Hip pain when running: causes and symptoms

Why can running cause hip pain?

Running is a great form of cardiovascular exercise and can also help lift your mood. However, it can also injure the different tissues that make up your joints and this includes those in your hip joints. Hip pain is, therefore, a common problem in runners, often due to the hips becoming tight and less flexible, which increases the risk of injury when under strain. 

Hip pain can occur whether you run regularly or not. Common causes include wear and tear with age, arthritis, infection of the hip joint and inflammation of a nerve that passes through your hip (eg sciatica). In runners, in particular, hip pain is often caused by overuse. Overuse can cause muscles, tendons and ligaments to become inflamed and/or bones to sustain stress fractures.

Understanding your hip joint

Your hip joint is the largest ball and socket joint in your body and is weight-bearing ie it carries the weight of your body and helps you remain stable. The joint is formed between the top of your thigh bone (femoral head) and a cup-shaped socket (acetabulum) in your pelvis. The joint is held together by your hip muscles (ie hip flexors, extensors, adductors, abductors, internal rotators, and external rotators) and soft tissues called ligaments, which connect bone to bone, and tendons, which connect muscle to bone. Your ligaments prevent your hip joint from dislocating and overextending.

Inside your hip joint are also several fluid-filled sacs (bursae) that act as cushions and alongside lubricating fluid in your joint (synovial fluid) help your hip joint move smoothly.

Muscle strain and tendonitis

Overuse of your hip joints can strain the hip muscles and cause tendonitis, where the tendons in your hip become swollen and damaged. 

This can cause a burning sensation, an ache, pain and stiffness in your hip that is worse when you run or move your hip. You may also feel a rubbing or popping sensation on the outer side of your hip.

You can treat tendonitis and strained muscles with rest and by applying an ice pack several times a day for up to 20 minutes at a time. You can also take over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) for up to a week to reduce inflammation and relieve pain. In severe cases, you may also need physiotherapy. 

Iliotibial band syndrome

Iliotibial band syndrome causes pain and tenderness along the outer side of your hip, thigh and knee; you may also hear a clicking or popping noise on movement.

The iliotibial (IT) band is a stretch of connective tissue that runs along the outer side of your body from the top of your thigh to your knee. Overuse when running can cause it to become tight, irritated and inflamed.

You can treat IT band syndrome by applying ice packs several times a day for up to 20 minutes at a time, stretching your outer hip muscles, and taking over-the-counter NSAIDs. In more severe cases, you may need steroid injections.

To help loosen up your IT band, you can also roll a foam roller along the outer side of your hip and buttocks. Avoid rolling it directly over your inflamed IT band as this may cause more pain. It can take several weeks for your IT band to heal.

Bursitis

Overuse of your hip joint can put excess pressure on your bursae, causing bursitis where the bursae become inflamed and swollen. This can cause hip pain, redness, swelling and tenderness. 

There are two main types of hip bursitis: 

• Iliopsoas bursitis — inflammation of the iliopsoas bursa that sits at the front of your hip; this causes pain down the front of your thigh down to your knee, and can also cause your groin area to become tender
• Trochanteric bursitis — inflammation of the greater trochanteric bursa that sits between the bony lump on your femur (greater trochanter) and the muscles and tendons that cover it; this causes pain on the outer side of the hip

You can treat bursitis with rest, however, you should still perform gentle exercises to keep your hip moving and prevent stiffness. You can also apply an ice pack several times a day for up to 20 minutes at a time and take over-the-counter NSAIDs to reduce inflammation and relieve pain. 

Once the swelling has subsided, you can apply a heat pack for pain relief. If your hip is not tender to touch, a gentle massage can improve your blood flow and help relieve pain. 

In more severe cases, steroid injections may be needed. In most cases, bursitis will get better in a few days or weeks with rest and treatment. When you return to running, gradually ease yourself back into your routine with slower, shorter runs and apply an ice pack after your run. 

Hip pointer

A hip pointer is a bruise on your hip caused by an impact eg a fall or direct blow to your hip. This causes bruising, soreness and swelling.

You can treat a hip pointer with rest and by applying an ice pack several times a day for up to 20 minutes at a time. You can also wear an elastic bandage to reduce swelling and pain but make sure it isn’t too tight as this can reduce blood flow to the area and cause more damage. Taking over-the-counter NSAIDs can help reduce inflammation and relieve pain. In more severe cases, you may need steroid injections.

Labral cartilage tears

The hip labrum is a ring of cartilage that sits on the outer rim of your hip joint socket. It acts as a cushion and secures the femoral head in the socket. Running can cause your hip labrum to tear.

Symptoms include a catching, clicking or locking sound when you move your hip, a reduced range of motion and stiffness. However, not all labral tears produce symptoms. 

A labral tear can be diagnosed by a physical examination alongside other tests, such as an MRI scan or X-ray. Your doctor may also suggest an injection of anaesthesia — if this relieves your hip pain then you likely don’t have a labral tear but another problem in the hip joint.  

You can treat your labral tear by taking over-the-counter NSAIDs and performing daily physiotherapy exercises. You may also need steroid injections. In more severe cases, where these treatments aren’t successful, your doctor may recommend you have a keyhole surgery called arthroscopy. 

Bone fractures

Running can cause stress fractures in your hip, especially if you aren’t running properly or are wearing unsuitable footwear. In most cases, stress fractures in the hip occur in the femur just below the femoral head (femoral neck). Symptoms include severe pain, especially when moving and in the groin area, swelling and an inability to bear weight on your leg.

An X-ray isn’t always enough to detect a stress fracture. Your doctor may therefore recommend you have an MRI scan. In most cases, your stress fracture will get better with rest, which means stopping running and in some cases, using crutches when walking. However, if you have a more serious fracture, you may need surgery.

Osteoarthritis

Hip osteoarthritis is more common in older runners and occurs when the cartilage of your hip joint wears away and breaks apart. Once the cartilage has worn away, the bones of your hip joint will rub against each other, causing inflammation, irritation and chronic (long-term) pain. 

Osteoarthritis is a degenerative condition and therefore early treatment is important to reduce or limit the damage caused. This may involve medication, following an anti-inflammatory diet, physiotherapy, losing excess weight and in severe cases, surgery. 

Strength imbalance

Most people have one leg that is slightly longer than the other. This can cause strength imbalances, which may only become apparent when you run long distances. This increases your chances of a running injury. Strength imbalances can also occur due to an old injury.

You can treat a strength imbalance by practising daily leg strengthening exercises and with massage to loosen up tight muscles in your leg. You can also help prevent an injury due to a strength imbalance by maintaining good posture when running, holding your shoulders and head up, keeping your hips aligned and maintaining an appropriate stride distance.

How do I relieve hip pain from running?

If you develop hip pain when running, stop running and rest your hip. If you are in severe pain, see your GP as you may need more than home remedies to recover. 

Once your hip has recovered, you can return to running but do so gradually. You will heal faster if you follow a healthy diet, including foods rich in vitamin D and calcium, such as fortified cereals, milk, salmon and sardines. 

How to prevent hip pain when running

It is important to balance any high-impact exercise, such as running, with low-impact exercises, such as yoga, which will help loosen up your muscles, improve your flexibility and reduce your chances of injury. You should also perform exercises that focus on strengthening and stretching the muscles in your hips, buttocks, thighs and lower back. Core-strengthening exercises can also help by improving your balance and stability.

When you’re running, pay attention to any discomfort or pain, and stop running if you notice either. It is also important to run properly; a personal trainer can help you learn how to develop the correct running technique, which includes maintaining good posture.

Make sure that when you run you wear supportive, shock-absorbing shoes and change them once they have worn down. You should also make sure that you warm-up before and cool down after running — this should include stretching out your muscles.

Finally, avoid overtraining by gradually increasing the duration, frequency or intensity of your running.