Running can potentially cause all sorts of lower body injuries, and pain in lower-body joints such as the hips and knees while running is unfortunately rather common.
Pelvic pain after running is a less frequent complaint, though certainly something to take seriously, as the pelvis supports the abdominal cavity, pelvic organs, and spine, and plays the vital role of supporting and connecting your trunk and lower body so you can run.
If you are having pelvic pain after running, or pain in the pelvis while 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.
Imbalances in your pelvis can cause you to favor one side as you run, which can throw off your knees, shins, ankles, and feet, as your body scrambles to compensate for biomechanical alterations in your running stride.
To help you identify the possible causes of pelvic pain after running, we’ve compiled a guide to pelvic pain in runners, including the likely causes of pelvic pain after running and how to fix and prevent pelvic pain from running.
We will cover:
- Pelvic Pain In Runners
- 9 Causes of Pelvic Pain After Running
- Risk Factors for Pelvic Pain In Runners
- Preventing and Treating Pelvic Pain From Running
Let’s get started!
Pelvic Pain In Runners
Before we cover common causes of pelvic pain in runners, it’s helpful to review the basic anatomy of the pelvis.
The pelvis is a basin-shaped bony structure at the base of the spine that connects the trunk to the lower limbs, protects the abdominal organs, and supports the spine.
The pelvis consists of several bones, namely the sacrum, which is a fusion of five vertebrae at the base of the spine; the coccyx, or tailbone; and the three hip bones, the ilium, ischium, and pubis.
The pelvis also contains several large and small muscles, which work together to stabilize the pelvis, spine, and core, and move the legs and hips.
For example, the pelvic floor muscles form the base of the pelvic cavity and support the pelvic organs.
The glute muscles (gluteus maximus, gluteus medius, and gluteus minimus) help extend the leg and stabilize the pelvis and hips, so they play a key role in running.
There are also smaller and deeper muscles like the piriformis, tensor fascia latae, gemellus superior and inferior, and obturators that help rotate the hips, and a large group of adductors in the inner thigh that connect near the pubic symphysis.
The hamstrings attach to the ischial tuberosities (sit bones) at the bottom of the back of your pelvis, while the iliopsoas, the abdominal muscles, and the quads attach to the ilium at the front.
9 Causes of Pelvic Pain After Running
The pelvis plays a crucial role in every single step you take while you run. It forms the root of your lower limbs, supports the spine, anchors the core, and provides a stable base of support for your hips and legs, which pull against it during every step of your running stride.
Pelvic pain after running may be due to damage to the muscles, tendons, ligaments, bones, or cartilage in the pelvis due to overuse or acute injury.
The most common causes of pelvic pain after running include the following:
#1: Piriformis Syndrome
Piriformis syndrome is one of the most common causes of pelvic pain in runners. This small muscle is located in the buttocks and can become aggregated by running, especially uphill running or stair climbing.
Some runners are particularly prone to piriformis syndrome because their sciatic nerve wraps around the muscle, though even runners whose sciatic nerve runs under the muscle are still prone to piriformis pain.
Any irritation to the muscle can put pressure on this nerve, resulting in butt pain while running.
The pain may radiate down the leg or be referred to the hip, but it is usually most localized around one side of the butt between the meaty part and the hip.
#2: Pubic Symphysis Dysfunction
The pubic symphysis is a bony union of the two sides of your pelvis at the front portion of the bottom of your pelvis. It serves as the attachment point for the adductor muscles as well as the rectus abdominis muscle (the “six-pack” muscle in your abs).
The pubic symphysis also plays a key role in balancing and stabilizing your pelvis when you walk and run.
Pubic symphysis dysfunction can occur when the pubic symphysis becomes too loose and relaxed. This can occur during or after pregnancy, though runners who increase their mileage too quickly can also experience difficulty.
Pain will be worse when you are weight bearing on one leg, so you will feel pelvic pain while running during each step, particularly with long strides or while making lateral movements as with trail running.
#3: Sacroiliac Joint Dysfunction
Your two sacroiliac (SI) joints are found at the back of your pelvis where the sacrum (the base of the spine) connects to the ilium bone of either side of the spine.
The ilium bone is the large bone that forms a prominent crest at the side and front of your hip (known as the iliac crest).
Therefore, the SI joints play the key role of connecting your spine to your pelvis.
Normally, there is very little motion permitted at this joint, as it is a fibrous joint designed to provide stability rather than significant mobility.
However, one or both SI joints can become irritated from running, which can cause inflammation and pain.
SI joint dysfunction is especially common in runners with a leg length discrepancy or who run on cambered or sloped roads because this puts the hips at different heights and places torque on the pelvis in the frontal plane.
If you have SI joint dysfunction, you might feel pelvic pain while running, walking, or climbing stairs.
The pain will be localized in the back of the pelvis about 2-3 inches (5-7 cm) left or right from the midline.
#4: Muscle Pulls or Tears
Injuries to the quads, hamstrings, back extensors, hip flexors, adductors, and glutes can cause pelvic pain while running since these muscles connect to the pelvis.
The location of the pain can clue you into the damaged muscle.
#5: Osteitis Pubis
Osteitis pubis is an overuse injury and fairly common cause of pelvic pain in runners.
This injury develops slowly over time and is caused by lack of core strength and instability in the pelvis and hips. This causes excessive movement and strain on the tendons and connective tissue attached to the pubic symphysis.
#6: Pubic Stress Fracture
You can also get a stress fracture at or near the pubic symphysis. This injury usually causes dull pelvic pain while running.
Pain usually subsides when exercise stops, but as the injury progresses, you may also experience pelvic pain after running.
Pain may be centralized on the pubic ramus on either side.
#7: Pelvic Floor Dysfunction
One of the most common causes of pelvic pain while running is pelvic floor dysfunction. Pelvic floor pain after running is particularly common in postpartum women, although it can affect runners of any sex or life stage.
The pelvic floor refers to a group of muscles that span the bottom of the pelvis in a hammock-like arrangement.
These muscles work together to support your pelvic organs, such as the bladder, bowel, uterus, and prostate and they allow you to control the flow of urine and the excretion of feces and gas.
As the base of your core muscles, the pelvic floor muscles also play a key role in every phase of your running stride.
When your foot lands, the pelvic floor contracts and shortens (concentric contraction) to cradle and support the load of your pelvic organs and entire abdominal cavity.
When you push off into the flight phase of running, the pelvic floor muscles lengthen (eccentric contraction) to support these organs and control the opposing movement of your legs.
Pelvic floor dysfunction can occur when any of the muscles in the pelvic floor become weakened, overstretched, or unusually tight.
This can result in pelvic floor pain after running or even pain in the lower abdomen.
Running can potentially cause pelvic floor dysfunction due the the jostling, impact, and load of running on the muscles of the pelvic floor, leading to the development of trigger points.
Trigger points then cause pain and/or neurogenic symptoms, such as the sudden need to pee.
Finally, other injured tissues sometimes refer pain to the pelvic floor while running as well. For example, runners with tight adductors (the muscles on the inner thighs) may experience pain in the pelvic floor when running.
#8: High Hamstring Tendinopathy
Pelvic pain from running that’s centralized around the bottom of your butt where your butt connects to your leg can be due to high hamstring tendinopathy.
This injury occurs when the hamstrings become irritated, inflamed, and damaged due to overuse.
The hamstrings play the key role of eccentrically decelerating knee extension while you run (along with concentrically and extending the leg).
The eccentric contractions in particular can result in microtears and chronic overuse.
#9: 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 pelvis.
Risk Factors for Pelvic Pain In Runners
There are several training errors and risk factors for pelvic pain while running and pelvic injuries in runners, including the following:
- Sudden increases in mileage or intensity
- Not warming up prior to a workout
- Osteoporosis and/or inadequate caloric and nutrient intake
- Pregnancy and childbirth
- Poor running form
- Weak glutes
- Muscle imbalances
- Leg length discrepancies
- Trail running
- Tight hips
- Overstriding
- Running on sloped/cambered roads
- Overtraining or insufficient rest and recovery
Preventing and Treating Pelvic Pain From Running
Treating pelvic injuries from running usually involves some amount of rest from running, 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 pelvic pain from running, consider implementing the following practices:
- Warming up before your workouts.
- Running on even surfaces rather than cambered roads.
- Strengthening the core, glutes, and hips.
- Strengthening the pelvic floor through exercises like kegels and diaphragmatic breathing.
- Stretching and doing mobility work after running. Examples of good mobility exercises include donkey kicks, fire hydrants, hip circles, hip swings, and side leg lifts.
- Wearing supportive running shoes that optimize your gait.
- Progressing mileage and intensity gradually, heeding the 10% rule and listening to your body.
- Giving your body ample recovery time after workouts.
- Improving your diet to prevent deficiencies in total calories, calcium, vitamin D, and protein.
- Avoiding excessive uphill or downhill running.
- Returning gradually to running after an injury, and especially after pregnancy.
Addressing pelvic pain after running at the initial onset is the best way to prevent any injury from escalating, so heed your body’s signals if something is awry.
For some exercises to begin strengthening your glutes and core, check out the following guides:
Glute Activation Exercises For Runners
12 Core Strengthening Exercises
Found this very educative I am new runner I have done two marathons and in both I made it the podium. But now I have been experiencing pelvic pain so I am going slow even missed a marathon.