Hip pain after running: how to treat it, according to physical therapists

You’re cruising along, training enthusiastically for a 5K (or a marathon!) when it sneaks up on you: hip pain. Maybe it’s a dull ache or a sharp stabbing feeling. Either way, it threatens to derail your entire workout routine and the runner’s high that comes with it. “Runners who come in with hip pain are usually really frustrated because they can’t do the thing they love as they want to, and they also miss the mental relief running brings them,” says Mary Kimbrough, PT, DPT, OCS, a physical therapist at Hinge Health, and an avid runner. 

Pain is always due to a combination of factors, and understanding what might contribute to your pain can help you manage it. Although hip pain is very common, it’s also treatable and preventable, says Dr. Kimbrough. 

Here are the most common causes, plus effective ways to fix and prevent hip pain after running, including at-home exercises from Hinge Health physical therapists to keep your hips as strong and healthy as possible.

Why do my hips hurt after running? 

As one of the largest joints in the body, hips are incredibly strong and resilient. Strong hip muscles help you power up hills and stabilize your pelvis so you can run more efficiently, using less oxygen even as you exert more effort. But like any other joint in the body, hips are prone to some aches and pains, especially if you do too much too fast.

“Running is a high-intensity activity that puts a heavy load on the body, so overuse injuries are common,” says Dr. Kimbrough. Most overuse injuries and causes of hip pain after running can be treated at home with conservative treatments, most notably movement, and exercise therapy.

Some common causes of hip pain include: 

• Muscle strain. If muscles or tendons supporting your hip stretch too far, it can cause mild or moderate strain. Strains can occur as a result of a fall or a sports injury, or they can happen slowly over time, as with running or other activities that involve repetitive motions. With a strain, you may notice some pain, swelling, muscle weakness, or stiffness, especially after activity. 

• IT (Iliotibial) band syndrome. This is when the iliotibial tract, a flexible band of tissue that runs from the hip to the knee, becomes inflamed. “We usually see the pain on the outside of the hip in these cases,” says Dr. Kimbrough. 

• Tight hip flexor muscles. The hip flexor muscle runs from the pelvis to the top of the thigh. This muscle is prone to tightness, which can lead to pain in the front of the hip, says Dr. Kimbrough. You may notice this pain more when you stop running. 

• Tendon bursitis. Bursae are small, fluid-filled sacs that provide cushioning between bones and soft tissues. Each hip has two major bursae that may become inflamed with repetitive motions, leading to pain on the outside of the hip or near the groin, depending on which bursa is involved. “You might feel a sharp stabbing pain that turns to a dull ache,” says Dr. Kimbrough. The pain may feel worse when lying on your injured hip. 

• Piriformis syndrome. If glute muscles press against nearby nerves, it can cause a burning or shooting pain in the back of the hip that may travel down the leg (known as sciatica). It’s often associated with overtraining or, conversely, sitting for long periods of time. Piriformis syndrome is more common after middle age. 

• Hip osteoarthritis (OA). OA is characterized by a gradual decrease in cartilage in a joint. While this can sound scary, cartilage charges are actually a very normal part of aging, just as some people lose hair on their heads or develop wrinkles on their skin. OA causes your bones to sit closer together and sometimes rub against one another during movement. Though this doesn’t always cause symptoms, it can contribute to pain, stiffness, and reduce hip flexibility for some people. 

A Hinge Health perspective check

When something hurts, it’s common to want a diagnosis — to know what exactly is going on under the surface. Whether you have IT band syndrome, arthritis, or no diagnosis at all, know this: There are always things you can do to heal and get back to doing what you love. How do we know this? In the Osteoarthritis Initiative study, only 24% of those with image-diagnosed hip osteoarthritis reported chronic hip pain. In another study, 73% of participants had hip “abnormalities” on MRIs, despite having no symptoms. 

This means your imaging findings do not always correlate with your symptoms. It's a possible contributor to your pain, but it's often not the only factor. You can always do something to improve your hip pain and keep running, and that often starts with moving more (or differently). As our Hinge Health care team says, movement is medicine.

Treatments for hip pain in runners

Most hip pain after running can be relieved at home using the following remedies: 

• Start exercise therapy. Therapeutic exercises help increase strength and flexibility, both of which are needed to help the hip joint bear the intense load of running. “In general, you want to work with not only the hip, but the areas above and below it, because they support the hip and they all have to work together,” says Dr. Kimbrough. That means your exercise therapy routine may include core exercises (to support the hips from above), quad and hamstring exercises (to support the hips from below), and balance exercises which engage the whole leg from hip to knee to ankle. A physical therapist can provide personalized guidance. You can see one in person or use a program like Hinge Health to access a PT via telehealth/video visit.  

• Apply ice. Ice can reduce swelling and helps temporarily prevent pain signals from reaching the brain, giving you a much-needed physical and mental break from hip pain after running. It’s best to apply ice for 20 minutes at a time several times per day, according to the American Academy of Orthopaedic Surgeons. 

• Scale back for a short period. Although your hips are able to handle a lot of loads and gentle movement is a crucial tool in reducing pain, you want to avoid overdoing it if your pain flares up. Avoid demanding too much of a painful hip, just for a few days, before nudging back into your normal routine. During that time, Hinge Health physical therapists recommend walking and doing other gentle activities, as well as stretching and exercise therapy. 

• Over-the-counter (OTC) pain relievers. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for hip pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Steroid injections. If over-the-counter medication does not offer sufficient pain relief, your doctor may suggest cortisone steroid injections to help counter pain and inflammation. These shots contain an anti-inflammatory steroid that helps decrease inflammation and reduce pain temporarily. 

When to see a doctor for hip pain

Most cases of hip pain, especially when it arises after running, can be managed at home. In rare cases, it may signal an underlying medical condition that requires a doctor’s attention. See a doctor if you have a history of stress fracture injuries or experience any of the following:

• Pain resulting from a trauma, fall, or sport injury

• Pain that is severe, unrelenting, or interferes with daily tasks

• You have difficulty putting weight on your leg

• Pain that does not improve with the treatments mentioned above and makes it difficult to move your hip or leg

• Pain that travels from the hip to other areas 

• A clicking, popping or catching sensation in the hip

How to prevent hip pain  

Many seemingly inconsequential details about your workout can make your hip muscles more prone to strain. Tight or tired muscles are more prone to injury, for example. Anything that adds stress to your joints, like poor footwear, running on hard surfaces, or increasing your mileage too fast, ups your odds of injury. Remember: Hip pain is usually due to a combination of factors. While you may not be able to control all of them, these simple steps can reduce daily stress on your hips and prevent injuries from occurring (or reoccurring): 

• Progress gradually. “Hip muscle pain is influenced by overuse, like if you increase your mileage too fast,” says Dr. Kimbrough. “A good rule of thumb is to take the amount of time you run and increase that by 10% per week.” So if you run 120 minutes this week, for example, you could feel confident increasing to 132 minutes next week. 

• Embrace a flexible mindset. If you need to ramp up your training quickly for an event or a race, be prepared to modify your training schedule to avoid injury. “Runners are good at creating these very rigid, structured training plans,” says Dr. Kimbrough. “Allow yourself some grace to listen to your body and be really flexible. It’s okay to take a step back and change a few of your training sessions. You’re still going to make it to race day.” 

• Warm-up. One of the advantages of running is that you can put on your shoes, walk out the door, and just go. But if you don't warm up, you miss the chance to prepare your muscles for more intense activity. Dr. Kimbrough recommends dynamic stretches such as high knees and butt kicks to get your hips ready. “Even just walking for five minutes can warm you up and prepare your body to run,” she says.

• Cool down. Taking the time to hold some slow, static stretches (like the ones below) helps keep your muscles elongated and flexible — and flexible muscles are more resistant to injury. “Just like you need to prepare your body to sprint, you need to cool down before suddenly stopping movement. Otherwise, it’s kind of like hitting a wall,” says Dr. Kimbrough. 

• Strength train. Many runners shy away from strength training, says Kimbrough. “We’re runners because we enjoy endurance exercise.” But research shows that strength training two to three times per week helps prevent injury and improves running economy or the efficiency with which you increase speed while expending energy. 

• Soften your steps. Wear appropriately cushioned shoes and, when possible, choose more forgiving running surfaces such as running tracks, grass, or dirt trails. 

Strengthening and stretching the muscles in and around your hips is crucial to managing and preventing running-related hip pain. The given exercises are recommended by Hinge Health physical therapists as a starting point. Start by working these into your routine once or twice a week and build up to doing them daily if they’re helpful.

If you have any concerns or questions about whether this routine is right for you, check with your healthcare provider first.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Strength Train the Affordable Way

“Contrary to what many believe, you don’t have to purchase special equipment to do strength training,” says Dr. Kimbrough. “You can use items lying around the house as weights, such as heavy books, a gallon of milk, or filled water jugs.” Try adding these objects to a set of squats to add resistance.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here. This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References: 

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