What It Means if You Have Hip Pain When Running
That sore hip could be a strain, tear, or something else. Here's the scoop on possible causes, treatments, and prevention of hip pain while running.
When running hurts
Many people turn to running to improve cardio fitness, because, well, running is great.
It requires little equipment—just a solid pair of running shoes, maybe some reflective workout gear, and a treadmill if you really want—and you can do it almost anywhere and anytime, as long as you don’t have pain or a health condition that prevents you from doing it.
Speaking of pain, running itself can can increase the risk of certain aches and pains—particularly if you don’t ease into it.
A study published in 2018 in the journal The Physician and Sportsmedicine found that more than 30 percent of runners experience a running-related injury within one year of starting. New runners reported more injuries per 1,000 hours of running, compared with experienced runners.
While runners most often complain of knee problems, another common issue is hip pain. But what causes hip pain while running? Here’s what to know about the differences in hip pain, what leads to the aches, and how to prevent and treat it.
How to identify hip pain while running
Hip pain can show up in a few ways, particularly when you’re running.
Heather Jeffcoat, DPT, owner of Fusion Wellness and Physical Therapy in Los Angeles, says that while pain can happen at the hip joint, other areas of the body may be affected.
Pain at the pelvis or sacroiliac joints (you’ll find them where the pelvis and lower spine connect) can feel like hip pain. Muscle aches or tendon issues can also be a cause, as can a combo of a few issues. Even conditions of the lower spine can radiate to the hip, she says.
According to Jeffcoat, typically a doctor or physical therapist will do a full exam and potentially take an X-ray to see exactly what’s causing your hip pain. You’ll also go through a series of movement assessments as well as tests to reproduce the pain or screen for spine issues. All of these evaluations help determine whether the pain is joint-, muscle-, tendon-, or nerve-related.
Muscles involved in hip pain while running
Jeffcoat says muscle-related hip pain can have any of a number of sources:
- Gluteus maximus: largest of three gluteal muscles that make up the butt
- Gluteus medius: muscle on the side of the hip
- Gluteus minimus: smallest of the gluteal muscles, found under the gluteus medius
- Piriformis: another muscle deep in the butt
- Tensor fasciae latae: a hip abductor
- Quadriceps: at the front of the thigh
- Hamstrings: along the back of the thigh
- Obturator internus: a muscle deep in the pelvis
- Iliopsoas: on the front of the hip
- Adductors: of the inner thigh (often associated with groin pain).
Problems might even pop up involving the iliotibial band (or IT band), which runs from the pelvis, across the knee, and attaches to the shinbone. Check out these IT band stretches to find relief.
Injuries leading to hip pain
Of course, trauma to the hip may be a source of hip pain. If you fall while running and land on your hip, you’ll bruise and ache and, yeah, you’ll feel it while you run. But there are many other issues that might lead to aches in that area.
Here’s what to look out for and what to know about prevention and treatment.
8 causes of hip pain while running
Muscle strains and tendonitis are the most common causes of hip pain in runners, often in the hip flexors or hip adductors. A strain to the hamstring muscles may also cause pain in the hip, says Amanda Weiss Kelly, MD, orthopedic physician and chief of the division of pediatric sports medicine at University Hospitals Rainbow Babies & Children’s Hospital.
A muscle strain can be acute (say, from a fall) or it can result from overuse. If you have a hamstring strain, the hip pain also often comes with pain in the butt, Dr. Kelly says.
“Someone who adds miles too quickly, or they try to make their pace faster while also increasing their mileage, may experience this problem,” Dr. Kelly says.
She suggests the 10 percent rule: Don’t increase your total weekly mileage by more than 10 percent each week. This will help you avoid muscle strains.
Working with a physical therapist and taking over-the-counter pain medications can help with the aches from muscle strains.
Another overuse injury, hip tendinitis (more specifically, tendinitis of the iliopsoas tendon at the hip) can lead to pain, Jeffcoat explains.
Tendinitis refers to inflammation, often caused by consistent pulling on that tendon, which causes aches. Tendinitis of the hamstring can also occur in runners and cause hip pain, Dr. Kelly says.
To avoid tendinitis, you need flexibility in the hips, so count stretching as an important part of your routine, Jeffcoat says. Add a kneeling hip flexor stretch to your warm-up and cool down, before and after running. Here’s how to do it:
- Kneel on the floor with your left knee directly under your left hip.
- Place your right foot flat on the ground, in front of your right hip. Your knee will be bent at a 90-degree angle and your thigh parallel to the floor.
- Keeping your back straight and hands at the front of your thigh by your knee, lean forward. Avoid rotating your pelvis.
- Hold for 30 to 45 seconds. Repeat 2 to 5 times, then do the same stretch with the other hip.
Often after a tendon heals from tendinitis, it’s not as strong as it was prior to the injury, Dr. Kelly explains. That means it can’t handle the force of a hard run as it previously did, and this can cause pain.
In order to help with this, Dr. Kelly says many doctors will work on eccentric loading the tendon, which means working the muscle in the elongated (or downward phase) of an exercise.
(Try these groin stretches that can help ease aches.)
“The labrum is like a suction cup in the hip,” Jeffcoat says. It’s a ring of cartilage that rounds the hip joint socket to protect your bones. Sometimes this ring can tear.
Pain caused by a labral tear might feel like a pinch at the front of the hip, more intense pain when you go from sitting to standing, or a catching sensation at the hip.
You can get a labral tear either from trauma (like a fall) or it can come from poor running mechanics, particularly if you have any abnormalities in your anatomy at the hip, Dr. Kelly says. Labral tears often get misdiagnosed as muscle strains.
Your doc often will diagnose a labral tear through hip impingement testing, a physical hip-movement test for pain, and a hip arthrogram, a radiology test that involves contrast (or “dye”) at the joint and then imaging.
While surgery is the only way to fully repair a labral tear, that’s not the only route to remedy the pain. “Once we work on fixing run mechanics, patients can often go back to activity,” Jeffcoat says.
However, sometimes fixing form isn’t enough, and people have to find another form of cardio other than running, or opt for the surgery.
This often happens in older individuals, Jeffcoat explains. However, trauma to the hip can also increase your risk. For example, fractures may make you more prone to osteoarthritis.
Osteoarthritis of the hip causes pain as the cartilage wears away at the joint and bone starts to rub against bone. Over time, this can worsen, so it’s best to catch the condition early.
Pain from osteoarthritis can increase with intense physical activity. You may feel stiffness, which makes it difficult to walk; a locking or sticking at the hip joint; and/or decreased range of motion. Doctors will determine if you have the condition by taking an X-ray.
While there’s no cure for osteoarthritis, physical therapy can help you lessen pain and increase range of motion and flexibility. Limiting high-impact movements—that includes running—can help decrease pain associated with the condition.
The piriformis muscle lies deep in the butt and works to externally rotate the hip. Piriformis syndrome can often affect the sciatic nerve, which runs from the lower back down the butt and leg. The sciatic nerve and muscle run close to each other.
Jeffcoat says this syndrome often arises due to overuse (aka running too long or too hard or too often without building up to it), poor running mechanics, and lack of proper stretching before or after a run.
These can all lead to microtrauma at the buttocks, which leads to inflammation and pain.
Most people will experience pain after sitting for more than 15 minutes, as well as pain while walking, according to The Journal of the American Osteopathic Association. You’ll likely also feel pain in the butt if you have piriformis syndrome.
Doctors will often suggest nonsteroidal anti-inflammatory drugs (NSAIDs like Advil), muscle relaxants, ice, and rest to help ease pain. Stretching the piriformis muscle and strengthening both the abductor and adductor muscles of the legs may also help.
Bursae are fluid-filled sacs that, when swollen or inflamed, can lead to bursitis. This condition can occur in a number of areas of the body, including the elbow and shoulder—as well as the hip. When you perform a repetitive activity, like running, you may experience pain from bursitis.
Hip bursitis is distinguishable from other types of aches, as it feels painful to the touch and might make it difficult to sleep on the side of the injury.
“You need to balance the activity you’re doing and the positions you’re holding,” Jeffcoat says. Doing so will help you avoid hip bursitis.
That means, if you’re sitting all day and then going right out for long runs, your hip bursa could easily get inflamed and lead to pain.
To cut your risk of the condition, make sure you’re stretching properly before and after runs and breaking up bouts of sitting with frequent walks.
IT band syndrome
Another reason to properly warm up and cool down before and after your runs: If you don’t, you up your risk of IT band syndrome.
The IT band runs from the hip to the knee, and often causes knee pain along with hip pain. Bending and extending the leg moves the band over the outer lower edge of the thighbone, and then can irritate surrounding tissues, leading to pain.
This overuse injury can stem from a weak core, too, Jeffcoat says. Your core muscles are those in your abdomen, pelvis, lower back, and hips.
Making sure you’re actively stretching your legs and working your entire core, as well as cutting back on activity will also help to alleviate aches associated with IT band syndrome.
This often comes from a combination of training errors and lack of proper nutrition, says Dr. Kelly.
“If you’re not replacing the calories you expend when running, then you don’t have the supplies in the body to build bone appropriately and can end up with a fracture,” she says. “Unfortunately runners get into a trap of thinking that if they weigh less, they’ll run faster, which is true to a point, but there is also a point where you break your body down.”
Doctors often pinpoint this injury because tasks like standing on one leg or jumping up and down on one leg is significantly more painful in people with a fracture, versus a muscle strain or labral tear.
Just looking at a runners’ weight probably won’t signal if they’re getting enough calories. But if you notice that your period is lighter, that could be a sign you’re lacking adequate nutrition.
In order to prevent a stress fracture, focus on a combo of gradually (not drastically) building up mileage or speed, as well as replenishing the calories you lost on a run, Dr. Kelly says. She suggests eating about 80 to 100 calories for every mile you run.
For the treatment of stress fractures, Dr. Kelly suggests pulling back on mileage and working with a physical therapist to address the issue and your aches.
Strength training for hip pain prevention
If you want to increase your chances of avoiding hip pain, make sure you have a balanced core strengthening routine, Jeffcoat says. That means you’re not just doing crunches, but also working your obliques and the deepest muscles of the core, also known as your transverse abdominis muscles. (You’ll target those in moves like planks.) These muscles support a strong posture through daily activities like running.
Dr. Kelly also mentions having strong glutes, including the gluteus medius, and a strong low back, as well as adductor and abductor muscles, to help with running performance and avoiding hip pain while running.
It’s also important to have a flexibility routine for the hips, Jeffcoat says. Aim to loosen up all of the muscles of the lower body, including the hip flexors, glutes, quads, hamstrings, and calves.
How to avoid hip pain from poor running mechanics
If you’re a serious runner (or want to be a serious runner), Jeffcoat suggests getting a biomechanical assessment by a medical professional to test your subtle movement patterns—like transferring load from one side of the body to the another.
You need good strength in your pelvic stabilizers, big and small glute muscles, and the tensor fasciae latae to avoid pain in the hip. Getting an assessment will help to address any muscle imbalances you have before they lead to aches, she says.
Another movement pattern that can lead to additional strain on areas of the body, including the hips, is the ability to stabilize the hip and pelvis together as you’re planting one foot and stepping over with the other. (If your hip drops as you run, this could be a sign that you’re not stable in this area.)
“If there’s weakness, especially through the glute medius and tensor fasciae latae, then you’re putting a lot of repetitive strain on the muscles,” Jeffcoat explains.
You can then develop trigger points and abnormal mechanics that lead to the above-mentioned conditions, like IT band syndrome, bursitis, and tendinitis. The inability to stabilize both the hip and the pelvis together could also come from a weak core, hip flexor tightness, or hamstring tightness.
Getting a video assessment of your gait, and working with a physical therapist to address imbalances and other injury-causing technique issues, can also help you avoid hip pain while running, Dr. Kelly says.
A professional will likely examine your knee and ankle too.
“Even if you have a problem at the ankle, it might present at the knee or hip,” Jeffcoat explains. “If you have pain in one joint, you need to assess the entire kinetic chain… It’s important to identify other causes above and below that joint, because a lot can be going on.”
When to see a doctor
“If any pain just happens once, it’s something we can overlook, particularly if it occurs with a benign activity, such as sitting to standing,” Jeffcoat says.
But if you feel pain after trauma, a numbness or tingling, or muscle weakness, that could be a sign of something more serious and it’s important to seek medical attention.
Tell your doctor about any recurrent pain, such as pain on the front (or anterior) side of the hip, even if it happens as you go from sitting to standing but does so repeatedly.
- The Physician and Sportsmedicine: "Differences in Injury Risk and Characteristics of Injuries Between Novice and Experienced Runners Over a 4-Year Period"
- Heather Jeffcoat, DPT, owner of Fusion Wellness and Physical Therapy in Los Angeles
- Amanda Weiss Kelly, MD, orthopedic physician and chief of the division of pediatric sports medicine at University Hospitals Rainbow Babies & Children's Hospital
- ACE Fitness: "Kneeling Hip-Felxor Stretch"
- American Academy of Orthopaedic Surgeons: "Osteoarthritis of the Hip"
- The Journal of the American Osteopathic Association: "Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach"
- Cedars Sinai: "Iliotibial Band Syndrome"