Why Do My Hips Hurt when I Run? (Common Risk Factors and Solutions)

People are quick to assume that running is bad for your joints because the sport is notorious for its high injury rates. Most runners end up dealing with some variation of aches and pains, many of which manifest within the joints themselves.

Runners most frequently have gripes with pain or injury in their knees or even their ankles, leaving the hip overlooked. And while experiencing pain within the hip joint is less common than other parts of the body, it shouldn’t be pushed to the sideline — your hips are an integral part of proper running form.

Let’s break down what hip pain tends to look like in runners, why it happens, and what you can do to either eliminate it or prevent it in your running down the line.

Different Types of Hip Pain

The difficulty with trying to categorize hip pain is that it can present itself in so many different ways. Even within specific diagnoses — hip impingement and gluteal tendinopathy being the most common — the symptoms you experience can vary greatly from runner to runner.

For instance, the quality of your pain is dependent on how severe your condition is. Some runners experience a sudden onset of sharp, stabbing pain at a particular point in their workouts, whereas others deal with more gradual, dull and achy pain that fades in and out over the course of their run.

A lot of runners also report an initial pain at the start of their run that gradually decreases, only to find that it returns and worsens as they’re deeper into the workout. This often happens with issues in the soft tissue or tendons of the hip: when your body’s still a bit colder or stiffer at the start of the run, the pain is present, but as you warm up, the tissue starts feeling a little better…

That is, until you hit the point in your run where you overwork the tissue, reintroduce the pain, and feel the symptoms worsening. (You may experience this pain in the aftermath of your workout, as well.)

So, while identifying what your pain feels like is important, it may just not provide concrete insight into the specific diagnosis you’re dealing with.

Perhaps the most defining feature of hip pain is where you feel it.

Pain that sits anywhere from your lateral hip to the front of your hip is more likely indicative of either hip impingement or gluteal tendinopathy. But, if the pain exists predominantly in your buttocks, there could be a chance that it’s a nerve compression issue. It’s important to receive a formal assessment to ensure that your pain isn’t being caused by nerve pain radiating from the low back.

If you do rule out the possibility of nerve issues, it’s important to acknowledge that most other causes of hip pain are brought on by repetitive stress or strain to the tissues. Meaning, as long as you continue to run and to place stress on those tissues, the longer your symptoms will persist (and likely worsen).

But, the good news is that you’re also able to put an end to your pain by tackling the other most common culprit behind running injuries: biomechanical impairments.

Biomechanical Risk Factors for Hip Pain in Running

When hip pain is brought on by deficient biomechanics, it almost always involves some degree of pinching, compression, or tension in the tissues of your hip or glutes.

In cases of hip impingement, the issue typically stems from compression of the soft tissue within the ball and socket joint of your hip. With optimal biomechanics, your hip joint should allow for smooth range of motion in all directions — but, if anything affects how well the femoral head (ball) can move through the acetabulum of your hip (socket), the tissue in between both bony structures gets pinched or compressed.

However, when dealing with an issue like gluteal tendinopathy, your symptoms are primarily caused by large amounts of tension straining or overworking the tendon tissue. This is most commonly associated with weakness in the glute muscles, causing the gluteal tendon and other muscle groups to overcompensate and undergo excessive stress.

Both of these issues are typically associated with some variation of pelvic or femoral misalignment. When either of these structures move into improper positioning, it interferes with your hip joint’s complete range of motion, thus affecting proper biomechanics. Below are the four most common impairments we’ve found correlated to our runners’ hip pain.

Anterior Pelvic Tilt

Or, in layman’s terms, when your pelvic bone is tilted forward.

Anterior pelvic tilt most often occurs when there’s weakness in the glutes and abdominal muscles. If either (or both) of these major muscle groups present insufficient strength, the pelvic bone doesn’t have enough stability to remain level throughout dynamic movement.

When your pelvis is angled in this position, the acetabulum is moved closer to the femoral head. This already reduces the amount of space between the ball and socket, increasing the likelihood that your femur pushes into the acetabulum and pinches that soft tissue in between.

That slight pelvic tilt alone can already cause painful tissue compression — and that risk only worsens when you account for the high loading and impact forces with running. With every landing impact, your femur gets pushed against the soft tissue of your hip socket, and that repetitive compression is what leads to longer term injuries like hip impingement.

Pelvic Drop

Also known as hip drop, this biomechanical impairment is a common contributing factor to many different running pains and injuries.

Pelvic drop occurs when one hip drops lower than the other in the lateral plane. Oftentimes, you can spot this issue when watching a runner from behind; as the runner moves into the stance phase of their gait, the hip opposite of their stance leg will dip noticeably lower:

Excessive hip drop is usually a result of weakness in the glute muscles (the gluteus medius, more specifically). Your gluteus medius attaches to both your hip bone and your femur, so it plays a key role in pelvic stability and hip abduction.

If your gluteus medius lacks sufficient muscular strength or activation, it’s unable to keep your pelvic bone laterally level and produces that drop in one side. This then “drags down” the hip in your stance leg, causing tissue compression similar to that of anterior pelvic tilt, as the femoral head and acetabulum are being pulled closer together and end up pinching the soft tissue. 

On top of that, because pelvic drop occurs during stance phase, your body has to mitigate the highest volume of loading forces as it bears your bodyweight on one leg and takes in the impacts of your foot landing. With these forces combined, your hip joint is even more vulnerable to repetitive compression.

Hip Adduction and Internal Rotation

Though these are two distinct mechanics, they often come hand-in-hand while running.

Hip adduction refers to the motion that brings your femur towards the midline of your body, like when you cross your ankles while standing and get a diagonal leg position.

Hip internal rotation is when the femur rotates towards the midline of your body. This is a much subtler mechanic that we don’t usually notice in our everyday movement, but it’s an essential component (in moderation) for many activities, including walking and running.

Both of these are standard biomechanical movements — they only become detrimental if they happen in excess:

Femoral Internal Rotation

Similar to the other two impairments, excessive hip adduction and internal rotation are most commonly caused by weakness or insufficient activation in the glute muscles. Without enough strength or stability from the glutes, the hip joint lacks the support necessary to keep either of these mechanics within a healthy range.

These increased inward motions pull the femoral head closer into the hip socket, increasing the risk of pinching the soft tissue, once again. And, without the glute muscles to pull the femur back into alignment, your gluteal tendon is working twice as hard to try and keep everything in place, causing that tendon aggravation.

It’s important to note that both hip adduction and internal rotation also occur during the stance phase of your gait, so that added consideration of high loading forces and increased weight bearing only further worsens the chances of experiencing pain or injury.

How Do I Relieve Hip Pain with Running?

The good news is that these diagnoses — and most general, nagging hip pain — are considered self-limiting.

That is, it’s generally safe to run through the pain if you work within a specific set of guidelines to prevent more severe problems. Here are some of the most common parameters we suggest for runners dealing with recurring hip pain:

  1. Don’t run through sharp pain, or pain that’s rated anywhere from a 3 to 10.
  2. Don’t run through pain that affects or inhibits your everyday activities, or any pain that disrupts your sleep.
  3. Don’t run through pain that lingers well after your workout. (Some pain after running can be normal, but if it persists longer than 8-12 hours, that’s a strong indication that your tissues have been overworked.)

But, of course, learning how not to aggravate your symptoms is far from a true solution; these parameters are meant to supplement a complete treatment plan.

Similarly, there are plenty of treatments that people use for temporary pain relief, like manual therapies, icing, STIM, ultrasound, etc… but fully resolving the issue requires the more direct approach of improving your biomechanics and physiology.

So what would a treatment plan look like?

Types of Treatment for Hip Pain

For hip pain, your treatment should be structured with several key training components: activation, strengthening, alignment control, shock absorption, and specific running retraining drills.

The extent to which you train for each component will vary from runner to runner, but these building blocks serve as a solid foundation for most cases of hip pain:

Muscle activation (or neuromuscular) training is created by the connection between your brain and your muscles. The communication between both structures is what allows your muscles to turn on effectively during specific movement patterns. But, after sustaining injury (or after relying on biomechanical compensations for a long period of time), that brain-to-muscle connection often grows weaker or less efficient. In order to combat that decrease in neuromuscular activity, you need to practice specific, targeted exercises to “retrain” your brain for stronger muscle activation and running biomechanics.

Strength training is necessary to ensure that, once your muscles are “awake” and active, they’re also strong enough to match the demands of your activity. Remember: running is a high-load, high-impact sport, so muscular strength is essential to keep your joints and other passive tissues protected. Most runners need several weeks of concentrated strength training to ensure that they’re targeting the right muscles to suit their running needs.

Alignment control training is a natural next step — harness your newly activated and strengthened muscles to deliberately control your leg alignment during running-specific drills. While some coordination drills will be helpful for your training, you’ll likely practice more single-leg exercises to specifically target your hip, femur, and knee control while under load.

Shock absorption training ensures that your muscles are the primary tissues absorbing forces with every landing impact. When done correctly, shock absorption recruits a combination of both muscular strength and leg alignment, so practicing specific drills will prepare your body for absorbing and repurposing energy into your running. This will protect your joints and prevent many of the biomechanical impairments that can cause hip pain.

Specific running retraining, simply put, allows you to combine all the aforementioned training components and apply them to your running as you run. The goal is to adapt your form in real-time so your body grows familiar with what proper form feels like, as well as what cues can keep your impairments in check as you move through your workout.

(Perhaps this all sounds a little vague, but without a complete running assessment, we can’t guarantee all the specifics that go into your exercises or training phases. Addressing hip pain is far from a “one-and-done” approach — for the most success, you’ll need to work with a running specialist and hash out a specific plan.)

How Long Does it Take to Fix Hip Pain?

Treatment timelines are dependent on your current biomechanics and any underlying factors that may be present. However, based on the runners we’ve worked with, some of the aforementioned training components have approximated timelines…

For instance, your muscular activation and strengthening phases are absolutely essential. Progressive activation drills alone may take a few weeks (again, depending on how well or poorly your muscles activate already). From there, your strength training phase may range around 6-8 weeks, based on what we know about the biological requirements for muscle building.

But in the case of insufficient alignment control or coordination, you’ll need some more time, often in addition to the baseline strength work.

Issues like hip adduction and internal rotation certainly require sufficient muscular activation and strength, but those two aspects alone aren’t enough to correct the root of the problem! Your body also has to undergo training to know how to properly recruit its muscles to avoid excessive inward movement in the hip and thigh.

This is where you’ll practice those running-specific exercises to enhance your movement control and retain proper leg alignment. On average, most runners tend to take around 3-4 months of alignment and coordination training to ensure that they 1) are really recruiting the right muscles, and 2) aren’t overworking their newly strengthened muscles while adapting their biomechanics.

Now, we know that training for several weeks or months feels less than ideal… but you won’t just be dealing with the same pain the whole time.

When the training is done correctly, you should start feeling progressively better over the course of your program. Those average timelines represent how long it can take for runners to truly feel the “final result” of improved biomechanics and long-term, sustainable pain relief.

Granted, these general time frames may be impacted by other underlying factors. To gain better insight into your specific hip pain, it’s best to speak with a running and movement specialist who can help tailor your training to match your exact needs.

Treat the Root Cause, Not the Symptoms

Whether your hip pain presents as dull and achy or sudden and sharp, it’s a problem that needs to be solved — and you can’t do that by addressing the symptoms alone.

There are plenty of temporary solutions that can help mitigate your pain, but having to trial-and-error different options or repeat the same ones time and time again isn’t the best option for truly sustainable running.

Hip pain with running is most often caused by biomechanical impairments and improper running form. So, what better way to fix the problem than by tackling those exact causes?

Seek out the expertise of a movement and running specialist. They’ll help you understand why your pain happens and how to biomechanically fix it, leaving you better equipped to maintain proper running form and technique for smarter, healthier running in the long-term.

By Dr. Torey Page DPT OCS

Dr. Page is recognized as a specialist in evaluation and rehabilitation of the lower extremity, spine, and shoulder. He has had years of experience working as a physical therapist and as a strength and conditioning coach, so he is well-versed in the analysis of human movement and biomechanics (as well as advanced training in running mechanics and return to sport training). Torey has advised a wide range of clients, from sports teams to triathletes to the Woodside Fire Department. In his spare time, he enjoys spending time with his wife Joey, their beautiful daughter Savannah, and their dog Gatsby.

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