Why Does My Hip Hurt After Running?

When is hip pain after running a red flag?

Start here, because this one cannot wait. A femoral neck stress fracture is a crack in the narrow part of the thigh bone just below the ball of the hip. It is uncommon, but missing it can lead to a complete break.

A review of these fractures in recreational runners describes the typical pattern: groin pain that comes on gradually, worsens with activity and weight bearing, and eases with rest. Early on, it shows up late in a long run. Later it can be present at night and at rest, often with a limp.

If your groin pain gets worse with each run, hurts at rest or at night, or makes you limp, stop running and get examined. Plain X-rays often miss these fractures early, so an MRI is commonly needed. If you cannot bear weight at all, go to the ER.

Women runners, people with low bone density, and anyone with irregular or missed periods or very low energy intake may be at higher risk. If that describes you, mention it at your visit.

• Deep groin or front-of-thigh ache that builds run after run
• Pain at rest or at night
• A limp or pain with hopping on that leg
• A recent jump in mileage, speed or hills

What causes pain in the front of the hip after running?

The hip flexors lift your thigh with every stride, so they take a beating with speed work, hills and longer runs. Cleveland Clinic notes that overuse and skipping a warm-up are common causes of hip flexor strains, and that most heal in a few weeks with home care.

Pain deeper in the crease of the hip, especially with clicking, catching or a sharp pinch when you twist, can point to the labrum or femoroacetabular impingement (FAI). These tend to flare with hill running, long strides and sitting for long periods after a run.

A hip flexor strain usually feels like a pulling tightness that improves day by day. Joint problems tend to linger, recur with the same movements and feel deep inside the hip.

What about pain on the outside of the hip?

Pain over the bony point on the side of the hip is very common in runners. It is often called hip bursitis, though many cases involve irritation of the gluteal tendons, known as gluteal tendinopathy or greater trochanteric pain syndrome.

AAOS OrthoInfo lists running as a repetitive stress that can trigger hip bursitis, along with a tight IT band. Cleveland Clinic notes that gluteal tendinopathy pain is often worse lying on that side, climbing stairs, sitting cross-legged or standing on one leg.

Runners with this pattern often have weak hip abductors, a narrow crossover stride or a sudden increase in mileage. Physical therapy that loads the gluteal tendons gradually is the usual first treatment.

Which training errors lead to hip pain?

Most runner hip injuries trace back to doing too much, too soon. The body adapts to running, but bones and tendons adapt more slowly than heart and lungs.

MedlinePlus suggests warming up and cooling down, walking down steep hills instead of running them, choosing smooth, softer surfaces, wearing supportive shoes, and cutting back the amount of exercise when pain appears.

• Sudden jumps in weekly mileage or long-run distance
• Adding speed work and hills in the same week
• Running on a sloped road shoulder every day
• Worn-out shoes
• Skipping strength work for the hips and core
• Not eating enough to fuel training, which can weaken bone

What can I do at home while it settles?

For mild pain without red flags, a short break from running or a switch to swimming or easy cycling often helps. Keep moving in ways that feel comfortable, since complete rest is rarely needed.

Start simple hip strengthening such as bridges, side-lying leg lifts and step-ups, and stop any exercise that causes sharp pain. When you return to running, begin with shorter, flatter runs and build gradually.

Over-the-counter pain relievers can help in the short term, but they should not be used to run through pain. If pain is not improving after a week or two of sensible changes, it is time for an exam.

How do I get back to running safely?

Once daily walking and stairs are pain free, a walk-run program is a sensible way back. Alternate short running intervals with walking, and add running time only when the previous session caused no pain that day or the next morning.

Keep runs flat and easy for the first couple of weeks, and save hills and speed work for later. Change one thing at a time, so if pain returns you know what caused it.

Keep doing your hip and core strength work two or three times a week even after you feel better. Runners who stop the exercises once the pain fades are often the ones who end up back in the clinic.

When should a runner see a hip specialist?

See a specialist if pain persists beyond a couple of weeks, keeps coming back each time you build mileage, comes with clicking or catching, or changes the way you walk. Any red flag symptom for a stress fracture deserves prompt imaging.

At your visit, our team looks at where the pain is, how your hip moves, your strength and your training history. We also check the lower back, because back problems can send pain into the buttock and hip.

Bring your training log and running shoes if you can. The details of your last few weeks of training often explain the injury better than any scan.

Questions patients ask