Hip pain when running is a common problem that many runners face. Understanding the causes of hip pain can help you find the right solutions and get back to your running routine. Whether it’s a result of tight muscles, joint irritation, overuse injuries, or improper form, identifying the root cause is important.
Tight or weak hip flexors, hamstrings, quads or glutes muscles can lead to discomfort and increase your risk of injuries. The hip joint itself can also become irritated by running, including if there is a change in your running mechanics due to muscle weakness or tightness. There are also some tendinopathy conditions that are common with running, for example gluteal tendinopathy or hamstring tendinopathy. Bone stress injury or stress fractures are a less common but more significant cause of running-related hip pain. Knowing what to look for and how to address these issues can make a big difference to your recovery and get you back running as quickly and safely as possible.
There are also several preventive measures that you can use to reduce your risk of hip pain. Strength training is among the most important ways to reduce your risk of many running-related injuries, including hip pain. Another is making sure you follow a good training program that is suited to your running experience and ability, avoids rapid increases in running volume or intensity, and allows adequate recovery time between runs. . Other factors that can reduce your risk include mobility drills (stretching, foam rolling, massage guns etc…), improving your running form, and choosing the right running shoes.
Hip Pain When Running – Key Takeaways
- Hip pain when running is a common problem, and physio is able to manage the majority of cases quickly and effectively
- Common causes of hip pain include muscle weakness or tightness, joint irritation, and tendinopathy (irritation of the tendon). Bone stress injury and stress fractures are a less common but potentially more serious cause of running-related hip pain.
- You can reduce your risk of hip pain with running by doing strength training, following a good training program, doing mobility drills, improving your running form, and choosing the right running shoes.
Causes of Hip Pain in Runners
Hip pain in runners can result from a variety of causes. These range from acute (sudden-onset) injuries to gradual-onset pain, i.e. they start as niggly pain but gradually increase to more intense and long-lasting problems. Often hip pain in runners is due to tissue overload, usually due to increasing running volume or intensity too quickly.
Common Causes and Risk Factors For Hip Pain
1. Increasing Running Too Quickly: Like many running-related injuries, one of the most common causes we see for hip pain is increasing your running volume or intensity too quickly. This rapid increase in load going through your tendons, muscles, joints and bones causes overload injuries because your body has not had time to increase the strength in these structures. In a more gradual program, one which has enough recovery time between runs, your body has adequate time to repair tissue damage from one run before your next sessions. A commonly used principle is to only increase running volume by a maximum of 10% per week. While this can be a useful general rule, there are many factors that can affect what is a “safe” increase in running volume, for example running experience, previous injury, general strength and fitness, running terrain (rods, trails, hills etc…)
2. Muscle Weakness: Because most hip pain with running is caused by overloading the body’s tissues, a lack of strength in those tissues is a primary cause of pain and injury. If your muscles and tendons are weak then they are more at risk of being overloaded by the loads placed on them during running. This is why we recommend that all runners include some strength training in their regular exercise routine. It not only greatly reduces your risk of injury, but it really helps you run faster for longer by improving your running economy and efficiency.
3. Muscle Tightness: Tight hip muscles, like the hip flexors, hamstrings, and glutes, can lead to hip pain. Muscle tightness can be caused by several things, including by muscle weakness, for example weak hamstrings are also often tight. Lifestyle factors can also cause tightness, for example desk workers often have tight hip flexors because they spend extended periods sitting, which places the hip flexors in a shortened position.
Another factor that can cause muscle tightness is muscle imbalance or compensation. In this case, one muscle (or group of muscles) has to work harder to compensate for another muscle being underactive or weak. This overactivity, over time, can lead to muscle tightness, for example gluteal weakness/insufficiency can cause tightness in the ITB/TFL chain, or the hamstring muscles.
4. Poor Running Form: Hip pain can also be linked to poor running form, especially if you have a crossover gait. This is when your foot lands too far inwards, across the midline under your body. Technically this is when there is too much hip adduction and sometimes internal rotation. This causes hip pain by placing too much stress on the anteromedial (i.e. front + inner) part of the hip joint, and also by overloading the ITB and gluteal tendons, causing ITB syndrome or gluteal tendinopathy.
5. Other Factors: Several other factors can increase your risk of hip pain when running. These include previous injuries, running on uneven surfaces, not using proper footwear, and increasing age.
Overload/Overuse and Stress Injuries
Overload injuries occur when runners push their bodies too hard without adequate rest. These injuries usually develop over time and can result from increasing mileage too quickly or not varying training routines. Running long distances without proper recovery can lead to stress injuries in the hip. The muscles and tendons around the hip can become irritated, damaged or inflamed due to too much load. Bone Stress Injuries and Stress Fractures are a more serious type of overload injury, and need to be managed properly as early as possible to avoid more serious problems.
Hip Muscle Strains and Tendinopathy/Tendonitis
Muscle strains in the hip result from overloading the muscles, commonly the hip flexors, glutes, ITB and hamstrings. These strains often happen when the muscles are weak – tightness is less of a factor. Tendinopathy means irritation or degeneration of the tendons, while tendonitis is the old term which indicated that inflammation was a major feature, which has been shown to be incorrect. The most common muscle and tendon injuries are ITB syndrome, gluteal tendinopathy, hamstring tendinopathy and hip flexor tendinopathy. Symptoms include pain and stiffness around the hip joint, especially after running. Load management and strengthening are the main ways of treating muscle and tendon injuries, sometimes accompanied by ice, anti-inflammatories and stretching. Your running physio can provide you with a personalised treatment plan to relieve your pain and get you back out on the road.
Bursitis and Inflammation
Bursitis occurs when the bursa, a small fluid-filled sac that reduces friction between tissues, becomes inflamed. In runners, hip bursitis often results from repetitive movements and prolonged pressure on the hip. Trochanteric or gluteal bursitis are the most common types, causing pain on the outside of the hip. Interestingly, these conditions aren’t as common as previously thought, with new research showing that most lateral (outer) hip pain is caused by tendinopathy rather than bursitis. The pain worsens with running. climbing stairs, lying on your side, and extended periods of sitting, especially with your legs crossed. Inflammation around the hip joint can also cause pain and stiffness. Anti-inflammatory medications, physiotherapy, and modifying running routines can help manage symptoms.
Labral Tears and Hip Impingement
A labral tear involves damage to the labrum, a ring of cartilage that surrounds the hip joint socket. These tears can be caused by repetitive stress or acute injuries. Symptoms include deep pain in the front inside area of the hip, sometimes clicking, and can include a feeling of instability.
Hip impingement occurs when the front part of the labrum is pinched between the thigh bone and the pelvis bone. It is more common in runners who have a crossover gait, because their hip joint moves into a more adducted and internally rotated position during their gait, bringing the font parts of the bones closer together.
Hip impingement is more common in cases of femoro-acetabular impingement (FAI), where extra bone grows along one or both bones that form the hip joint. This bone overgrowth causes the bones to rub and pinch the front of the labrum and hip joint during movement. FAI can lead to labral tears, and your physio may ask you to have an x-ray to check for FAI, or an MRI if a labral tear is suspected.
Bone Stress Injuries and Stress Fractures
Bone stress injuries occur when the bones in the hip undergo too much repetitive stress, eventually leading to small cracks and bone swelling. Stress fractures are the next stage of bone damage, where visible fracture lines are visible on MRI. Symptoms include progressively worsening pain, which gets significantly worse with running or any impact-type activity like jumping or hopping. If you continue to overload the bone the pain will get significantly worse, to the point where you will have to stop running, and it will also start to last longer after you stop running. Runners with osteoporosis or other conditions that weaken the bones are more prone to stress fractures.
Early diagnosis is critical, ideally trying to catch the condition at the bone stress injury stage, before it progresses to a stress fracture. Stress fractures are one of the more serious running injuries, so seeing a running physio for correct management is vital. Clinical tests include taking a thorough history, testing impact tolerance by assessing the pain response to a light jog, jump, or hop, and the fulcrum test for femoral stress fractures. Usually an MRI will be used to confirm the diagnosis. Treatment involves rest, reducing impact activities, and then strength training within pain-free limits. Once the pain has settled, progressive reloading with running and other impact activities is started, as well as continuing to focus on strengthening.
Physio For Hip Pain – Assessment and Diagnosis
Identifying the cause of hip pain when running involves several important steps, including taking a thorough history, performing a clinical examination, and possibly utilising imaging like an x-ray or MRI. By diagnosing the cause of your hip pain you can get a clear understanding of how to manage and treat the injury, and then return to running safely. Importantly, seeing a running physio can make sure you avoid continuing to run on potential bone stress injuries or stress fractures.
Taking a Thorough History – Especially Your Running Program
Your running history is key to diagnosing hip pain. This will include reviewing details such as how long you’ve been running, how often, and the types of surfaces you run on. Important factors include any changes in your training, like increased mileage or adding in hills or speed work. Footwear can also be a factor.
Your physio will also ask you to describe some features or the pain, for example;
- Where is your pain – at the front, outside or back of the hip? Does it spread anywhere else, for example down your thigh or come from your low back.
- Is it a sharp, dull, or burning sensation?
- How bad is it? For example on a scale of 0 – 10 (0 = no pain, 10 = agony), what is the worst it gets?
- Is it there all the time, or just when you run or put load though it?
- When does it occur, and what makes it worse?
- Is there anything that makes it feel better? Or how long does it take to settle down after a run or aggravating activity?
- Do you get any night pain, or pins and needles?
Physiotherapy Examination of the Hip
A physical examination helps pinpoint the source of the pain. Your physio will check your range of motion, joint mobility, and muscle length and strength. Functional tests are used to help clarify how sensitive the pain is and how your body moves as a whole, for example a light jog, squat, step-up, lunge, jump or hop. Its important to screen other areas of the body to see if they are related to the pain, for example the low back can refer pain down into the hip.
Palpation involves feeling different structures around your hip to see if they are sore or tight. This can include muscles, tendons, bones and joints. Then specific tests are used to assess different structures. This will vary depending on your particular injury, but here are specific tests for conditions such as bone stress injury/stress fractures, hip impingement and FAI.
Hip MRI and X-Ray
Imaging tests are not usually needed for diagnosing hip pain related to running. However, in some cases it is important, especially if bone stress is suspected. X-rays are helpful to show general bone and joint structure, which may be relevant conditions such as FAI or osteoarthritis (OA). MRI provides a much more detailed view of the bones and also soft tissues. It is the gold-standard investigation for diagnosing bone stress injury and stress fractures, labral tears, and for grading the degree of tendinopathy or muscle damage.
Physio Treatment For Hip Pain With Running
Addressing hip pain due to running requires a mix of approaches, including adjusting your running load, targeted strength exercises, manual therapy (hands-on treatment), and sometimes medication. Each of these strategies plays a role in relieving pain, returning you to running, and minimising your risk of further injury.
Load Management – Adjusting Running Training
To allow you hip to recover, you will often need to adjust your running load. This involves modifying the intensity, duration, and frequency of your runs. It is important to note that whenever possible we still keep you running at some level, but sometimes this is not possible, for example if your injury is very sensitive or a bone stress injury is suspected. However, we try to keep you running at a level that doesn’t aggravate your pain excessively, potentially just by reducing the frequency, distance or intensity of your runs. Often during this stage of treatment cross-training on a bike is a good way to maintain fitness and strength with your running is reduced.
Physio – Exercise and Strengthening
Strengthening exercises play a major role in recovery from hip pain, and also in minimising your risk of future problems. Focus on exercises that build the hip, leg, glute, and core muscles. Common lighter exercises include bridges, clamshells, plank variations and hip abductions. Resistance bands can add an extra challenge to these exercises. Once these feel manageable we progress to heavier exercises like squat variations, split squats, lunges, sliders and deadlift progressions. The weight and complexity of the exercises is gradually increased, and speed variations leading to plyometrics may be used. Strength is a key quality for being able to run consistently to the best of your ability and minimise your risk of injury, so even once your hip pain has resolved we recommend that you continue with an appropriate strength training program.
Physio – Manual Therapy (Hands-On Treatment)
Manual therapy involves hands-on techniques provided by a physiotherapist. Treatments like massage and joint mobilisation can relieve pain, increase joint mobility and reduce muscle tension. Techniques such as myofascial release help reduce tightness in your hip flexors and IT band. Soft tissue mobilisation can improve blood flow and promote healing. Regular sessions may be needed depending on the severity of your symptoms.
Pilates for Running
Recent research shows that Pilates can help your running. While the study didn’t focus on hip pain specifically, it is a great way to improve the stability in your core, pelvis and hips. So, if you’re not really a “gym-and-weights” type of person, or don’t have access to gym facilities, then doing regular Pilates may be a good alternative.
Returning to Running
Following a personalised and well-structured return to running program is critical for a safe return to running. You will usually begin with shorter runs including a mix of running and walking intervals, gradually working up to continuous runs, for example 30 minutes. From there, you will usually start to bring in some intervals, longer runs, and then hills. However, the rate at which you progress back to running will depend on many factors, for example the type and degree of your injury and how long it was there for. Sometimes you will progress quickly, while other cases may be much slower, for example after a stress fracture. This variability is one reason why a personalised program is required – there is no generic “works for everyone” approach!
During your return to running program you’ll need to monitor your body’s response to running, and adjust your program appropriately. Often your runs don’t don’t need to be completely pain-free, for example in most tendinopathy cases a low level of discomfort (3/10) that settles quickly after a run and feels fine the next morning is ok. However, in cases where bone stress is involved, you need to be cautious and generally avoid running through pain. Your running physio will guide you through this process.
Medications for Hip Pain
Over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen or Voltaren can help manage initial pain and inflammation. While they can be helpful to relieve pain, they should be used sparingly and only for a short time. This is because they can mask pain, giving you a false sense of security and potentially continuing to overload your hip during running. This is especially problematic if a bone stress injury is involved.
There is also some research to show that NSAIDs can reduce your healing and recovery response after an injury. This means that while they may reduce your initial pain, they can also reduce or slow down your healing, meaning that your recovery may take longer overall, or be less complete. so they should be Your doctor may also recommend corticosteroid injections to reduce inflammation and provide temporary relief. These injections are done at the site of pain and are often guided by ultrasound. Always consult with a healthcare professional before starting any medication or injection therapy.
Cortisone (Corticosteroid) Injections for Hip Pain
In some cases you may be recommended to have a guided corticosteroid (cortisone) injection to reduce inflammation and pain. This is generally only used in really persistent or recurrent cases, and it is not a replacement for other treatments like strength training. Research shows that following the correct exercise and strength training program is usually just as effective in the early (acute) stage, as well as providing long-term recovery, as cortisone injections. And, given that most cases of running-related hip pain are due to tissue overload or weakness, simply taking the pain away with an injection is not fixing the underlying problem! However, in some really persistent cases, cortisone injections can be helpful to reduce pain and sensitivity, which allows your strength program to progress and long-term recovery to be achieved.
Surgical Options for Hip Pain
In cases of severe or persistent hip pain, surgical options might be considered. These could include procedures like an arthroscopy to repair a torn labrum. Surgery is rarely required, and is seen as a last resort when other treatments have failed. Recovery from surgery will often require a significant period of rehabilitation guided by a physio, and unfortunately a significant time out of running maybe required.
How To Minimise The Risk of Hip Pain When Running
Minimising the risk of running-related hip pain involves a balanced approach that includes;
- following a training program that is suited to your experience, ability, injury history and overall strength and fitness
- allow enough recovery time between runs, and mix up your types of runs, for example tempo, hills, recovery runs…
- Cross-training with cycling or swimming can be good to build your fitness while still allowing enough recovery time between runs.
- doing regular strength training, focussing on the key muscles used in running (calf, quads, glutes and core muscles)
- improving your running gait to achieve a more efficient and economical running style
- maintaining adequate flexibility using stretching, foam rollers, trigger-point release balls and massage guns
- choosing the right type of running shoes – having a professional fitting at a running shoe store is ideal
- improving lifestyle factors such as nutrition and sleep
Use the Correct Running Training Program
Following a well-structured running training program, one that is appropriate for your ability and level of running fitness, is vital to reduce your risk of hip pain and most other types of running injury. Ensure that you gradually increase your running volume and intensity, to avoid overloading your hips and other structures. Make sure that your program includes different types of runs, for example long runs, intervals, tempo runs, hills and recovery runs. Include enough rest days to allow your body to recover and adapt to the stress of running. Use cross-training to build fitness without increasing your running too quickly. Listen to your body, and if you feel discomfort, especially if it lasts until the next day after a run, reduce the volume or intensity of your running. Working with a running coach is the best way to ensure your training program is matched to your current running ability and goals.
Strength Training for Runners
Aside from following the right training program, strength training is the next most effective way to minimise your risk of hip pain when running. Consistently performing strengthening exercises that are appropriate for your current level of strength, and targeted at the key running muscles, has been shown to almost halve your risk of overuse injuries. Read more about strength training for runners.
Strength training does more for your running than just reduce your risk of injury. It also improves your ability and performance by increasing your running economy and efficiency. Focus on exercises that target your calf muscles, quads, glutes, hip flexors, and core muscles. Strong hips and a stable core can improve your running form and reduce your risk of injury.
Common Strength Exercises That Are Beneficial For Runners Include
- weighted squats and single-leg squats
- lunges, walking lunges and split squats
- step variations – forward, side, backwards, and sliders
- loaded calf raises, in both straight-knee and bent-knee positions
- hip thrusters, with weight and/or single leg progressions
- use a sled for resisted runs, pushes and pulls
- plank progressions for core and glute strength
- plyometrics can be beneficial however, if you don’t have experience with this type of exercise, its best to see a trainer with experience coaching runners before introducing plyos
Improve Your Running Gait
Improving your running gait can help you run faster for longer with less risk of injury. Having your form properly assessed and improved can correct biomechanical issues in your running style. This means you run with a more efficient and economical gait, allowing you to run further while expending less energy and with less risk of overloading any of your body’s tissues like a muscle, tendon, joint or bone. For runners of all abilities, improving your running form brings the dual benefits of improved performance and reduced injury risk. Read more about the benefits of having a having a running assessment.
Flexibility and Stretching for Runners
While research shows that strength is more important than flexibility for preventing running injuries, there is still a need to maintain adequate flexibility and muscle length in key muscles. The most important muscles for runners to work on for flexibility are the hip flexors, quads, hamstrings, glutes and calf muscles.
There is no clear evidence for what is the best way to stretch a muscle. Practicing dynamic stretches before running and static stretches afterward is generally recommended, for example doing leg swings or walking lunges can warm up your hip muscles before a run, while holding a hip flexor stretch for up to a minute after running may help with muscle lengthening and recovery. Similarly, the use of foam rollers, trigger point balls and massage guns varies greatly between runners, and there is no clear “best way” to release muscle tension using these devices. It is generally a case of trying different routines, and find the one which works best for you.
Choose the Best Running Shoes
Wearing the right running shoes can help you achieve better running mechanics, which can reduce your risk of hip pain as well as many other running injuries. However, there is no shoe that is best for every runner. In fact, even two runners with the same foot type (neutral, flat foot or high arch) may prefer quite different shoes. This is because, while there are shoes that are designed for the different foot types, there are also a lot of other factors that influence which model of shoe is the best for each individual to run in. For example if we have two runners, both with flat feet, but one runner has a forefoot gait and the other has a mid- or rear-foot gait, they may feel better in different models of shoe despite having the same foot type.
Other factors like overall running gait, muscle strength and length, injury history and running experience can all play a role. So, how do you chose the right running shoe? We recommend going to a running shoe shop and being properly assessed and fitted. During this process, as well as assessing your foot type and running gait, you will also be able to try a few different models of shoe to see which feels the most comfortable for you to run in. It’s a really individual thing, and the most important factor in the process is which shoe feels the most comfortable for you to run in.
Lifestyle Factors – Diet and Sleep
Your diet and sleep habits play an important (and often overlooked) role in minimising your injury risk with running. This is especially true if you are training for a race and may be doing a high volume training block, or pushing your training near your limit. Eating a balanced diet and keeping well hydrated is important for recovery after runs, as well as maximising you performance during your training sessions. Making sure you are eating enough calories to fuel your sessions is important, especially if you are running high mileages.
Prioritise sleep as it allows your body to repair, recover and rejuvenate. Research shows that most adults should aim for at least 7-9 hours of quality sleep each night. Establish a consistent sleep schedule and create a restful environment to improve sleep quality. Also, listen to your body. If you have a long or hard run planned but feel fatigued after a bad (or short) night’s sleep, then you should probably adjust your session to be shorter or lighter. If you try to do the harder session when you feel fatigued before you even start, not only are you more at risk of injury, but you’re probably not going to get much benefit anyway because you will perform poorly, so maybe shuffle your weekly training plan to have an easier session that day and a harder one another day.
Having a good diet and getting enough sleep are essential for overall health, as well as reducing your injury risk and improving your running performance. If you aren’t sure what to do with your diet, or if you have specific dietary concerns or general health issues, then consulting with a sports dietitian is a good idea. There are also lots of good resources online about improving your sleep quality.
Physio for Hip Pain When Running – Central Performance
If you have hip pain when you run, and need some advice or treatment, we’re here to help. You can click on the buttons on the right to ask us a question, or book physio online. You can also click to find out more about the services available at the Central Performance Running Centre, where we work with runners of all abilities to provide running physio, coaching and strength and conditioning programs.