Hip Pain After Running? Here Are 9 Likely Causes And How To Fix It

One of the most frequent (and irritating) questions that runners field from their non-running friends and family members is, “How do you do all that running without hurting your knees?”

Fortunately, despite the common myth that running is bad for your knees, most runners can confidently report that their knees are fine.

With that said, runners aren’t universally free from battling running injuries, and while knee pain might garner most of the public attention and worry, hip pain after running can be nearly as prevalent, if not more debilitating. 

To help you identify the possible causes of hip pain after running, we’ve compiled a guide to hip pain in runners, including the likely causes and how to fix and prevent hip pain after running.

We will cover: 

Let’s get started! 

Hip Pain In Runners

The hips are massive joints with numerous muscular and ligamentous attachments, so the hips are not only vital to sustaining a strong, efficient, and powerful running stride but are also at risk for various musculoskeletal injuries.

Before we cover common causes of hip pain in runners, it’s helpful to review the basic anatomy of the hips.

The hips are the largest synovial joints in the body and have a ball-and-socket configuration wherein the head of your femur (thigh bone) articulates into the concave acetabulum (socket) formed by the bones of the pelvis. 

The ball-and-socket configuration makes the hip highly mobile, allowing for forward flexion and backward extension, lateral abduction (out to the side) and adduction, and internal and external rotation.

The hip joint is controlled by several large and small muscles, which work together to carry out these movements in a controlled and powerful fashion.

For example, the hamstrings and glutes are muscle groups composed of several synergistic muscles that together help extend the hip. The Iliopsoas group of muscles flexes the hip. 

There are also smaller and deeper muscles like the piriformis, tensor fascia latae, gemellus superior and inferior, obturators that help with rotation, and a large group of adductors in the inner thigh, among others. 

While you don’t need to be an anatomy buff or memorize every muscle to prevent hip pain after running, the takeaway is that hip motions are highly complex, and it’s important for runners to engage in a well-rounded routine of exercises that increase the strength and mobility of the hip musculature.

Hip Pain After Running? Here Are The Likely Causes

If you are having hip pain after running, it’s crucial to identify the cause as soon as possible before it escalates into a more serious running injury or causes additional injuries further down the kinetic chain to your knees, shins, ankles, and feet due to compensations or biomechanical alterations in your running stride.

The hips play a key role in every single step you take while you run. They form the root of your lower limbs, so your hips power and control your entire running stride. 

Hip pain in runners may be due to damage to the muscles, tendons, ligaments, bones, cartilage, or bursa due to overuse1Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Clinical Journal of Sport Medicine, 15(1), 14–21. https://doi.org/10.1097/00042752-200501000-00004 or acute injury.

The most common causes of hip pain after running include the following:

#1: Trochanteric Bursitis (Hip Bursitis)

When you run, structures in the hips, such as bursa and cartilage, reduce friction to enable a smooth and comfortable stride. 

The trochanteric bursa is a fluid-filled sac at the top of the femur (thigh bone). The repetitive motion of running can irritate this bursa, leading to painful inflammation of the sac, termed trochanteric bursitis.

Runners with hip pain on the outside of the hip that gets worse with running, walking, climbing stairs, getting up from a low chair, or out of a car should consider this potential sports injury. The pain usually increases if you press on the side of your hip or try to lie on that side when you sleep. 

#2: Hip Flexor Strain

The general consensus from research²Paluska, S. A. (2005). An Overview of Hip Injuries in Running. Sports Medicine, 35(11), 991–1014. https://doi.org/10.2165/00007256-200535110-00005is that the most common causes of hip pain in runners are muscle strains and tendonitis. These injuries usually result from sudden directional changes, sudden acceleration/deceleration maneuvers, or eccentric contractions. 

Runners tend to have chronically tight hip flexors, especially if they sit at a desk. If you have pain at the front of your hip in the soft tissue where your thigh meets your trunk, particularly if it’s more superficial than deep (deep is more likely iliopsoas), it might be a hip flexor strain. 

#3: Iliopsoas Tendonitis

Pain in the front of the hip or groin while running, lifting your leg up, climbing stairs, and getting out of a car may be indicative of iliopsoas tendonitis. The pain may also radiate to the knee.

This hip injury in runners is usually due to overuse, particularly after an increase in speed workouts or running mileage. It often has a gradual onset, with the soreness initially subsiding after you are done running but eventually progressing to lingering at rest.

#4: Hip Joint Impingement 

Hip joint impingement, referred to as femoroacetabular impingement, leads to sharp pain after running and during running, which may also radiate to the groin. The hip pain is due to inflammation that occurs in the ball-and-socket joint of the hip from excessive internal rotation of your hips when you run. 

This inflammation results in a painful pinching of the nerves or ligaments in the hip joint. The pain usually develops gradually over several weeks. 

#5: Iliotibial Band Syndrome 

The IT (iliotibial) band is a thick band of fibrous connective tissue that runs down along your outer thigh from the hip to just below your knee on the side of your shin. The IT band crosses both the hip and knee joints and is a structure prone to injuries in runners. 

IT band syndrome is an inflammatory condition marked by tightness, pain, and increased friction at either the hip joint, knee joint, or both. There is sometimes a clicking sensation.

This hip injury can affect runners of any experience level, although it is most common after jumps in mileage and intensity and from wearing worn-out running shoes and excessive running downhill.

#6: Hip Arthritis 

Hip arthritis is a degenerative condition that refers to a thinning of the cartilage between the bones of the hip joint. It can cause rubbing and crepitus in the joint and has a gradual onset.

#7: Hip Stress Fracture

A stress fracture of the femoral neck or hip is an overuse injury. Runners with poor bone density are at increased risk of this hip injury. Pain may radiate to the groin. 

#8: Labral Tears

The hip joint socket is lined with strong, flexible cartilage called the labrum. This cartilage can tear from repetitive overuse, which can lead to a constant dull ache at rest and sharp, stinging pain while you are running.

Runners may also feel a catching, clicking, or locking sensation, with or without the feeling of hip instability while running.

You may also experience hip pain after running, which may calm down after several hours.

#9: Muscle Pulls or Tears

Injuries to the quads, hamstrings, and glutes³Lenhart, R., Thelen, D., & Heiderscheit, B. (2014). Hip Muscle Loads During Running at Various Step Rates. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 766-A4. https://doi.org/10.2519/jospt.2014.5575can cause hip pain while running. The location of the pain can clue you into the damaged muscle. Pain in the back bottom of the thigh may be a hamstring injury. The quads are in the front of the thigh.

Risk Factors for Hip Pain In Runners

Preventing and Treating Hip Pain After Running

Treating hip injuries from running usually involves some amount of rest, with the potential for low-impact cross-training so long as it is pain-free. Depending on the diagnosis, ice, heat, and physical therapy might be recommended. Surgery is sometimes implicated, depending on the type and severity of the injury.

In terms of returning to running and preventing hip pain, runners should implement the following practices:

#1: Warm-Up

It’s crucial to warm up before jumping into your workout in order to increase circulation to your tissues. Cold tissues are tight, and this limited range of motion can cause muscle pulls or tendon strains. 

To help prevent hip pain after running, do 5-10 minutes of brisk walking or easy jogging, followed by dynamic stretches before heading out for your full workout.

#2: Run On Even Surfaces

Cambered roads, which slope from side to side, put your hips at different levels, increasing the stress on your hips and pelvis. Try to run on a level footing or run on a track or treadmill until your hip pain after running subsides.

Moreover, both downhills and trails put excessive strain on the adductors and hips due to the increased demand to stabilize the pelvis.

#3: Get New Running Shoes

The general advice is to replace your running shoes every 300-500 miles to ensure optimal support. Worn-out shoes can increase your risk of hip pain while running because they lack the cushioning and support you may need.

#4: Progress Gradually

Overtraining and sudden increases in mileage and intensity put you at a greater risk for hip injuries from running. Heed the 10% rule, meaning you should only increase your mileage by a maximum of 10% from one week to the next. For example, if you are currently running 25 miles a week, run no more than 27.5 miles next week.

It’s also important to pay attention to jumps in intensity. Hip flexor strains often follow hard workouts, so ensure you give your body ample recovery between hard efforts.

#5: Improve Your Diet

To promote healthy bones and recovery from workouts, make sure you are getting enough calcium, vitamin D, protein, and total calories through your diet. Consider speaking with your doctor or sports nutritionist if you have concerns.

#6: Strengthen Your Core and Hips

Studies show⁴Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Clinical Journal of Sport Medicine, 15(1), 14–21. https://doi.org/10.1097/00042752-200501000-00004that hip muscle weaknesses and imbalances increase the risk of hip injuries in runners. A weak core also leads to instability of the pelvis, which puts extra strain on the hips and pelvis.

A well-rounded strength training program for runners should strengthen the entire core, including the iliopsoas, and also target the hip’s internal and external rotators, adductors, and abductors. 

#7: Do Mobility Work

Tight hip flexors, hamstrings, quads, glutes, IT band, hip abductors, adductors, and internal and external rotators increase the risk of hip injuries in runners.

Ensure you are stretching frequently, especially after running and doing soft tissue mobility work with a foam roller, lacrosse ball, or massage gun. 

As you can see, there are many preventative measures you can take to help prevent hip pain after running.

If you do, however, feel pain, it is important to seek a physical therapist or healthcare professional help to find the root of the problem and a plan of action to get better quickly!

They may recommend the use of anti-inflammatory drugs such as ibuprofen to help lower symptoms.

If you are looking to add in some stretching exercises after your workouts, take a look at the following:

References

• 1
  Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Clinical Journal of Sport Medicine, 15(1), 14–21. https://doi.org/10.1097/00042752-200501000-00004
• 2
  Paluska, S. A. (2005). An Overview of Hip Injuries in Running. Sports Medicine, 35(11), 991–1014. https://doi.org/10.2165/00007256-200535110-00005
• 3
  Lenhart, R., Thelen, D., & Heiderscheit, B. (2014). Hip Muscle Loads During Running at Various Step Rates. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 766-A4. https://doi.org/10.2519/jospt.2014.5575
• 4
  Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip Muscle Weakness and Overuse Injuries in Recreational Runners. Clinical Journal of Sport Medicine, 15(1), 14–21. https://doi.org/10.1097/00042752-200501000-00004