Runners can suffer from hip pain. Hip pain from running can be due to muscles, tendons, joints, or bones. So, what are the common causes of hip pain when running, and how do we get to a diagnosis quickly?

Common causes of hip pain after running 

Hip muscle pull or strain 

A pulled muscle can occur while running. Overloading a muscle produces muscle micro tears leading to swelling and pain. The site of the muscle tear determines where you will feel hip pain. For example, a hip adductor muscle tear will present with pain in the groin or inner thigh. Conversely, a tear of the gluteus maximus or medius causes pain in the outer hip or buttock area. Other muscle groups that are commonly torn include the hip flexor, such as the iliopsoas and rectus femoris, and the upper hamstring.

Hip tendonitis 

female clutching her right hip due to hip pain

Tendonitis is a term used to describe the overload of the tendon attached to a hip bone. Overload can occur from excessive training or inadequate recovery from training sessions. The common hip tendons affected include:

  • Hip flexors: These tendons include the iliopsoas and rectus femoris tendons. Both these tendons flex the hip so work hard when running uphill or springing. Generally, hip flexor pain is localised to the front of the hip.
  • Hip abductors: These tendons help the muscles to move the hip outwards. They are also crucial in stabilising the hip during walking and running movements. Ususally, hip abductor tendon pain, also called greater trochanteric pain syndrome, usually causes pain outside the hip.
  • Hamstring origin: Your hamstrings help to extend the hip and work hard, particularly toward the end of a longer run. Pain from hamstring origin tendinopathy presents primarily as buttock or posterior thigh pain.

Hip arthritis 

X-ray showing hip arthritis

 

Pain from hip osteoarthritis occurs when the cartilage supporting the joint wears away, leading to bone-on-bone rubbing, inflammation, and severe pain.

Hip arthritis pain ususally occurs in the older person, although some in their thirties and forties can develop early-onset arthritis.

Generally, you’ll notice stiffness after running. However, as arthritis progresses, you’ll feel pain during and after impact activities such as running.

Femeroacetabular impingement 

Femeroacetabular impingement is a motion-related condition related to an abnormal ball and socket joint. It is common in active people and even more common in elite athletes.

Often, bony spurs develop on the ball and socket, restricting the movement of the hip. In extreme hip movement, such as jumping or running, the bony spurs pinch together, leading to swelling and hip pain.

Hip stress fractures 

A hip stress fracture is a crack that develops in the bone of the hip or pelvis caused by repetitive activity – such as running. Most often, it occurs near the ball of the socket, the neck of the femur. In addition, stress fractures occur in the pelvis, such as the pubis or sacrum. Sacral stress fractures are common in runners.

Generally, symptoms are an ache in the hip or groin starting after activity. However, as the stress fracture progresses, many people feel pain with simple activities such as walking. Often, a limp and constant pain develops in more severe cases.

Rare causes of hip pain after running

Nerve entrapment causing hip and groin pain

Nerves from the pelvis and spine travel to the hip and groin. Sometimes, these nerves can become trapped or compressed, leading to pain.

A few of the common nerves causing pain in the hip and going include:

  • Pudendal nerve causing buttock pain
  • Obturator nerve causing adductor and groin pain
  • Ilioinguinal nerve leading to suprapubic and inguinal pain
  • Lateral femoral cutaneous nerve producing pain and numbness in the outer thigh

Generally, nerve pain is challenging to manage as it overlaps with many conditions in the hip and groin. Often, investigations such as X-rays, ultrasounds, and MRIs are normal. However, we rely on tests such as a diagnostic injeciton or nerve conduction studies to help diagnose.

Referred pain from the spine and pelvis

Sometimes, damage to the lumbar spine or sacroiliac joints can refer to the side or front of the hip. For example, nerve trapping in the upper part of the lumbar spine can cause hip and groin pain. Sometimes, sacroiliitis affecting the sacroiliac joints causes pain in the hip or groin.

How to diagnose hip pain after running

Your doctor will take a comprehensive history and thoroughly examine all the structures around the hip. Ususally, investigations will help clarify the source of pain. For example, an X-ray will show a problem with the hip joint and surrounding pelvic bones. MRI demonstrates a labral tear in the hip or tendon inflammation around the joint. Finally, ultrasound can visualise the movement of tendons around the hip and help direct injections with accuracy.

Sometimes, we use ultrasound-guided injections to help us find the cause of hip pain. Also, injections can help relieve symptoms and improve rehab. Using ultrasound means that the injeciton will be more accurate.

Final word from sportdoctorlondon about hip pain when running 

Hip pain when running is challenging, as many conditions can cause it. If you have hip pain while running, don’t ignore your symptoms and hope it will go away. We suggest you consult an experienced sports and exercise doctor who can advise regarding a diagnosis and management.

Related conditions to hip pain from running:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.