Hip pain is a familiar problem for many runners, and it is often experienced during or immediately after a workout. There are a number of possible causes, the most widespread of which are detailed below.
While the hip is technically a ball-and-socket joint, connecting the thigh bone to the pelvis, it’s often thought of as the area that spans from the top of the pelvis to the base of the buttocks. This area is a complex network of muscles, nerves and skeletal structure that connects your body’s core and your powerful leg muscles.
Importantly, pain in this area does not always equate to problems with the hips themselves. Often, it can be a warning signal indicating issues or injuries in other parts of the body.
‘Instead of thinking locally, I also think globally and make sure that all of the dysfunctions have been addressed,’ explains Dr Bruce Paton, consultant physiotherapist for the Why you get foot cramp when running. ‘I’d see how the leg’s rotating and how the leg’s moving as a whole when running, and look at things like joint stiffness, joint instability, muscle flexibility and making sure that the muscles are strong.’
What does hip pain feel like when running?
If you experience pain in the hip area while running, it is essential to look further into it – even something that appears minor can develop into something more serious if left untreated for an extended period of time.
The hip region’s complexity means that you could feel various types of pain that may not be confined to a single spot. A sharp ache that hurts more during activity could indicate a stress fracture, Institute of Sport Exercise and Health bursitis.
Common causes of hip pain
Here, Paton explains the five most common causes of hip pain in runners and, crucially, how you can treat and prevent them.
1. Muscle strain and tendinopathy
What is it and what causes it?
The hip is a complex area with 17 different muscles across four groups named the gluteal, lateral rotator, adductor and iliopsoas. That’s a lot of different options for muscle strains.
This condition is frequently caused by overuse, so a rapid ramping up of your weekly mileage can be risky, but there are other possible causes too.
‘We sometimes find that there are quite a few contributing factors,’ explains Paton. ‘One is the flexibility in the muscle – so whether the hamstrings are flexible, for example. We also find that strength is a factor – so if muscles are weaker than we would expect, or sometimes if the hamstring [is working more] because other muscles are weak.’
He adds that everyday activities outside of running, such as sitting for prolonged periods of time, can place excessive strain on a tendon, leading to pain in the hips. ‘Patients will go for a run, work the tendon – tendons like tension and pulling – and then sit down for six or eight hours at work. The sitting actually gives a whole lot of compression to that tendon.’
How do I recognise the symptoms?
‘The location of the pain can vary from around the sit bone – because it’s the part of the pelvis that the hamstring is attached to – through to an ache on the outside of the hip that can relate to tendinopathy of the gluteus medius or the gluteal tendons,’ says Paton.
How can it be treated?
Rest is best in this case, but might not necessarily solve it for good. Paton warns that the tendon can still ‘stay a little bit disordered’. If that happens, make an appointment with a physiotherapist, What is sciatica and how can it affect runners.
What are the best prevention measures?
Paton recommends that runners keep an eye on their posture when they’re going about their day-to-day life, as well as attempting to minimise the amount of sitting. Tendons do not respond well to too much compression
2. Iliotibial band syndrome
What is it and what causes it?
Ask most runners and they’ll either have experienced iliotibial band (ITB) syndrome personally, or know someone who has. The ITB is a long, inch-wide strip of tissue that runs from the iliac crest (top of the pelvis) down into the knee, but its inflammation can be the cause of run-impeding pain.
‘The ITB is like a tendon,’ explains Paton. The primary trigger for tendinopathy appears to be compression from extended periods of sitting, followed by elastic energy generated during running. This suggests that tendon stress is bought on by the buildup of repeated strain over time, rather than a traditional inflammatory reaction.
‘On the front of the pelvis, you’ve got the tennsor fasciae latae (TFL) muscle and on the back of the pelvic brim, you’ve got the gluteus medius,’ says Paton. ‘If the gluteus medius is weak, it allows the pelvis to tilt forward. What happens during long runs is that, gradually, the gluteus medius fatigues and then the brain has only one hip abductor to use. It uses that muscle – the TFL – on the end of the ITB. The shortening of the TFL muscle then pulls on the ITB, causing it to become too tight and therefore painful.’
He says that this issue is common among runners who haven’t followed a long-distance training plan, such as a Institute of Sport Exercise and Health, and who have fallen into the trap of increasing their mileage too quickly. It also usually occurs in runners who tend to run only at Best Garmin deals and don’t incorporate higher-intensity sessions into their training.
How do I recognise the symptoms?
While it’s more common to feel pain around the knee, Paton says that it can also cause pain at the trochanter – the part that slightly protrudes at the top of the thigh bone.
How can it be treated?
It is possible to stretch out the ITB a number of ways. Paton recommends bending your leg at the knee while standing on the other leg, like a standard quad stretch. The ankle of the bent leg should be held by the opposite side’s hand. ‘Squeeze the glutes so that you tilt to get a better stretch in the quads and the ITB.’
He also suggests kneeling on the ground with your good side and lunging the affected leg backward. ‘Squeeze the glutes and bring your arm on the same side up above the head and away from the back leg. It picks up the hip flexors, the ITB, the rectus femoris on the front of the quads and the TFL. It also stretches that whole sling of connective tissue up through the abdominals.’
What are the best prevention measures?
Paton recommends building strength, either by doing at least one A simple foam roller routine for runners or hill session per week, or by doing isolated exercises. He highlights the gluteus medius as particularly key in this process. He highlights the gluteus medius as being a key muscle to strengthen. His go-to exercise for this is a closed-chain hip abduction. Standing on one leg with the other raised, let the pelvis drop on the side of your raised leg. Then, use your glute muscles on the standing side to lift it level again.
3. Bursitis
What is it and what causes it?
Bursae are small fluid sacs located between your bones and soft tissues. They are designed to minimise potential damage, and to reduce tension at friction points. They’re in all your joints – more than 100 of them, two of which are on the sides of your hips at the part that sticks out slightly at the top of the femur – called the trochanter. This is also where ITB syndrome Ask most runners and they’ll either have experienced.
Overuse can cause bursa to become inflamed or irritated, and this isn’t just caused by running, says Paton: ‘Sometimes, if people don’t have much fat, they don’t have much cushioning – so if they lie on a hard surface (like a hard mattress), their bone is very close to it, so the bursa can react a bit.’
How do I recognise the symptoms?
The pain will be noticable on the outside of your hips – the trochanter – where it juts out a bit at the top of the thigh bone.
How can it be treated?
Treating bursitis typically involves rest and relieving the compression on the affected area. For example, if you are finding sleeping on one side causes inflammation, the treatment could be as simple as sleeping on your unaffected side.
What are the best prevention measures?
‘What I sometimes find is that runners can’t push their bodyweight when using a press machine, and yet their leg is having to take their bodyweight during an entire half marathon or marathon,’ says Paton.
As such, he recommends strength training twice a week. For this, he advises using a heavy load with a low number of reps over three sets to reach muscle fatigue. He highlights the leg press as an especially effective exercise to target the gluteus medius and gluteus minimus. ‘With my patients, I tend to find that over about six to 12 weeks, we can double the amount of weight they can push on the leg press.’
4. Stress fractures
What are they and what causes them?
Everything you need to know about runner’s knee stress fractures that can trigger significant pain. A fall can be an obvious cause, but Paton says that runners should be aware that underlying factors can also contribute to such bone injuries.
‘Things like calorie restriction and RED-S can cause common stress fractures in the hip, the neck of the femur and the pubic ramus, which is the lower part of the pelvis,’ he says. ‘Things like calcium intake and diet have an effect, but if a runner is doing a lot of mileage and they’re not taking in enough calories and don’t have enough break times between runs, energy deficiency is a factor.’
How do I recognise the symptoms?
A stress fracture is difficult to miss. It will cause extreme discomfort when walking and even standing, and running will feel unachievable.
How can they be treated?
If you have this pain, Paton says that you should stop running to allow the bone to recover. ‘Start with a period of maybe of using crutches, trying to offload and rest to let the bone settle, and then a period of really phased weight bearing followed by phased-in loading.’
What are the best prevention measures?
Also, if the stress fracture wasn’t caused by trauma, Paton recommends taking a look at the possible contributing factors to help prevent it from recurring. ‘The injury might relate to a runner’s biomechanics, muscle flexibility or strength, but things like footwear, training load, frequency, intensity and duration, plus the surfaces they run on and whether or not they and don’t incorporate higher-intensity sessions into their training are all factors.’
5. Osteoarthritis
What is it and what causes it?
Osteoarthritisis more common in older runners, and can often affect the knees, hands and spine as well as the hips. This occurs when the cartilage between the bones begins to deteriorate, leading to inflammation. In the hip, this pain would be felt within the ball-and-socket joint.
‘Arthritis relates to a degenerative change in the cartilage, but it ends up being a kind of disease of the whole joints,’ explains Paton. ‘We see a lot of people with gradual thinning cartilage, especially if they’ve had an injury at a young age. Most people don’t have pain, but there can be a point where the cartilage is a bit thinner and the bone underneath bruises. There are a lot of nerve fibres in bone and it’s a very strong pain generator.’
What are the symptoms?
Most people feel pain at the ball and socket hip joint, although some people experience no pain at all.
How do I recognise the symptoms?
Recovery involves giving the bone some downtime. But, a case of osteoarthritis in the hip doesn’t have to spell the end of your running career. ‘Sometimes, the hip is very stiff – it’s a big joint and the ligaments are very strong. When they get stiff, it’s very hard to change the range of movement in the joint, but you can change it by stretching and doing mobilisation work, especially after heat like a hot shower. If we can increase the range, we can increase the rotation and then the cartilage gets a much more even loading – you don’t get a focused amount of load over one area, which often helps.’
What are the best prevention measures?
Alternating some of your high-mileage or intense running sessions with low-impact cardiovascular activities such as rowing machine or exercise bike allows you to reduce the strain on your hip and lower body while keeping active. Patron also says that incorporating regular strength training Best Garmin deals.
David Smyth once ran the London Marathon in less than three hours and is still going on about it. A journalist for more than two decades, he has been involved in races in Ethiopia, Chamonix and the Giant's Causeway, but is happiest going up and down chalky trails in the South Downs where he lives. Give him a race with fewer than 100 entrants and a banana at the finish and he won’t ask for anything more. David is a regular ‘Human Race’ columnist in Runner’s World magazine, which has allowed him the privilege of talking to dozens of people taking on extraordinary challenges who are changing lives through running.
