As runners, we often feel some hip pain, soreness, weakness or loss of flexibility. Another common pain issue for runners can be knee pain, but hip pain is a more common issue for most runners. The reason we often get some hip pain issues is that hips are in the middle of our body, attached to most of our joints, ligaments and muscles that support a good running form.
Our hips are massive joints with numerous muscular and ligamentous attachments, so the hips are not only vital to sustaining a strong, efficient, and powerful running stride, but are also at risk for various musculoskeletal injuries.
Our hips are the largest synovial joints in the body and have a ball-and-socket (spheroid joint) configuration where in the head of our femur (thigh bone) articulates into the concave acetabulum (socket) formed by the bones of the pelvis.
The ball-and-socket configuration makes the hip highly mobile, allowing for forward flexion and backward extension, lateral abduction (out to the side) and adduction, and internal and external rotation.
The hip joint is controlled by several large and small muscles, which work together to carry out these movements in a controlled and powerful form.
Our hamstrings and glutes are muscle groups composed of several synergistic muscles that together help extend the hip. The Iliopsoas group of muscles flexes the hip.
There are also smaller and deeper muscles like the piriformis, tensor fascia latae, gemellus superior and inferior, and obturators that help with rotation, and a large group of adductors in the inner thigh.
While we don’t need to memorize every muscle to prevent hip pain after running, the takeaway is that hip motions are highly complex, and it’s important for runners to engage in a well-rounded routine of exercises that increase the strength and mobility of the hip muscular structure.
Causes Of Hip Pain After Running
If you are feeling hip pain after running, it is important to identify the cause as soon as possible before it increases into a more serious running injury or causes additional injuries further down the kinetic chain to your knees, shins, ankles, and feet due to compensations or biomechanical alterations in our running stride.
The hips play a key role in every single step we take while we run. They form the root of our lower limbs, so our hips power and control our entire running stride.
Hip pain in runners may be due to damage to the muscles, tendons, ligaments, bones, cartilage, or bursa due to overuse or acute injury.
The Most Common Causes of Hip Pain After Running
1. Trochanteric Bursitis
When we run, structures in the hips such as bursa and cartilage reduce friction to enable a smooth and comfortable stride.
The trochanteric bursa is a fluid-filled sac at the top of the femur (thigh bone). The repetitive motion of running can irritate this bursa, leading to painful inflammation of the sac, termed trochanteric bursitis.
Runners with hip pain on the outside of the hip that gets worse with running, walking, climbing stairs, or getting up from a low chair, should consider this potential injury. The pain usually increases if we press on the side of our hip or try to lie on that side when we sleep.
2. Hip Flexor Strain
The most common causes of hip pain in runners are muscle strains and tendonitis. These injuries usually result from sudden directional changes, sudden acceleration, deceleration or eccentric contractions.
Runners tend to have chronically tight hip flexors, especially if they sit at a desk. If we feel pain at the front of our hip in the soft tissue where our thigh meets our trunk, particularly if it’s more superficial than deep (deep is more likely iliopsoas), it might be a hip flexor strain.
3. Iliopsoas Tendonitis
Pain in the front of the hip or groin while running, lifting our leg up, climbing stairs, and standing up from a chair, may be indicative of iliopsoas tendonitis. The pain may also radiate to the knee.
This hip injury in runners is usually due to overuse, particularly after an increase in speed workouts or running distance. It often has a gradual onset, with the pain feeling mild after we are done running, but eventually progressing to lingering at rest.
4. Hip Joint Impingement
Hip joint injury, referred to as femoroacetabular impingement, leads to hip pain after running and during running, which may also radiate to the groin. The hip pain is due to inflammation that occurs in the ball-and-socket joint of the hip from excessive internal rotation of our hips when we run.
This inflammation results in a painful pinching of the nerves or ligaments in the hip joint. The pain usually develops gradually over several weeks.
5. Iliotibial Band Syndrome- IT Band
The IT (iliotibial) Band is a thick band of fibrous connective tissue that runs down along our outer thigh from the hip to just below our knee and on the side of our shin. The IT Band crosses both the hip and knee joints and is a structure prone to injuries in runners.
IT Band syndromes is an inflammatory condition marked by tightness, pain, and increased friction at either the hip joint, knee joint, or both. There is sometimes a clicking sensation.
This hip injury can affect runners of any level, although it is most common after sudden increase in kilometres and intensity and from wearing worn-out running shoes and excessive running downhill.
6. Hip Arthritis
Hip arthritis is a degenerative condition that refers to a thinning of the cartilage between the bones of the hip joint. It can cause rubbing and crepitus in the joint and has a gradual onset.
7. Hip Stress Fracture
A stress fracture of the femoral neck or hip is an overuse injury. Runners with poor bone density are at increased risk of this hip injury. Pain may radiate to the groin. We need to make sure we take some calcium and magnesium supplements daily to support our bone and muscle health.
8. Labral Tears
The hip joint socket is lined with strong, flexible cartilage called the labrum. This cartilage can tear from repetitive overuse, which can lead to a constant dull ache at rest and sharp, stinging pain while we are running.
Runners may also feel a catching, clicking, or locking sensation, with or without the feeling of hip instability while running.
We may also experience hip pain after running, which may calm down after several hours.
9. Muscle Pulls or Tears
Injuries to the quads, hamstrings, and glutes can cause hip pain while running. The location of the pain can confirm which muscle is damaged. Pain in the back bottom of the thigh may be a hamstring injury. The quads are in the front of the thigh.
Risk Factors For Hip Pain For Runners
There are several training errors and risk factors for hip injuries from running:
Sudden increases in kilometres or speed workNot warming up prior to a workout
Osteoporosis and/or inadequate caloric and nutrient intake
Excessive downhill running
Poor running form
Leg length difference
Running on sloped/technical or imbalanced roads
Overtraining or insufficient rest and recovery
Preventing And Treating Hip Pain After Running
Treating hip injuries from running usually involves some amount of rest, with the potential for low-impact training until it is pain-free. Depending on the diagnosis, ice, heat, and physical therapy might be recommended. Surgery is sometimes implicated, depending on the type and severity of the injury.
In terms of returning to running and preventing hip pain, runners should add the following practices:
It’s crucial to warm up before jumping into our workout in order to increase circulation to our tissues. Cold tissues are tight, and this limited range of motion can cause muscle pulls or tendon strains.
To help prevent hip pain after running, we need to perform dynamic stretches for close to 5 minutes before starting our full workout.
2. Run On Even Surfaces
Cambered roads, which slope from side to side, put our hips at different levels, increasing the stress on our hips and pelvis. We should try to run on level footing or run on a track or treadmill until our hip pain after running reduces.
Both downhills and trails put excessive strain on the adductors and hips due to the increased demand to stabilize the pelvis.
3. Get New Running Shoes
The general advice is to replace our running shoes every 450-800 km to ensure optimal support. Worn-out shoes can increase our risk of hip pain while running because they lack the cushioning, balance and support we need.
4. Progress Gradually
Overtraining and sudden increases in kilometres and intensity put us at a greater risk for hip injuries from running. We should follow the 10% rules, we should only increase our kilometres by a maximum of 10% from one week to the next. It’s also important to pay attention to jumps in intensity. Hip flexor strains often follow hard workouts, so we need to give our body ample recovery between hard efforts.
5. Improve Your Diet
To promote healthy bones and recovery from workouts, we need to make sure we are getting enough calcium, magnesium, vitamin D, protein, enough carbohydrates, and total calories through our diet. Consider speaking with a sports nutritionist if you need help.
6. Strengthen Your Core and Hips
Hip muscle weaknesses and imbalances increase the risk of hip injuries in runners. A weak core also leads to instability of the pelvis, which puts extra strain on the hips and pelvis.
A well-rounded strength training program for runners should strengthen the entire core, including the iliopsoas, and also target the hip internal and external rotators and adductors and abductors.
Hip strengthening exercises for runners:
Rear-elevated split squat
Hamstring curls with a stability ball
Side leg raises
Resistance band lateral walks
Single-leg glute bridges
Dumbbells hip thrusts
Banded hip marches
Inner-thigh ball squeezes
7. Do Mobility Work
Tight hip flexors, hamstrings, quads, glutes, IT band, hip abductors, adductors, and internal and external rotators increase the risk of hip injuries for runners.
We should make sure that we are stretching frequently, especially after running and doing soft tissue mobility work with a foam roller, lacrosse ball, or massage gun.
Hip mobility exercises for runners:
Frankenstein walks- Step and kick opposite leg up and toe tap
Side leg raises
Hip flexor stretch
Agility ladder drills
Straight leg raise
With all this information, there are many preventative measures we can take to help prevent hip pain after running. If we do feel pain, it is important to seek a professional physio therapist to help to find the cause of the problem and a plan of action to get better quickly.
Focus on Good Running Form, Hip Strength, Flexibility And Recovery, Enjoy Good & Comfortable Runs!