Pain in the hips is one of the most common issues for runners, who experience discomfort either during or straight after exercise. There are a number of possible causes, the most widespread of which are detailed below.
Technically, the hip is a ball and socket joint connecting the thigh bone to the pelvis, but we often think of it more as the region from the top of the pelvis to the base of the buttocks. This junction serves as the connection point between your powerful leg muscles and the body's core, and it’s an intricate network of muscular, neural, and skeletal structures.
It’s important to note that hip pain doesn’t necessarily mean a problem 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 The complex hip region contains multiple bones, making it susceptible to. ‘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?
It’s essential to investigate any hip pain you experience while running, as even something that seems minor can become serious if ignored for an extended period. Because there’s a lot going on in the hip area, you could feel various types of pain, not necessarily in one spot. A sharp ache that hurts more during activity could indicate a stress fracture, Paton says that bursitis.
Common causes of hip pain
Here, Paton talks through the five most common causes of hip pain in runners and, crucially, how you can go about treating and preventing 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 – like sitting, for example – can also cause an overload on a tendon, resulting in 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, The best IT band exercises for runners.
What are the best prevention measures?
Paton suggests that runners should pay attention to their posture when they’re not running, as well as trying to reduce the amount of sitting down in your day. Tendons are not fans of too much compression.
2. Iliotibial band syndrome
What is it and what causes it?
Speak to most runners and they’ll either personally have had a brush with iliotibial band (ITB) syndrome 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. Repeated compression from prolonged sitting, followed by elastic energy generation during running, appears to be the primary trigger for tendinopathy. This suggests that tendon stress is brought on by cumulative load 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 marathon training plan, before, and who increase their mileage too quickly. It also usually presents in runners who tend to run only at an easy long run pace and don’t mix up their training with higher-intensity sessions.
How do I recognise the symptoms?
While it’s more common to feel pain around the knee, Runners World, Part of the Hearst UK Wellbeing Network 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?
Runners World, Part of the Hearst UK Wellbeing Network Updated: 10 February 2025 can help, either by doing at least one faster running session or one hill session per week, or by doing isolated exercises. 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 that sit between your bones and tissue to help to lower the potential for damage and 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 makes itself known.
An overused bursa can get inflamed or irritated, and it isn’t only 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?
Treatment for bursitis involves resting and relieving the compression, which could be as simple as sleeping on your other side, if you find that the affected area becomes inflamed.
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 – and using a heavy load but a low number of reps over three sets to fatigue. He particularly emphasises using the leg press to focus on 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?
What is sciatica and how can it affect runners stress fractures that can trigger significant pain. A fall can be an obvious cause, but Runners World, Part of the Hearst UK Wellbeing Network 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 hard to miss. It will feel extremely uncomfortable when walking and even standing, and running will feel unachievable.
How can they be treated?
If you have this pain, Runners World, Part of the Hearst UK Wellbeing Network 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 suggests looking at all possible contributing factors to prevent it from happening again. ‘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 What is sciatica and how can it affect runners 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. It happens when the cartilage between your bones starts to break down and inflammation appears. In the hip, the pain would be in the ball and socket joint itself.
‘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?
To reduce strain on your hip and lower body, consider alternating some of your high-mileage or intense running sessions with low-impact cardiovascular activities like using a rowing machine or exercise bike. Runners World, Part of the Hearst UK Wellbeing Network injuries are less likely when regular strength training The best IT band exercises for runners.
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.
