Experiencing Runner’s Hip a.k.a. Pain After a Workout? Here’s What To Do

If you’ve ever experienced hip pain after running, you’re certainly not alone. Injuries at the hip can plague many athletes, especially runners as they work through repetitive motion and high impact. But determining what’s causing your hip pain can sometimes be tricky.

That’s why we chatted with experts to find out exactly what could be going on at this important joint, plus how to prevent and treat runners’ hip aches.

First, a quick refresher on hip anatomy: The hip is a basic ball-and-socket joint. The ball is the femoral head—a knob on the top of the thigh bone—and the socket is an indentation in the pelvic bone. There is cartilage lining the joint (called the labrum) and ligaments that attach the pelvic and thigh bones. Numerous muscles attach around the hip, too, moving the joint through the basic motions of flexion (bending), extension (extending the leg behind you), abduction (lifting the leg away from the body), adduction (moving the leg inward), internal rotation, and external rotation.

Any of these movements can lead to pain in runners and knowing the anatomy can help pinpoint what’s going on so you can stop or treat the discomfort.

The most common culprits of discomfort include hip flexor strains or hip flexor tendinitis, stress fractures, and osteoarthritis. Less commonly, labral (cartilage) tears, bursitis, and hip impingement may cause hip pain.

Here’s a little more about each type of hip pain and what you need to know about treatment and prevention.

Strains or pulls often occur in the top of the hamstrings, the iliopsoas, the rectus femoris (quad muscle), and the adductors, while the gluteal tendons are prime targets for chronic damage and inflammation. Both are generally a function of muscle imbalances, which are typically caused by a lack of side-to-side training. “If [these muscles] are weak, they are constantly doing a tug of war, under load, while contracting,” says Robert Gillanders, P.T., D.P.T., physical therapist at Ivy Rehab Physical Therapy in Charlottesville, Virginia. That tug is exacerbated by big increases in training volume or intensity.

Prevent it

Strength train at least twice a week with an emphasis on eccentric lower-body exercises (like slowing the lowering phase of your squats to three or four seconds) to improve your muscles’ and tendons’ ability to lengthen under tension without pulling apart.

Spot it

Muscle strains and tendinopathy both cause moderately sharp localized pain, swelling, weakness, and stiffness, says Janet Hamilton, C.S.C.S., an exercise physiologist with Running Strong in Atlanta. They typically develop slowly, but if you trip on the trail, muscle and tendon tears can happen in a second, causing strong, piercing pain as well as bruising. (If you do have bruising, that definitely a sign you should see a doctor!)

Treat it

Ice for 10 minutes, several times a day, and limit activity until your symptoms subside, then ease back into running. Mild muscle strains can take three to six weeks to fully heal. Tendons can take six weeks to many months to heal. Avoid nonsteroidal anti-inflammatories (like ibuprofen) if possible, as inflammation actually prompts healing, Hamilton says. Significant tears require surgery.

Femoroacetabular impingement (FAI) is a mismatch in the shape of the femur (ball) and the acetabulum (socket), which causes them to beat up the joint’s protective cartilage (labrum) and, over time, contribute to degenerative osteoarthritis. FAI is a leading cause of hip pain for athletes.

Prevent it

FAI is believed to be partially genetic, but environmental, weight, strength, and activity factors also play a role. Core and hip strength work like monster walks, single-leg deadlifts, and dead bugs will give your body more control and power to protect the hip and help prevent injury.

Spot it

Start with the FADIR test: Lie flat on your back, draw your knee toward your chest, gently press your knee across your body, then rotate your foot as far out and away as possible. A pinch in the front of your hip is a sign of possible impingement, but you’ll need an MRI from an orthopedist to confirm.

Treat it

Correcting muscle weaknesses and abnormal movement patterns through physical therapy can curb discomfort. Physical therapy can also determine a safe range of motion to avoid pinched positions when running or cross-training. In some cases, surgery is needed. In general, it can take a long time to deal with a hip impingement, which means a treatment plan also requires patience.

“Wear and tear” arthritis is less common in active marathoners than it is in the general population, according to research from the Rothman Orthopaedic Institute (loading the joint may improve its health by strengthening the surrounding muscles). But in runners with structural hip abnormalities such as FAI, osteoarthritis in the hip can crop up as early as age 40, says Peter Moley, M.D., a physiatrist with New York’s Hospital for Special Surgery.

Prevent it

Treating any existing hip injuries or imbalances is key. Try to maintain a healthy weight to further reduce stress on the hip joint.

Spot it

Joint stiffness, poor range of motion, and at least three months of deep, aching pain after sitting or running or at the end of the day are common symptoms, says Scott Paluska, M.D., a sports medicine specialist at Evergreen Family Health in Williston, Vermont. X-rays can confirm suspected arthritis.

Treat it

Most flare-ups will abate with RICE (or rest, ice, compression, and elevation). In the long run, low-impact strength-training, and switching to softer running surfaces (treadmill, grass, sand, track, pool) can strengthen the supporting muscles without excessively loading the joint and causing pain and further joint damage, says Paul Sorace, M.S., C.S.C.S., exercise physiologist. Even a softer shock-absorbing insole can help.

To further head off hip pain and eventual replacement, many doctors offer injections such as steroids, or regenerative treatments. In platelet rich plasma (PRP) therapy, doctors inject your own blood, minus the red blood cells, into the joint. In stem cell therapy, they use cells from your bone marrow. Some patients experience improvement with these therapies, but more research is needed to prove their effectiveness—and to get insurance to chip in, says Harrison Youmans, M.D., a sports medicine specialist with Rothman Orthopedics Davenport, Florida. Because more research is needed on these treatments, it also best to try them after other protocols like physical therapy and medication.

A torn labrum is most commonly caused by FAI in younger runners, as it places them at a higher risk for injury or increased wear and tear, says Kristin Morrison P.T., D.P.T., a physical therapist at Impact Physical Therapy in Chicago.

Hip dysplasia, a genetic condition in which the hip socket is too shallow to fully cover the femur, can also tear the labrum.

Prevent it

Warm up the muscles protecting the joint with monster walks, single-leg bridges, deadlifts, and clamshells to help reduce midrun grinding.

Spot it

Labral tears can cause sharp or dull groin pain and a limited range of motion. You may hear a clicking as the loose labrum moves over bone, says Youmans.

Treat it

Start with rest and physical therapy that includes strengthening the hip and core (fire hydrants, stir-the-pots), says Shane J. Nho, M.D., co-director of the sports medicine fellowship program at Rush University Medical Center in Chicago. Steroid injections can curb the pain; if they don’t, you may need surgery, but not all tears require surgery.

It’s common for active individuals to experience labral tears without hip pain, so it’s important to find the primary cause of hip issues to help with healing.

More than a dozen little fluid-​filled sacs, called bursae, are a cushion between your hip bones and neighboring soft tissues. Repetitive motion, along with muscle imbalances or poor form, can inflame any one of them. Issues most often arise at the side of the hip (greater trochanteric bursitis), and are four times more common in women, says Paluska.

The iliopsoas bursa (the front of the hip) is another prime target for inflammation, along with ischial bursa (located at the buttocks, near the origin of the hamstring).

Prevent it

Bursitis occurs when there is excess friction of overlying tendons, and this occurs when muscles are tight or fatigued. So strengthening the muscles around the hips is crucial for preventing bursitis. Focus on strengthening the hips in all planes of motion with single-leg deadlifts, monster walks, high-knee raises, fire hydrants, and lying inner-thigh lifts.

Spot it

Inflamed bursae ache, feel warm and tender to touch, and get angrier with hill running or sprinting. The most common diagnostic method: injecting the bursa that’s suspected to be inflamed with numbing lidocaine. If the pain goes away, there’s your answer. MRIs are a less invasive but more time- and cost-intensive tool.

Treat it

Visit a physical therapist who specializes in running to see if strength deficits, faulty running gait, inadequate balance, or all of the above are to blame for the inflammation. When paired with corrective exercises, RICE and injections can help ease inflammation. In stubborn cases, surgeons can remove the swollen bursa. But it will grow back after several months, so it’s best to address the root cause.

About two-thirds of hip stress fractures in runners are caused by excessive mileage, and the injury is significantly more common in women. Because stress fractures develop slowly—progressing from a stress reaction that isn’t given enough time to heal—they can take a long time to diagnose. Left untreated, stress fractures may develop into full breaks.

Prevent it

Ramp up your mileage or intensity gradually, sticking with a “no more than 10 percent increase per week” rule. A bone-mineral density test can help determine if you need improved nutrition (more calcium and vitamin D) or medications to reduce your risk of breaks.

Nutrition is key for prevention overall, as you need not only adequate vitamin and mineral intake, but also enough protein to keep bones healthy.

Spot it

Pain is usually sharp when walking, running, or jumping, and may feel dull the rest of the day. “It is not uncommon for it to present symptoms at rest and at night,” says Moley. But if you feel pain starting earlier and earlier in your run, and even progressing to walking, it’s definitely time to see a doctor.

You’ll need an X-ray and likely an MRI to confirm a stress fracture.

Treat it

Rest for four to six weeks and do low-impact exercise like cycling and swimming for another four to six (if your doctor says that’s okay). Then ease back into walking and running, Hamilton says.

Medically reviewed byJohn Vasudevan, M.D.

Sports Medicine Director & Medical Advisor

John Vasudevan, M.D. is an associate professor at the University of Pennsylvania. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He is a Team Physician for UPenn Athletics and  medical director of the Broad Street Run and Philadelphia Distance Run, and previously for the Rock 'n' Roll Half-Marathon and Tri-Rock Triathlon in Philadelphia. He is a director of the running and endurance Sports Medicine Program at Penn Medicine.  Dr. Vasudevan provides non-operative management of musculoskeletal conditions affecting athletes and active individuals of all levels, and combines injury rehabilitation with injury prevention. He utilizes a variety of ultrasound-guided procedures and regenerative approaches such as platelet-rich plasma and percutaneous ultrasonic tenotomy. He sees patients at the Penn Medicine and the Philadelphia Veterans Administration hospital. Dr. Vasudevan attended medical school at the University of Wisconsin School of Medicine and Public Health in Madison. After his Transitional Year in Tucson, Arizona, he went to residency in PM&R at Thomas Jefferson University in Philadelphia and onwards to Stanford University for his fellowship in Sports Medicine. He has been in practice at the University of Pennsylvania since 2012.