uneven use from side to side - such as when you rotate your hips to swing a golf club - can inflame the bursa.
As you can imagine, a tight hip flexor can be involved in the development of hip bursitis. Tension in the iliacus or psoas creates tension in muscles like the TFL, gluteus medius, gluteus maximus, piriformis, and other deep hip rotators like the obturator internus.
And guess where all of these muscles attach?
Yup, the greater trochanter where that bursa lives.
This tension creates a perfect opportunity for irritation of that bursa to develop. Since the hip rotator muscles are active as you rotate your hips during your golf swing, it’s not hard to imagine an irritation developing.
Depending on the severity, hip bursitis from golf could cause pain or soreness that starts in the hip, and travels down your thigh to your knee area. This is because the IT band (iliotibial band) also attaches at the greater trochanter and makes its way to the knee.
Unlike muscles, the IT band is connective tissue and is an innocent bystander in the mix. And, although it’s trendy to roll out your IT band, connective tissue doesn’t like to be rubbed or stretched.
The real source of irritation to the IT band that goes from the outside of your hip to your knee is coming from those muscles in your hip and ultimately from a tight hip flexor.
You may not feel pain directly while golfing. In fact, the pain can be amplified when you rest, and even make it hard to sleep on your side.
Hip tendonitis is another common reason for golf hip pain. The primary difference between hip tendonitis and hip bursitis from golf is that tendonitis impacts the tendons, not your bursa.
Now, remember how I said your iliopsoas muscles, or your hip flexors, are made up of the iliacus and the psoas muscles, which run from your pelvis to your thigh?
Well, your iliopsoas tendon connects these inner hip muscles to your femur, or thighbone.
And, when your iliacus and psoas muscles become fatigued or tight, it makes your tendons more vulnerable. Your tendons begin to take on more stress than they are designed to tolerate.
This chronic stress could cause a dull ache, clicking, or severe enough pain to make even daily activities like putting your socks on difficult. Iliopsoas tendonitis shows up as pain in the inner groin.
Since your iliopsoas muscles and tendons are used so often in daily life, overuse during an activity like golf can cause discomfort in totally unrelated activities.
Hip arthritis or osteoarthritis is a progressive disorder that usually starts small and grows in intensity. While there are so many variations of arthritis - and it’s important to properly identify the specific type you may be suffering from - they all boil down to the same thing: joint inflammation.
Hip joint inflammation occurs when your cartilage tissue has been broken down from overuse or aging. It then can create your bones to sit in your joint socket unnaturally, even rubbing against each other.
You see, the cartilage in any of your joints acts as a barrier and cushion for your bones to glide smoothly on each other. When your cartilage is damaged or weakened, that friction is no longer dispersed and movements directly impact the joint instead, causing inflammation.
You can develop osteoarthritis due to genetics, injury, or malformation of your joints. And, while your cartilage will naturally break down over time, repetitive movements - such as a golf hip turn, can speed up this normal process.
As such, arthritis is a common cause of golf hip pain, but it can be prevented.
One of the reasons hip arthritis develops is due to the hip joints not being aligned properly.
When a muscle is holding tension around the hip, it subtly changes the way the joint aligns and creates more grinding. Muscle tension around a joint also compresses a joint, contributing to more pressure on the joint surfaces. Tension in the iliacus and psoas is a major cause of the phenomenon and is one of many reasons to keep that iliacus and psoas relaxed!
My clients often ask me, “Can I golf with sciatica pain?”
Fortunately, sciatica pain doesn't mean you need to retire your clubs early. Once the root cause of sciatica pain is determined, it can be solved.
Sciatica pain can often present in the lower back, but spread to the hips and can even travel to the outside of the foot. Pain will usually be isolated to one leg, often your back leg while golfing, and a numbness or tingling sensation may occur as well.
A herniated disk or tension in the piriformis muscle deep in your hip is typically what is responsible for pressure on the sciatica nerve. Because tension in the iliacus is playing tug of war with the piriformis, this tension could be at the source of why the piriformis is chronically tight and, in turn, irritating the sciatic nerve.
Since the game you love involves intense trunk and hip movement, this can be tricky.
Some golfers will opt to wear a back brace, but this doesn’t treat the problem, just the symptoms.
Another solution is to ensure that you maintain proper form and have released your iliacus muscle with a tool such as the Hip Hook prior to golfing. This ensures that your muscles are not causing an unnatural twist in your core, putting added pressure on your sciatica nerve.
4 treatments for golf hip pain
While hip pain may arise from golfing, it doesn’t mean it needs to become your new normal. Golf pain can be managed and often prevented in a number of ways.
1. Rest and recovery
Rest and recovery is the age-old remedy for hip flexor pain, injury, and inflammation. Using the RICE (rest, ice, compression, and elevation) method is an excellent way to manage an injury, especially hip bursitis from golf.
To ensure your body has time to recuperate and recover between golf games, space out the days you play. You can also choose to play shorter courses or fewer holes during sessions.
It may seem strange that you’d need to work in recovery time for golf, especially since it isn’t a high-intensity exercise. Still, you use the same muscles repeatedly as you swing and make your golf hip turn. Allowing proper recovery time is important for managing, and avoiding, golf hip pain.
Gentle stretching to the muscles around the hip during your recovery period lets the area know you will take care of it after all you ask of it during your game.
2. Strength exercises
One of the best ways to protect your hip from injury, no matter the sport, is to practice cross-training exercises and focus on strengthening and stabilizing your hip muscles and your core.
If you are already injured, I advise seeking the help of a physical therapist during this process.
Part of strengthening your hip muscles and the surrounding muscles, like your glutes and abs, is relieving tension and maintaining a healthy range of motion.
This may look a little different for each person, but generally most people benefit from gluteus maximus, gluteus medius, and transverse abdominis strengthening. Box squats, clamshells, and planks are the ticket.
Rather than thinking about heavy weights or fast movements, focus on slowing down, maintaining proper form, engaging your core, and stabilizing your body during the movement.
Swinging a golf club requires you to exhibit control of your gluteal and all of the other hip muscles. Without proper control and strength of these muscles, it will be difficult to control the force pivoting in those hips with your swing.
When working on hip strength for a golf hip turn, don’t forget your core muscles, either. The transverse abdominis gets challenged during plank. It’s job is to allow for stability and protection to your spine with all movements, including your swing. Full crunches, boat pose, or movements that focus on your hip flexors may help you build a strong core but can overuse your already tight and fatigued iliopsoas muscles.
Therefore, it may be better to initiate those only after you know the muscles are relaxed and happy.
3. Proper form and warm-ups
Many professional golfers and amateur weekend players will be injured from golfing at least once in their lifetime. Most of the time, their injuries can be explained by looking at their golf swings.
While fixing bad habits with your golf swing may require a coach or trainer, it doesn’t mean your hip pain could have a fairly simple solution. It can also help to perform a few stretches and rotational movements to get your hips and shoulders opened up before the first tee-off.
A great pre-golf game warm-up exercise to hone a better golf swing is the parallel club swing. You’ll hold one club in each hand and stand in a golf stance. As you begin to swing the clubs from left to right, they should remain parallel.
When performing a parallel golf swing, make sure your trunk and hip rotation are equal. You should also keep your abdominal muscles and back/shoulder muscles tight, and your spine nice and tall as you swing. If the clubs are not parallel as you rotate, your body alignment is off.
In addition to perfecting your form, another option to consider here is to swing in the opposite direction. This can be an impactful change for your hip flexor pain, and doesn’t need to change your golf game at all. That’s because you don't have to actually strike a ball.
Simply replicate your swing in the opposite direction.
Remember that your joints and muscles have made millions of right or left sided swings, and almost none in the other direction. This creates an incredibly strong imbalance in your iliopsoas muscles that you could potentially take with you once you’re off the green.
Focus on your form before your game starts to give your body some much-needed muscle memory. Eventually, you won’t have to think as hard about your golf swing, because you’ll know your form is perfect. And, once you effectively release the iliacus, and posterior muscles locking the pelvis in a torqued position, start evening out your tissues with a swing in the opposite direction.
4. Massage and muscle release
My final tip (and arguably the most important) to ease golf hip pain is to get a professional sports massage or use a tool such as the Hip Hook to release your tight iliacus and psoas muscles.
If you are new to the Hip Hook, it’s a simple tool that you can use to find the exact location of the psoas and iliacus where they connect to your pelvic bone. Since these are inner hip muscles, this is something that can be very difficult to do on your own or with a normal massage. It’s a missing link for a lot of people. Due to their inner location on your pelvic bone, it’s also difficult to apply the right amount of pressure at the correct angle.
However, with the Hip Hook, you use your own body weight and the pivoting motion of this tool to get a full release.
As you can gather with the multiple mentions of the iliacus and psoas in this article, these muscles often get tight with golf and can ultimately be at the source of why you are experiencing pain in the hip region. Tension in the hip flexors not only causes pain in the hip area, it can affect the lower back, tailbone, knees and feet as well. I talk all about this chain reaction in my book if you’d like to learn more.
Relieving this muscle tension is one of the best ways to treat pain from hip injuries like muscle strain, hip tendonitis, or hip bursitis from golf. It’s also one of the best things you can do before an activity such as golf to help make sure your iliopsoas is happy, functioning at its highest level, and less likely to cause tension or pain.
As your muscles release - and stay that way over time - you may notice your pain subside and may feel stronger.
You will have an increased range of motion for your golf swing, with more hip rotation on your backswing in your back leg and more hip rotation in your front leg in the follow through.
The reality is that your muscles had that strength and mobility all along, but overuse, tension, or hip pain weren’t allowing them to reach their peak performance.