Do I have Hip Bursitis or Back Pain?

It’s a common story that I hear in the clinic, and a frustrating one. A patient complains of prolonged lateral hip pain (outside pocket area) that came out of nowhere. They went to see their doctor and the doctor says “Congratulations, it’s a boy!” Just kidding, they take an x-ray which comes back negative (good thing) and then say “You have hip bursitis. Let’s give you some cortisone and send you on your way.” The only problem is that your hip doesn’t improve and you are left frustrated, questioning “Why?” The answer is, you probably don’t have hip bursitis, you probably have a back problem. Allow me to explain further. 

What’s Hip Bursitis?

Hip bursitis is an inflammation of the bursa sac on the outside part of your hip. Its job is to keep your muscles and tendons from rubbing on your greater trochanter and damaging them. Bursitis happens when the bursa sac gets compressed and inflamed which will cause pain in the area.

Most of the time the pain is due to activity and will improve if you rest. The patients that I see are the exact opposite. They hip hurts when they rest and will feel better with certain movements. If that is the case then you probably don’t have true hip bursitis. 

If I Don’t Have Bursitis Then What Do I Have?

Let me introduce you to my friends dermatomes and myotomes. These little characters are areas of the body that are innervated by our back. They tell our brain what we feel (myotome) and how we move that area (dermatome). 

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If you can’t tell from the pictures there are two different areas of the spine that innervate the lateral hip where you might be having pain. Let’s look at the dermatome on the left first. You can see the two blue circles around where the L2 spinal segment innervates the skin. As you can see it starts up high by the hip and travels down the thigh. If your back is causing your “hip pain” you will have irritation all along that pattern. Simply take a fork and lightly press it into your skin and compare your irritated side to your non-irritated side. If your irritated side is way worse, or you don’t feel anything at all, your pain is probably coming from your back. 

Now let’s take a peek at the myotome pattern in the picture on the right. You can see in that blue circle that your L5 controls hip abduction (move your foot out to the side), and external rotation (clam shell exercise). Both those movements might cause pain in a patient with hip bursitis so that doesn’t tell us anything. If you have issues coming from your back we can test other movements though. Hip extension (bridges), knee flexion (hamstring curl), and ankle dorsiflexion (bring your foot up) are all partially controlled by L5 as well. If you test the strength in those movements, and they are weak as well, guess what, its coming from your back not your hip. 

Why Do You Hate My Doctor?

I started this post talking about a problem that I see all the time. It’s true that doctors miss a lot when it comes to orthopedic problems, but it’s not their fault. Most general practitioners are not educated enough in ortho. Most Ortho docs are too busy to try to tease things out. I don’t hate any of them. Heck, some PTs miss this stuff too (I know I did when I was just starting out). I just want to educate you so if you are having a similar issue you can be an advocate for yourself. So if you are someone who has been dealing with hip pain for a while that hasn’t gotten better, it’s time to think outside the box. If you run yourself through these tests and start to get some positive results, stop working on your hip, and start working on your back. 

I hope this helps you if you are having hip pain that hasn’t improved. If you have any questions please contact me here at OrthoCore Physical Therapy. Thanks for reading!

How to Increase Hip Mobility for Golf

The PGA season has begun and, if you’re anything like me, those golf juices are flowing! It has been at least two months since I have swung a golf club (thanks polar vortex). The off season is great for recovery but it’s also a great excuse to get lazy with your fitness program. It’s very easy to get stiff over the colder months because we don’t move as much. This stiffness can rob your golf swing of consistency and power. The biggest area of your body that is responsible for power in your golf swing is your hips. So let’s get those joints moving and get this season rolling!

When you swing a golf club your hips/pelvis to internally and externally rotate about 60 degrees in each direction. As a golfer, when you go to the top of your backswing you need internal rotation of your trail hip, and external rotation of your lead hip. In your downswing you reverse those movements. A restriction in either hip, in either movement, can lead to swing faults. No matter what the fault may be, it will definitely lead to inconsistencies in your golf swing.

Another problem with poor hip mobility is a guaranteed loss of power and distance. If you want to be able to hit the ball a far way you have to be able to spin fast. When we start our downswing we actually push down into the ground with our feet. The earth is just a little bit larger and stronger than us so it pushes back and creates what is called ground reaction force (hello physics!). Now before I lose you in all my golf swing dork talk let me simplify things. For 99% of the world, our legs are the strongest part of our body (not this guy, do you even leg day bro?).

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When we push into the ground, all that energy that is created gets pushed up the legs towards our abdominals. The pelvis turns that energy into torque. The more torque that is created, the faster we spin, and the harder we hit the ball. If we have a restriction in how much our hips and pelvis can twist we can’t create as much torque and we don’t hit the ball as far as we possibly can. Make sense?

Now that I have completely confused you with talk of physics, torque, power, blah, blah, blah let me just tell you what to do about it. Here is my favorite hip mobility exercise for golf. You can perform this stretch multiple times a day. Just be careful if you have any pain in your hips and/or in your knees. If you are consistent with performing this stretch, your mobility will increase, and you will be hitting that ball farther down the fairways before you know it.

If you have any questions please don’t hesitate to contact us here at OrthoCore. Enjoy the last month of the off season and use it to get your body ready for the upcoming season.

Hip PNF Kicks

Outside of your core muscles, the hips are probably the most important muscle group in the golf swing. They help your hips to twist and also transfer all of your leg strength up into the trunk muscles. It’s that energy transfer that helps to send that little white ball farther down the fairway. Most golfers who workout do work on their hip strength. The unfortunate part is that most are going about it all the wrong way.

The hip joint is a very dynamic joint. It is a ball and socket joint just like the shoulder.


The great thing about the hip joint is that it can move in almost any plane due to its kinematics (scrabble word, 800pts). That allows for all the movements that happen during the golf swing. Most people think there is just a twist at the hip. The truth is there is a natural twist, squat, and lateral shift happening at the same time in the golf swing. If it happens during the golf swing why wouldn’t you train that way?

When most golfers hit the gym they might do squats/deadlifts, and some lateral walk or side lunge. Awesome! I’m not saying those are bad to do. I certainly do them when I go to the gym. What I think is important is to incorporate all the movements of the hip joint into one exercise. That way when you make a golf swing your body has been trained to moving through all those planes of movement and can transfer that energy more efficiently. That will equal more power into the golf ball, and hopefully a lot more distance.

So I’ve teased you enough. You are probably saying at this point “what exercise does all this at once? That sounds like an infomercial.” PNF (Proprioceptive Neuromuscular Facilitation) patterns are the way to go. They are simple patterns that move the hip through all the ranges of movement in one movement. Here is a quick video that will show you how to go through the patterns on your own.

I prefer that clients do it without holding on if they can. That way you are working on balance as well which is also very important in the golf swing. I also will have people start with moving slow so you have to own the movement. Once that gets easy add some speed to it. Just don’t move so fast that you start to lose your balance and fall over. If you can’t do it with the resistance band at first that is okay. Just work on the patterns without resistance until it gets easy.  

You will definitely feel the burn in your hips when you do these exercises (take that Jane Fonda). Work on this over the off season and see how much farther you hit that golf ball once winter is over.

OrthoCore Physical Therapy has convenient locations in Westerly and North Kingstown, RI. For more information on our services please call (401) 667-0131