The hip is a classic ball and socket joint formed by the femur, or thigh bone, and pelvis. The femur’s top end is shaped like a ball called the femoral head. It fits into a round socket found on the side of the pelvis called the acetabulum. Where the bones come together, or articulate, is covered in articular cartilage. This provides a smooth thick surface to make movement easier and provide shock absorption. Shock absorption is important because the hip is designed for stability and weight bearing activities such as walking, squatting, and stair climbing. The labrum also increases the depth of the socket to provide a greater articular surface to improve stability of the hip.
The hip has a large amount of bony interlocking. The hip socket is deep and encompasses nearly all the ball, causing limited range of motion. More stability = less range of motion.
Main movements performed by the hip are:
- Flexion – lifting one leg towards the body
- Extension – backwards movement away from the body
- Abduction – sideways movement of one leg away from the other
- Adduction – inward movement of one leg towards the other
- External/lateral rotation – rotation of leg away from the body
- Internal/medial rotation – rotation of leg inwards from the body
What are the main muscles that help the hip move?
The gluteals (gluteus maximus, gluteus minimus, and gluteus medius) attach to the back of the pelvis and insert onto the thigh bone. These muscles extend, abduct, and keep the pelvis level as we shift weight from one leg to the other when walking.
The iliopsoas is the primary hip flexor. It originates from the spine and pelvis to insert onto the thigh bone. Sensing a trend?
The rectus femoris, part of the quadriceps group, is located on the front of the thigh bone. Its main function is to flex the hip. This is in opposition to the hamstrings.
The hamstrings run down the back of the thigh to extend the hip.
The groin muscles, or adductors, run down the inner thigh. As the name suggest, their job is to adduct the leg.
The hamstrings and gluteal muscles also assist in external and internal rotation.
Keeping these muscles strong will help prevent injuries because hip pain can be detrimental in maintaining good posture, a fluid swing, generating power, and shifting weight during the swing cycle. Two of the more serious injuries at the hip are labral tears and impingement.
The labrum can become torn through overuse, especially if excessive forces are exerted on the hip from faulty mechanics. Sometimes a tear can cause the ball to slip out of the socket due to decreased stability. If the tear is in the back of the joint, rotating your thigh bone inwards (internal rotation) will be compromised. If the tear is in the front, rotating your thigh outwards (external rotation) is compromised. Squatting to read a putt may cause pinching or temporary locking in the hip if the labrum is torn and getting caught in the joint. You may also notice your backswing feels restricted or experience groin pain in the trail leg. If the tear is in the lead leg, you may have pain during both the backswing and downswing.
A tear in the labrum is usually caused by impingement. Hip impingement occurs when there is excessive contact between the thigh bone and socket. When there is excessive contact, abnormal bone growth can occur, leading to a CAM or Pincer type deformity.
A CAM lesion is an abnormal formation of bone growth on the ball of the femur. This leads to increased contact between the femur and socket, causing a pinch when the hip flexes. A Pincer lesion is also an abnormal formation of bone growth, but on the OUTER rim of the socket. You can also have a combination of a CAM and Pincer lesion.
Impingement can also occur on either the ball or socket side in the lead or trail leg. As a result, you will experience pain, stiffness, and potentially a clicking/locking sensation. You may feel pain or limited movement when trying to squat (hip flexion) to get your ball out of the hole. This is because there is a bony blockage in the joint due to the excessive contact between the thigh bone and socket. However, this problem can go unrecognized for years since it tends to pain free in early stages. It is important not to push through the restricted motion because this can increase hip damage by continuously aggravating or pinching that growth.
Many times, impingement can be confused with a hip flexor or groin strain due to the close muscle attachment points. If one side feels different than the other, take extreme caution when training in positions such as squatting, lunging, twisting, and jumping without first consulting a physical therapist or other medical professional.
At Par4Success we offer two online appointments. The first is a live one-on-one virtual golf fitness assessment. This feature includes a golf fitness expert who can help you understand your injury and how to help fix it. The second is 15-minute discovery call consult but with a licensed physical therapist. Click to lean more: https://par4success.sites.zenplanner.com/scheduler.cfm
If you are waiting for an appointment, try fanning your feet out to better align your hip for avoiding pain during the golf swing. You may need to invest in a device such as a golf ball pick-up suction cup which prevents you from squatting to pick up your ball. You may also need to consistently club up if you’ve notice a decrease in carry distance.
If you are having other hip related pain not mentioned above, check out our blog post “Fixing Hip Pain for the Golfer” to more about hip muscles that can refer up to the back or down the leg.
DPT student, Clarkson University