Hip Pain in Runners: When It’s Not Just a Tight Hip Flexor
Understanding Hip Pain in Runners
Hip pain is a common complaint among runners, but it’s often misunderstood. Many people automatically assume it’s due to tight hip flexors, yet the causes can be much more varied. Understanding what might be contributing to your discomfort is key to preventing further injury and returning to running safely.
The hip is a complex joint that relies on muscles, tendons, ligaments, and bones all working together. Any imbalance, weakness, or overuse can lead to pain. While a tight hip flexor may be part of the problem, it’s rarely the only factor. Other structures such as the gluteal tendons, labrum, and surrounding muscles may also be involved, particularly if pain persists or worsens over time.
Common Causes Beyond Tight Hip Flexors
Several conditions can cause hip pain in runners, often presenting with similar symptoms. These include:
Gluteal tendinopathy – inflammation or degeneration of the tendons attaching the gluteal muscles to the hip bone. Pain is usually felt on the outside of the hip and may worsen with running or side-lying activities.
Labral tears – damage to the cartilage lining the hip joint, often causing deep, sharp pain or a clicking sensation.
Hip bursitis – inflammation of the fluid-filled sacs that reduce friction around the hip. Pain is often felt on the outer hip and can flare up during longer runs or prolonged sitting.
Muscle imbalances – weak glutes or tight adductors can alter running mechanics, increasing stress on the hip joint.
Overuse injuries – sudden increases in mileage, intensity, or hill training can overload the hip structures.
Signs You Should Seek Help
Not all hip discomfort requires medical attention, but there are signs that warrant assessment by a physiotherapist:
Persistent pain that doesn’t improve with rest or stretching
Pain that affects your stride or causes limping
Sharp or catching sensations in the hip
Pain radiating to the thigh or groin
Recurring injuries despite rest and self-care
Early assessment can identify the underlying issue, reduce the risk of chronic problems, and guide an effective rehabilitation plan.
How a Physiotherapist Can Help
A physiotherapist specialising in running injuries will perform a detailed assessment of your hips, pelvis, and lower limb mechanics. This may include:
Observing your running gait to detect inefficiencies
Testing strength, flexibility, and joint mobility
Identifying compensatory patterns that may be causing pain
Using targeted tests to determine whether tendons, muscles, or the joint itself are involved
Based on these findings, a personalised rehabilitation programme can be created to restore strength, improve movement patterns, and address any underlying issues contributing to hip pain.
Practical Strategies for Managing Hip Pain
While professional assessment is crucial, there are some practical steps runners can take to manage hip pain and prevent further injury:
Strengthening exercises – focus on glutes, core, and hip stabilisers to improve support and reduce stress on the hip joint.
Stretching and mobility work – gentle hip flexor and hamstring stretches can help, but should complement strengthening.
Gradual load management – avoid sudden increases in mileage, speed, or hill running.
Footwear and running surface considerations – worn shoes or uneven surfaces can alter mechanics and strain the hip.
Recovery practices – adequate sleep, nutrition, and soft-tissue care such as foam rolling or massage.
Returning to Running Safely
A structured return-to-run programme is essential for a safe recovery. This typically involves a gradual progression in mileage and intensity, combined with ongoing strengthening and mobility exercises. Close monitoring of symptoms allows adjustments before pain or compensatory patterns return.
For many runners, addressing hip pain isn’t just about relieving discomfort, it’s about optimising performance and reducing the likelihood of future injury. By considering the hip as part of the whole kinetic chain, physiotherapy can provide both immediate relief and long-term benefits.
Hip pain in runners is rarely just a matter of tight hip flexors. Understanding the multiple potential causes and addressing them through assessment, strengthening, and load management is key to a successful recovery. With the right guidance, runners can return to their favourite activities stronger, more balanced, and with confidence in their hip health.
