Common Reasons for Hip Pain After Running

Runners have a high rate of overuse injuries and aches and pains. It is very common to experience pain in the front of the hip, back of the hip or outside of the hip following long runs, changes in volume or speed.

This article will cover common reasons for hip pain after running, as well as key strategies to manage or prevent hip pain.

Common Overuse Conditions of Hip

IT Band Syndrome

The IT band is a large band of connective tissue that runs from the top of the outside of your hip all the way down below the outside of your knee. 

It is a very common pain condition in runners because of the forces put on the outside of the hip. 

You can feel pain and discomfort anywhere from the outside of your hip all the way down to the outside of your knee. 

Commonly, having hip muscle weakness in the muscles on the outside of your hip can result in hip drop while running, this hip drop will then put more stress and pressure on the IT band as a compensation.

Gluteal Tendinopathy 

Another potential cause of pain on the outside of your hip is gluteal tendinopathy. Tendons connect muscles to bones, and your glute muscles have tendons just like your achilles.

Any tendon can develop painful tendinopathy from overuse.  This is a combination of an inflammatory condition and tissue breakdown that results in pain.  

A common presentation for tendon pain in the hip is:

• Pain on the outside of your hip
• Worse in the morning
• Better after getting warmed up
• Worse at the end of a run
• Very sore at the end of the day after a run

You can learn more about how to manage tendon pain in our article Running Injuries: Tricky Tendons.

Hip Bursitis

Bursas are fluid filled sacs near tendons that help provide lubrication to reduce friction as the tendons roll over bones. Bursas are easily irritated, can swell and be very painful. This can happen from a trauma to the area or overuse.  

It may be difficult on a physical exam to differentiate between gluteal tendinopathy and hip bursitis as the structures are in a very similar area.

High Hamstring Tendinopathy

A literal pain in the butt! 

This is the first pain location that isn’t on the outside of the hip. 

Your hamstring tendon attaches onto your “sit bones” on the back of your hip and just like any tendon, can develop a painful tendinopathy from overuse. It will have a similar pain pattern as discussed above with gluteal tendinopathy:

• Pain in the morning
• Better when you get warmed up
• Worse at the end of the run and after you are done running
• Pain bending over to touch toes, climb stairs, or get into deeper lunges or squat positions

This tendon is commonly irritated in running, particularly when getting compressed with deeper hip flexion.

Commonly, runners that start working an increased amount of speed work or incorporating hill training can develop high hamstring tendon pain.

Hip Arthritis 

This is true “hip joint” pain and is inflammation of the hip joint. This tends to be more prevalent in older runners and develop gradually over time.

It presents with pain located in the groin, or inside the hip.

There is a specific complaint called “The C Sign” that is most associated with arthritic hip pain.

Commonly people will have restricted range of motion, muscle weakness and “pinching” in specific hip motions.  

Common Reasons for Hip Pain After Running

Those structures mentioned above are the location of the pain.  But, many times they aren’t the cause of the pain. 

What do I mean?

Let’s look specifically at hip arthritis. Hip arthritis is diagnosed by an X-ray, and some patients have very “bad” looking x-rays but no pain, while other patients have relatively normal x-rays showing minor arthritis but severe pain.

Why the difference?

Often people with pain have corresponding muscle weakness, restricted range of motion or movement inefficiencies that put more stress on the hip joint, overtime this results in pain.

Rather than worrying about the structure, we address the underlying issues and often find that pain will reduce over time. So let’s dive into some of the common reasons for hip pain to begin in runners.

Muscle Imbalances

When we evaluate an active patient with hip pain, one of the most common findings is asymmetries in muscle strength around the hip joint. Most commonly, we will see either side to side imbalances where the muscles around the painful hip are “weaker” than the non-painful hip. Or, we may see imbalances between the muscles on the inside of the hip compared to the outside of the hip.

Weak Hip Muscles and the Importance of Hip Strength

Why is hip strength so important?

The muscles of the hip joint are designed to add stability and coordinate movements between the hip and the pelvis. This is critical for a normal running stride.

Essentially, running is a small repeated single leg squat or jump about ~5000 times every mile. The ground forces can be over 2x your body weight with each step. If your hip muscles are not able to manage those forces it can cause breakdown and pain. 

Specifically, the muscles on the outside of your hips are key to keep your hips level while running.

If the muscles on the outside of the hip can’t support the ground forces it can result in hip drop. This pattern can contribute to pain in the outside of the hip, IT Band pain, knee pain and other issues.

Hip Exercises for Hip Pain

The primary muscles that we want to strengthen in runners are: hip flexors, hip extensors (the glutes), hip abductors (outside hip muscles) and the hip adductors (the muscles in your groin). 

Here are some of our favorite exercises for each:

Hip Flexion Exercise

Hip Extension Exercise

Hip Abduction Exercise

Hip Adduction Exercise

Incorrect Training Volume

Running form is one aspect of running, but training errors can have a huge impact on pain and injuries. And it isn’t always just “overuse.”

Frequently, we see runners doing too much too soon after doing too little for too long.

Runners will take time off, and then ramp up to train for a race. They might start adding in speed work or hill work into a training routine with no build up. 

These training errors end up putting extra stress on the structures surrounding the hip and can lead to pain and injury. 

Lack of Hip Mobility 

A “normal” running stride requires adequate hip flexion, extension, internal and external rotation. 

So what is normal?

Often less than people think. “Normal” hip motion is much less than shoulder motion. And many people think they are “tight” when in reality they actually have adequate hip mobility for running.

But if your hip motion is limited, it will force you to compensate with each and every step and improving your hip motion can improve your running efficiency and decrease your pain. 

Tight Hip Flexors

One common muscle that gets tight in runners are the hip flexors. This is often due to overuse of the hip flexors during the recovery phase of the running motion. Losing mobility through this area can have a variety of outcomes.

First, it can reduce your stride length, this will affect how you run and will make you less efficient. 

Additionally, if your hip flexors get tight it can affect your posture. It will tend to tip your pelvis forward which has a few effects:

• It can put more stress on your lower back
• It can decrease the space in your hip joint. This can limit hip rotation and contribute to a pinching feeling.

How do you know if your hip flexors are tight? What can you do to relieve some of that tightness? Hip mobility drills.

Hip Mobility Drills

Here are a few of our favorite stretches for the muscles around the hip:

A Better Hip Flexor Stretch

½ Split Adductor Rocking

World's Greatest Stretch with Band Distraction

Conclusion

Hip pain in runners is extremely common and often related to a combination of:

• Impaired hip mobility
• Decrease hip strength
• Hip muscle asymmetry
• Inefficient running mechanics
• Running training errors

Hopefully these strategies and exercises will give you a great starting point for caring for your hips and maintaining your running routine!

Have you recently been side lined from a running injury and are ready to get back to your training? Download our free Return to Running Scorecard to see if you're ready to get back out there.

At Kinetic Sports Medicine and Performance we help runners stay healthy, recover from injuries and perform at their highest level. If you are dealing with hip pain and would like to talk more about your specific case, schedule a free discovery call with one of our doctors of physical therapy today.