It's in the Hips: A Runner's Guide to Hip Pain & Running
Do you experience hip pain running? If so, you’re not alone.
While knee pain may be reported more commonly by runners, the answer to that pain may lie in the hips.
Hip pain can get in the way of a lot of your daily activities from going up and down the stairs, sitting at your desk while you work, and doing activities that you love - like running.
So what are you supposed to do? Just stop running?
Depending on the specific issue, you may need to take some time off doing high impact activities like running. But, more often than not, the cause of your hip pain while running boils down to one simple culprit: tight muscles.
Specifically, tight iliopsoas or hip flexor muscles.
Now, this isn’t the only reason for hip pain running, but your hips influence a lot of other areas of your body, so getting to the bottom of your hip pain should be a top priority.
Before we get into the causes of hip pain when running, it’s important to understand how exactly your body moves when you run.
Anatomy of running
When you run, your body primarily uses sagittal movements as your arms and legs propel you forward. Sagittal movements are joint movements that occur on the longitudinal plane that divides your body into left or right parts. These movements are a flexion or extension.
While running primarily utilizes sagittal movements, there will also be rotation of your leg joints to support your body weight as you move. An additional counter pelvic rotation will occur as your chest moves forward on the opposite side from your leg.
That’s all good to know, but what exactly does that mean? To break it down, let’s look a bit deeper at your running gait cycle.
The running gait cycle is characterized by having both of your feet off of the ground, versus walking where both of your feet are on the ground.
In this instance, we are defining a cycle as the period of time between one foot making contact with the ground until the same foot reconnects with the ground.
There are two phases in a runner's gait cycle: the stance phase (sometimes called support) and the swing phase.
When you are in the stance phase, and your foot makes its initial contact with the ground, you have a foot strike. This will occur mid-stance through your toe-off and takeoff.
Your swing phase starts with a float that moves forward into a swing or swing reversal, and then finishes with a foot landing. Once your foot has moved through these motions, the cycle begins again.
Your running stride length, form, and a few other physiological factors can impact the length of your running gait cycle.
Through all of these movements, several parts of your body are engaged. They are the:
- Plantar fascia
- Subtalar joint
- Achilles tendon
- Soleus
- Gastrocnemius
- Hamstring
- Glutes
- Rectus femoris
- Pelvis
- Abdominals
How much strain is on a particular area of your body while you run has a lot to do with your running form and the distribution of stress. If you have improper form, or something in your body is off balance, you are much more likely to develop hip pain running.
Why do I have hip pain from running?
While you engage several areas of your lower body while running, one of the primary motions is happening in your pelvis with your iliopsoas. The iliopsoas is made up of your iliacus and psoas muscles which are responsible for hip flexion, and are therefore also referred to as “hip flexors.”
Running utilizes the iliopsoas to swing the leg forward in the running pattern described above while simultaneously stabilizing your spine and your hips.
Your leg strides forward by using your iliopsoas. Then, when your leg extends behind you, the muscle stretches out. You are repeatedly contracting and stretching while your muscles work to stabilize your hip and spine which can quickly lead to overuse and muscle fatigue.
Because of this constant engagement of the iliopsoas as you move through the cyclical running gait cycle, there is a good chance one or both of your iliopsoas muscles will develop tightness.
When you have tight hip flexors, you may experience hip pain running, but many runners also experience pain in their knees, glutes, ankles, and lower back because of this muscle tension.
Some of these additional pain points along with hip pain while running can be signs of a tight iliacus.
What is really surprising to most runners is that your hip flexors never really get a break, even when you’re done running. When you are doing other things like sitting at your desk, laying on your couch, or simply doing household chores, your iliopsoas is still engaged.
That means these muscles could be why you continue to have hip pain after running or when you haven’t been running for a few days.
Since these are stabilizer muscles that control the flexion of your leg and any hip extension when running, they have a lot of pull in the surrounding muscles, joint structures, and bone alignment.
Tightness in the iliacus and psoas is so important to take note of as a runner because it can create a domino effect in your body.
Other common running pain points
If left untreated, overly tight hip flexor muscles can lead to a rotated pelvis, general body misalignment, poor posture, nerve pinching, hip joint pain, knee pain, ankle pain, SI joint pain, and lower back pain.
Not to mention, tight hip flexor muscles can impact your running gait and form - which can lead to further overuse injuries.
Not all running related pain points are directly associated with tight iliopsoas muscles, but many of them are. Here are some of the most commonly reported pain points for runners other than hip pain while running:
Knee pain after running
Have you ever heard of runner’s knee? Plantar tinnitus? IT band syndrome? All of these are common injuries that cause knee pain after running. Their causes vary but often knee pain and tight hip flexors go hand in hand.
Other causes of knee pain while running include overuse, improper form, or a muscular imbalance.
Ankle pain after running
If your ankles hurt during or after your run, it could be a matter of biomechanics or running form impacting the joint. Other causes of ankle pain associated with running include ankle tendonitis, arthritis, stress fractures, ankle instability, or sprains and strains.
Getting running shoes for overpronation can also help eliminate some ankle pain while running.
Hamstring strain
Much like your iliopsoas, your hamstrings are under a lot of stress and being continuously contracted as you run. When they are used for such repetitive movements, they may become strained.
If you’ve started to feel a sudden, sharp pain in the back of your thigh, swelling, bruising, or a popping sensation during or after your run, then you may have a hamstring strain. These symptoms may occur within 24 hours after the activity and may inhibit your ability to walk.
A hamstring strain can also cause hip pain while running.
Plantar fasciitis
Sometimes referred to as runner’s foot or running feet, plantar fasciitis is when the thick band of tissue that connects your heel bone to your toes becomes inflamed. This is a commonly reported pain point for many runners, especially long distance runners.
The most common symptom of plantar fasciitis when running or walking is a stabbing pain near your hee. This pain may be worse in the morning or during activity.
Piriformis syndrome
Your piriformis muscle is a small, stabilizing muscle in your hip joint under your glute. It is used to externally rotate your hips and stabilize your pelvis. The repetitive action of running can cause irritation of the piriformis muscle, especially if you have tight hip flexors.
When the piriformis is inflamed, it can irritate your sciatic nerve - causing symptoms in your thigh like weakness, numbness, or pain. Symptoms of piriformis syndrome often increase in severity when engaging in activities like running, squatting, lunging, or going up stairs.
Piriformis syndrome can also cause hip pain while running. Piriformis stretches can help.
Root causes of common running injuries
As we’ve mentioned, hip pain from running isn’t always due to tight muscles, and you can often narrow down the cause by identifying the area of the hip pain and visiting a medical professional.
For instance, if you have lateral hip pain, you may only have pain on your left hip. This hip pain may be associated with tight hip muscles and a rotated pelvis.
However, lateral hip pain can also be due to bone damage like a stress fracture which is why it is important to seek guidance from a medical professional.
Since tight muscles isn’t always the root cause of running injuries, we want you to be aware of three other common causes of hip pain while running:
Strength imbalance
Strength training is often recommended to runners as a cross training exercise. This is primarily to avoid strength imbalances that cause injury. If you have hip pain running, it could be due to a strength imbalance in your hips.
Muscle imbalances can also contribute to muscle tightness as stronger muscles overcompensate for weaker ones.
Having proper running form, performing regular counter muscle exercises, and engaging in cross training like yoga and swimming can help prevent muscular imbalance. You can also get regular muscle massages and practice muscle tension release.
Overuse
As the avid runners reading this know, running can be fun, amazing, and somewhat addictive.
What you also know is that it can be really hard on your body. That’s probably why you’re reading this article!
Overuse of your joints like your hips or your knees can lead to issues in muscle tightness, muscle strain, or even long-lasting disorders like bursitis. Overuse can also lead to more serious issues like stress fractures or cartilage tears if you continue to run on an already injured joint.
Most overuse injuries are noticeable while you are running and will cause inflammation after you’ve completed the run. If you feel hip pain running, running fewer miles and taking a few days off may help with mild overuse injuries.
Fractures or tears
Stress fractures and cartilage tears are also common causes of hip pain while running.
If you have a sharp pain on the inside of your hip when running, then it could be a stress fracture. This is especially true for road runners or long distance runners.
A cartilage or labral tear is often noticed by the clicking or catching feeling in your hip when you run, especially if it causes pain. If you’ve recently fallen or twisted your hip, a labral tear is even more likely.
Both fractures and cartilage tears will get worse if you keep running on them. So, if you suspect you have either of these, visit a doctor as soon as possible for treatment.
Running recovery
If you have hip pain running, one of the best treatment options is to visit a physical therapist. A physical therapist can help you determine the root cause of your pain, give you direction on treatment, and provide advice on running recovery to prevent future pain.
Physical therapy can easily answer some of your common questions like:
“Why do my ankles hurt when I run?”
“How can I learn how to run longer without causing hip pain?”
And “are there ways I can heal my hip pain at home?”
Delving into the causes of hip pain while running is just the start. From there, you can start to address the issue head on and hopefully get rid of your hip pain for good.
One of the most amazing discoveries I’ve made with my patients is how to release the iliacus muscle to prevent hip pain while running. To do this, you need to have a tool like the Hip Hook that can reach the iliacus muscle properly to perform a muscle tension release.
Muscle tension release appies prolonged pressure to release the tension. When tension is released, the muscle can finally relax and quit pulling on the surrounding area.
While stretching is a necessary and often recommended practice for runners, when it comes to releasing muscle tension, you do not want to stretch muscle knots.
Other trigger points to release that can help relieve running pain points include:
Doing a muscle tension release just once won’t solve your problem. Like most PT exercises and treatments, they take time and need to be performed daily. The same goes for the Hip Hook.
Investing in your running recovery is one of the most effective ways to curb some of the most common causes of hip pain from running. Use the Hip Hook daily along with strength training exercises, hip alignment exercises, and limited stretching for best results.
FAQs about hip pain and running
Is it okay to run when I have hip pain?
Anytime you feel pain when you run (in your hips, knees, ankles, feet) you should take a break from the activity. Find the root of your hip pain: releasing your the hip flexors with a specialized tool like the Hip Hook is a good start. You can gradually reintroduce running once you start to feel better, but it is in your best interest to address the hip pain to treat the root cause and avoid pain or injury in the future.
How do I strengthen my hips for running?
Working with a physical therapist can help you target weak muscle groups and balance out muscle strength. Tight muscles are weak muscles, so make sure you don’t have tension in key core muscles, like the psoas and iliacus.
There are several exercises you can do to strengthen your hips for running, including:
- Body weight squats
- Clam shells
- Side leg lifts
- Donkey kicks
- Single bodyweight leg squats
- Hip bridges
How do I know my hip pain is serious?
Once you notice swelling that doesn’t go away with rest, redness in the joint area, joint pain that persists even without activity, or intense enough pain that it makes it difficult to move your hip joint, you should see a doctor.
