Runners can suffer from hip pain. Hip pain from running can result from muscle, tendon, joint, or bone pathology. What are the common causes of hip pain during running, and how do we arrive at 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 microtears, 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 commonly torn include the hip flexors, such as the iliopsoas and rectus femoris, and the upper hamstring.
Hip tendonitis
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 tendons flex the hip and therefore work hard when running uphill or jumping. 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 for stabilising the hip during walking and running. 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
Pain from hip osteoarthritis results from cartilage loss, which leads to bone-on-bone contact, 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
Femoroacetabular impingement is a motion-related condition related to an abnormal ball-and-socket joint. It is common among active individuals and even more common among elite athletes.
Bony spurs often develop on the ball-and-socket joint, restricting hip movement. 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 can occur in the pelvis, including the pubis and sacrum. Sacral stress fractures are common in runners.
Generally, symptoms include hip or groin pain that begins after activity. However, as the stress fracture progresses, many people feel pain with simple activities such as walking. In more severe cases, a limp and persistent pain may develop.
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 groin include:
- Pudendal nerve causing buttock pain
- Obturator nerve causes adductor and groin pain
- Ilioinguinal nerve leading to suprapubic and inguinal pain
- Lateral femoral cutaneous nerve produces pain and numbness in the outer thigh
Nerve pain is challenging to manage because it can overlap with multiple conditions affecting the hip and groin. Often, investigations such as X-rays, ultrasounds, and MRIs are normal. However, we rely on tests such as diagnostic injeciton, nerve hydrodissection, or nerve conduction studies to aid diagnosis.
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 entrapment in the upper lumbar spine can cause hip and groin pain. Sometimes, sacroiliitis affecting the sacroiliac joints causes hip or groin pain.
Frozen Hip
This condition is a rare cause of pain and stiffness in the hip, similar to the shoulder. It is generally a diagnosis of exclusion.
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 they will go away. We suggest that you consult an experienced sports and exercise physician who can advise on diagnosis and management.
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