Hip Pain when running can be a worrying experience. One, you don’t understand it, and two you may have little knowledge of it. Maybe sometimes you think it’s that old injury creeping back into your life, but it’s usually is a lot simpler than that.

Table of Contents

Hip Flexors
Hip Abductors
Hip Adductors
Hip Extensors
Hip Rotator
What Can Cause Hip Pain?
 – Muscles
 – Tendon
 – Ligament
 – Joint
 – Bursa
 – Osteoarthritis
 – Bone Fracture
How To Prevent Hip Pain Running?
 – Warm-up before running
 – Activate Your Running Muscles
 – Mix Up Your Routine
 – Treatment of Hip Pain Running
 – Exercises To Prevent Hip Pain Running

Let us look at the hip joint:
The hip joint is known as a ball and socket joint, consisting of the socket (acetabulum) and femoral head (hip). These two structures fit into each other and are held in place by powerful ligaments (fancy names we won’t go into). The critical thing to note here is that these ligaments rarely tear or become injured from running.

Around the joint is a complex system of muscle that moves the joint to produce force:

Hip Flexors

  • Psoas Major
  • Illiacus
  • Rectus Femoris

Hip Abductors

  • Glute Maximus
  • Glute Medius
  • Glute Minimus
  • Tensor Fascia lata (TFL)

Hip Adductors

  • Adductor Magnus
  • Adductor Longus
  • Pectineus
  • Gracillus

Hip Extensors

  • Glute Max
  • Hamstrings
  • Adductor Magnus

Hip Rotator

  • Piriformis
  • Gemellus Superior
  • Obturator Internus
  • Gemellus Inferior
  • Quadratus Femoris
  • Obturator Externus

As you can see in the picture, the hip is highly complex, with many structures interacting to stabilise the femoral head in the acetabulum.

These muscles can interact in infinite ways depending on the stage of your stride. The speed you are running at, your body’s ability to decelerate as your foot hits the ground, and accelerate as it leaves the floor, all require muscles to interact differently.

A very simple way of looking at how the body works as a system is making a rule. If one muscle shortens, the muscle on the opposite side must lengthen. For example, suppose you lift your knee towards your chest. In that case, your hip flexor shortens to produce the movement and your glute (hip extensor) lengthens to facilitate the movement – insert photo of hip flexion.

Before we get into that, let us look at the common causes of hip pain.

What Can Cause Hip Pain?

Muscles

In general, unless you are running at very high speed, it will be unlikely that you will tear a muscle. But what can happen is one muscle tires, and then another power has to do twice the work. Let’s take sitting at a desk all day, you’re sitting on your glutes, then you go running, and your glutes don’t fire as fast as they should, resulting in the muscles at the front of the hip overworking as its partner (the glutes) don’t work.

Tendon

Tendons around the hip can become injured due to weakness or overuse. The most common tendons that are damaged are the adductors, glutes and iliacus. Again the reason for these tendons becoming injured is
1.) a very sharp increase in training intensity or duration, or
2.) due to a long term weakness in another muscle in the hip.

Ligament

Ligaments of the hip joint are robust and durable and rarely become injured unless a high-force trauma such as a road accident or fall from a height. It is not associated with running injuries.

Joint

Issues with the hip joint can be related to the cartilage within the joint. This cartilage acts as a shock absorber to protect the more rigid cortical bone beneath it. If a person has a sedentary job does not stretch enough and or has reduced strength in the hip extensors, this can lead to a breakdown of this cartilage, causing a dull ache around the front side and back of the joint. It is not always the cause, but it is what we see most often in the clinic.

Bursa

Bursae are small fluid-filled sacs between muscles and tendons to prevent friction and rub off each other. Sometimes, again due to weaknesses, these bursae become inflamed and result in sharp pain on the outside of the hip. It can be worse when lying on that side and gets worse when walking. Bursae pain is seen most commonly in females over the age of 30 who have reduced strength in gluteal muscles, causing a compression of the bursae as they walk.

Osteoarthritis

Osteoarthritis or OA is a degenerative joint disease that wears down the cartilage in the hip resulting in the patient requiring a hip replacement if the OA becomes severe enough. Thankfully in most cases, this is not needed, and simple exercises can help maintain the hip joint health, keep it mobile and most importantly, keep you away from the hospital. Severe OA is more challenging to manage. So if you are having hip pain, get it seen by a physiotherapist.
TOP TIP- Don’t leave it too late to have your hip assessed by a professional, if you fear you may have OA it is best to catch it early and prevent it from becoming worse.

Bone Fracture

Finally, bone fractures are uncommon and easily identifiable. They usually present after a severe fall onto the side of the hip and typically present to A&E with severe pain and are not commonly diagnosed in the physiotherapy clinic or associated with running injuries.

How To Prevent Hip Pain Running?

To prevent hip Pain from running, there are a few things you need to remember:

Warm-up before running

If you have a sedentary job, you need to do at least 10 mins of light jogging, skipping and stretching before you go running. Going from sitting to running without a good warm-up is not a good strategy to maintain your hips’ longevity. If you are stiff during or after a run, spend 30 mins doing some stretches to loosen your hip and lower back. Check out our hip mobility routine here. Don’t forget to subscribe to the Facebook group to get updates on more great content.

Activate Your Running Muscles

What do I mean by running muscles? These are your calf muscles, glute muscles, quad muscles, and hamstring muscles. Your body is a finely tuned machine and needs to be warmed up to perform at your best. Now you may say, well, I’m not an athlete, but that’s not to say you don’t work your body hard!

Here are four warm-up exercises to try:
Skipping forward
Skipping side to side
Hopping on two feet
Hopping on one foot then the other

It doesn’t have to be complicated, but it does need to be done.

Mix Up Your Routine

Your body hates routine; it likes to be challenged. 90% of running injuries we see in the clinic are due to people running at the same speed for long runs and short runs. A good program running three times a week should consist of:

Long Run: 5-10km +
Long Interval Runs: 2mins run, 2 mins rest, x 6-10 reps
Fast session: 100m – 200m fast run 85% max speed, 1-2 mins rest, x 10

People get scared when we say fast runs as they think they will be hard. They are not meant to be complicated. They are meant to be fast with a lot of rest. The idea is to get your body used to higher training loads and give it adequate time to recover. Most people will turn a fast session into a fitness session. People should avoid this at all costs. The idea is to run faster, improve your running technique and neuromuscular efficiency and do this repeatedly without fatigue, so you maintain good form.

Treatment of Hip Pain Running

Ok, so you didn’t follow the protocol, and now your hip is sore sitting on short walking and lying in bed at night. What can we do? Ultimately physio will do a full assessment of your current pain, any previous injuries that may be contributing to your injury, and get a feel for what level of exercises you need your body to complete and how often. This gives us an idea of what you want to achieve with physio and allows us to plan your treatment accordingly. From there, we will assess hip mobility, strength, core strength, balance, endurance, neuromuscular control. Suppose you are a higher-level athlete or have an interest in sports science. In that case, we use Output Sports capture to assess your power and plyometric ability and fatigue ability to give us a more in-depth analysis of how your body functions from a performance perspective.

Finally, putting this all together takes experience and knowledge to formulate a rehab program to get you out of pain fast so we can begin to strengthen your weak areas and bring your back running. If people are interested in doing long term rehab, we offer UNLIMITED TREATMENT PACKAGES, making the cost of treatment a little easier on your pocket.

Exercises To Prevent Hip Pain Running

Check out these five exercises that can help you prevent hip pain running, and keep your joints healthy for longer.

Hip Strengthening Exercises for Runners (link?)- landing page

This Article was written by Diarmuid Hegarty, Clinical Director ReSync Physiotherapy, MICP MSc Physio, MSc Sports Med, NSCA. Our team are here to answer any questions or queries you may have about your pain/injury. We offer Free Consultation for people who are unsure if physiotherapy is right for them.

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