Hip Pain When Running? A Guide for Runners & How a Physical Therapist Can Help
If you’ve ever experienced discomfort or sharp pain in your hip while running, you're not alone. Hip pain in runners is one of the most common complaints among the clients that consult us for our care at The Game Plan. While some causes are relatively benign and treatable, others may signal more serious underlying issues. Understanding the potential causes, seeking the right care with a sports orthopedic physical therapist, and addressing the problem early can ensure you get back on track ASAP.
Common Causes of Hip Pain in Runners
It’s essential to understand some of the most common causes of hip pain in runners. Here are some of the most common we see at our practice:
1. Iliotibial Band Syndrome
This occurs when the iliotibial band, a thick band of tissue that runs from your hip down to the outside of your knee, becomes overly compressed and irritated.
This study suggests that ITB Syndrome is often associated with suboptimal running mechanics such as excessive cross over past midline. Another study demonstrated that faster running paces result in a more narrow base of gait when running, which excessively loads the outer leg, and makes a runner more subject to developing IT Band Syndrome. If you’d like to learn more about ITB Syndrome and how we treat it, you can read more about it on a blog we published.
Normal landing mechanics
Excessive cross over gait pattern
2. Greater Trochanteric Pain Syndrome (also referred to as trochanteric bursitis)
This pain occurs on the outside of the hip, at an anatomical landmark called the “greater trochanter” of the femur (thigh bone). There can be inflammation of the bursa (a fluid-filled sac) on the outside of the hip, but it’s more likely that some of the gluteal tendons that attach to the area are the pain generator. Runners with this condition will complain of greater pain when walking up stairs, and running uphill hurts more than downhill. According to the literature uphill running loads the hip joint more than flat or downhill running. This is why we will often recommend that our runners temporarily avoid hills.
3. Hip Flexor Strain
Runners with hip flexor pain will point to the front of their hip and will have pain when lifting their leg against gravity and resistance. However, we don’t typically see true hip flexor strains in distance running athletes. In our clinical experience, this is often the most misdiagnosed hip injury in runners. Many of our runners believe they have a hip flexor strain, but they actually have hip labral pathology or a bone stress injury (BSI). The hip flexors are powerful and get recruited heavily during sprinting activities. Therefore, we do treat some sprinting athletes with hip flexor strains / pain.
Psoas Major (hip flexor muscle)
4. Hip Labral Tear
The labrum is a ring of cartilage that helps keep the ball of your femur (thigh bone) in place in the hip socket. A tear in this cartilage can cause deep, sharp pain in the hip joint and can be exacerbated by running, especially if you are making quick directional changes. A hip labral tear can be ruled in by your physical therapist by performing tests such a FADIR Test and a Scour Test. An MRI is considered the gold standard to diagnose a hip labral tear, but isn’t necessary if you haven’t had previous physical therapy treatment first. Conservative treatment is typically the first like of care. There is always the option of performing a hip labral tear repair should it be necessary. You can click here to learn more about hip labral tears in a blog we wrote about the topic.
5. Tendonitis
Tendonitis in the hip (particularly in the hip adductors or gluteal tendons) occurs when the tendons become inflamed due to repetitive activity or overuse. This condition often causes pain in the groin or outer hip area. A true tendonitis typically resolves within 2 weeks of rest, icing, and anti-inflammatory medication (you should always consult with your medical doctor before utilizing medication). However, in our practice we note that tendonitis isn’t the issue- it’s a tendinopathy or tendinosis that we come across much more often. These are different from tendonitis, which is more of an acute inflammatory condition. Tendinopathy/tendinosis occurs gradually over time, is associated with chronic overuse/repetitive stress beyond the tissues capacity, and involves structural changes to the extracellular matrix (collagen tissue) of the tendon.
The most commonly affected tendons of the hip are the gluteal, hamstring, and adductor tendons. If you’re dealing with proximal hamstring tendon pain when running and would like to learn more, you can read a blog we published about it.
6. Stress Fractures
A more serious cause of hip pain, stress fractures, occur when the bone is subjected to repetitive stress that leads to microtrauma of the bone. When the rate of bone cell breakdown exceeds the rate of new bone cells forming, that is when a stress fracture can occur. Stress fractures are most common in the femoral neck (the area near the hip joint) and can cause deep, localized pain in the groin that worsens with activity / weight bearing. Your physical therapist will help you rule this in by asking you a series of questions about your training and by performing tests that have a high rate of bone loading (hopping). If a hip stress fracture is suspected, your physical therapist will refer you to an orthopedist who can request MRI imaging. These types of injuries often require a period of non-weight bearing / rest from running. Depending on the location and extent of the fracture, surgery may be required to avoid long term complications.
7. Osteoarthritis
Hip arthritis is typically not seen in runners under the age of 50. This is a gradual fraying of the cartilage tissue at the hip joint which can cause pain and stiffness (especially in the morning time). Hip arthritis can be ruled in with clinical testing by your physical therapist and by x-ray imaging that your medical doctor suggests.
How a Physical Therapist Helps with Diagnosis and Treatment of Runners with Hip Pain
A physical therapist who specializes in treating runners is key in addressing hip pain. They use a combination of patient history, physical tests, and their clinical expertise to perform a differential diagnosis. This process helps determine the exact cause of your hip pain and rule out other conditions.
Questions a PT Might Ask
When you visit a PT for hip pain, they’ll start by gathering information about your injury. Common questions might include:
Where is your hip pain located?
How long have you been experiencing hip pain?
What makes the pain worse (e.g., certain running distances, paces, or terrain)?
Is the pain sharp, dull, or aching?
Are there any specific movements or actions that aggravate or relieve the pain?
Have you had any previous injuries to the hip or lower back?
What is your running history (weekly mileage, training intensity, shoes, etc.)?
This helps the PT determine whether the pain is due to a mechanical issue, muscle imbalance, overuse, or something more serious, like a bone stress injury (BSI).
Tests a Physical Therapist Might Perform
After gathering the initial history, your PT will perform various physical tests to confirm their diagnosis. These could include:
Range of Motion Tests: to assess flexibility and movement in the hip joint.
Strength Tests: to check for weakness in the hip muscles, particularly the glutes and hip flexors, which play a critical role in running.
Palpation: your PT will press on different areas around the hip to locate where the pain is coming from.
Special Tests: your physical therapist will perform tests that help target specific tissues in the hip (i.e. FADIR and FABER Tests)
Hop Testing: this is necessary for helping to rule out bone stress injuries (BSI’s) if your PT suspects one. We do not recommend doing this on your own, as you can potentially aggravate a BSI.
Gait Analysis: watching you run to assess your form, stride, and any mechanical abnormalities that may be contributing to your hip pain.
Why Working with a Physical Therapist is Crucial if You’re a Runner with Hip Pain
Working with a PT is incredibly beneficial for several reasons:
1. Personalized Treatment: PTs provide tailored treatment plans based on your specific condition, goals, and running habits. This includes massage, stretching, and joint mobilizations of the hip joint (and many times other joints that may be impacting how force is being absorbed at your hip). This individualized care helps ensure the most effective recovery.
2. Education: A PT will teach you about proper running mechanics, stretches, and exercises to help prevent future injuries. You’ll learn how to strengthen muscles and improve flexibility to address any imbalances contributing to your hip pain.
3. Pain Management: If you’re in pain, a PT can provide hands-on treatments, such as massage and joint mobilization to reduce discomfort and improve mobility.
4. Progressive Return to Run: A PT will design a gradual return-to-run plan that ensures you're building back your strength and stamina safely. This can prevent overloading the hip and causing a relapse or re-injury.
5. Collaboration with Other Healthcare Providers: If the PT suspects a more serious injury, such as a stress fracture, they will refer you to the appropriate provider (e.g., an orthopedic specialist) for further imaging and evaluation.
Conclusion
Hip pain while running can be stressful, and it can be difficult to establish an effective plan to address it. A physical therapist specializing in treating runners can help you navigate the differential diagnosis process, pinpoint the root cause of your pain, and create a personalized treatment plan. Whether you're dealing with common issues like ITBS or tendonitis, or suspect something more serious like a stress fracture, a PT can guide you on the road to recovery. Don’t let hip pain sideline your running journey – get the help you need to heal and come back stronger than ever before!
If you are experiencing hip pain when running and you would like to work with us, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Paul Nasri, PT, DPT, OCS, COMT
Doctor of Physical Therapy
Orthopedic Clinical Specialist
Certified Orthopedic Manual Therapist
