Hip Pain in Runners: Causes, Symptoms, and Prevention
Hip pain is a common complaint among runners and often emerges during or shortly after a run. Because the hip area is complex—comprising muscles, nerves, joints, and tendons—pain felt here isn’t always directly caused by the hip joint itself. It may signal issues elsewhere in the body.
Although the hip is anatomically a ball-and-socket joint connecting the thigh bone (femur) to the pelvis, many refer to the entire region between the pelvis and buttocks as the “hip.” This area is central to both core stability and leg movement. Understanding where your pain is coming from and what might be causing it is crucial to treating and preventing long-term issues.
“Instead of thinking locally, I also think globally and make sure that all dysfunctions have been addressed,” says Dr. Bruce Paton, consultant physiotherapist at the Institute of Sport Exercise and Health. “It’s about assessing how the leg is rotating and moving overall—joint stiffness, muscle flexibility, and strength all come into play.”
What Does Hip Pain Feel Like When Running?
Hip pain while running can present in different ways depending on the cause. Sharp, activity-related pain might indicate a stress fracture, while a dull ache on the bony outside of the hip could be a sign of bursitis. Regardless of intensity, any hip discomfort should not be ignored, as minor issues can become serious if left untreated.
1. Muscle Strains and Tendinopathy
Cause:
The hip region houses 17 muscles across four main groups: gluteal, lateral rotator, adductor, and iliopsoas. Overuse is the primary cause of muscle strain and tendinopathy, often due to rapidly increasing training volume.
Dr. Paton highlights factors like poor flexibility and muscle weakness. For example, tight hamstrings or underactive glutes can shift strain onto other muscles or tendons. Even non-running activities, such as prolonged sitting, can compress tendons and exacerbate pain.
Symptoms:
Pain may originate near the sit bone (where the hamstring attaches) or on the outside of the hip, pointing to gluteus medius tendinopathy.
Treatment:
Initial rest helps but isn’t always a complete solution. Consulting a physiotherapist is recommended to uncover root causes and begin targeted rehabilitation.
Prevention:
Avoid long periods of sitting when possible. Maintaining proper posture and strengthening hip muscles can reduce the risk of tendinopathy.
2. Iliotibial Band (ITB) Syndrome
Cause:
The iliotibial band is a long strip of connective tissue running from the pelvis to the knee. It becomes painful when inflamed or tight, often due to repetitive motion and muscle imbalances.
When the gluteus medius is weak, it causes the pelvis to tilt forward, placing strain on the tensor fasciae latae (TFL). This tightening pulls on the ITB, especially during long-distance runs or when runners suddenly increase their mileage without adequate conditioning.
Symptoms:
Though pain usually appears near the knee, it can also affect the upper thigh bone (trochanter).
Treatment:
Stretching can relieve tension. One effective method is a modified quad stretch: bend the affected leg backward, grab the ankle with the opposite hand, and engage the glutes for a deeper stretch.
Another option is a kneeling lunge, raising the arm on the affected side to stretch the TFL, hip flexors, and ITB.
Prevention:
Strengthen the gluteus medius with exercises like closed-chain hip abduction. Stand on one leg and let the pelvis drop on the opposite side, then use the standing side’s glute to level it. Incorporate hill sessions or speed work to improve muscle endurance.
3. Bursitis
Cause:
Bursae are fluid-filled sacs that reduce friction between bones and soft tissue. In the hip, two major bursae are located near the trochanter. Overuse, poor cushioning (such as sleeping on a hard surface), or muscle weakness can cause inflammation.
Symptoms:
Pain is usually felt on the outside of the hip, near the protruding bone at the top of the femur.
Treatment:
Reduce pressure on the affected area. If sleeping on your side causes discomfort, try the opposite side or use cushioning. Rest is essential.
Prevention:
Twice-weekly strength training can increase muscular support around the joint. Use a leg press machine with heavy weights and low reps to challenge the gluteus medius and minimus. According to Paton, most patients can double their strength in 6–12 weeks with consistent effort.
4. Stress Fractures
Cause:
Stress fractures in the hip can result from trauma, but they are often caused by energy deficiencies, low bone density, or inadequate nutrition—especially in athletes experiencing Relative Energy Deficiency in Sport (RED-S).
Factors like low calcium intake, overtraining, and insufficient calorie consumption increase risk. The femoral neck and pubic ramus are common fracture sites.
Symptoms:
Stress fractures cause significant pain during weight-bearing activities. Walking and standing become uncomfortable, and running is typically impossible.
Treatment:
Cease running immediately. Rest and non-weight-bearing support (e.g., crutches) are crucial, followed by a gradual return to activity under professional supervision.
Prevention:
Address underlying factors like training load, recovery time, footwear, nutrition, and running surfaces. Strengthening muscles and improving flexibility also reduce stress on bones.
5. Osteoarthritis
Cause:
Osteoarthritis (OA) is more common in older runners. It occurs when cartilage in the hip joint wears down, leading to bone-on-bone friction and inflammation.
Paton explains that cartilage thinning may not cause symptoms initially, but once the bone becomes bruised, the pain can become intense. Previous injuries and limited mobility increase the likelihood of OA.
Symptoms:
Pain is usually felt deep in the hip joint. Some individuals may feel stiffness or have restricted movement.
Treatment:
Stretching and joint mobilization, especially after using heat (e.g., showers), can improve joint rotation and distribute pressure more evenly.
Prevention:
Replace high-impact runs with low-impact cardio (e.g., cycling or rowing) to reduce joint stress. Strength training also supports joint health and function, making it an essential part of a runner’s routine.
Final Thoughts
Hip pain in runners can stem from a wide range of causes—some as minor as muscle tightness, others as serious as stress fractures. Addressing pain early, incorporating strength training, maintaining proper form, and adjusting training intensity are key to staying healthy and avoiding long-term injury. If symptoms persist or worsen, always consult a qualified physiotherapist or medical professional.
