Hip pain when running

When running your hip will bear over 7 times your body weight so it's no wonder that hip injuries are common. The month's bulletin explains the causes of hip pain & how to spot them.

This month’s topic does not often lead to an accurate self diagnosis and so if any of the following information sounds painfully familiar to you then please seek a medical or physiotherapy opinion.

The causes of hip pain in runners of all abilities can be varied and numerous. This article will outline a few major causes and offer advice to keep you running at your best.

The Hip Joint

The hip joint is a deep, well-fitted joint and is adapted for weight bearing and stability. It is so good at bearing weight that we take it for granted and push it to its limits.

Each time you pound the streets there will be over seven times your bodyweight driving down through each hip and leg. This is not only from the effects of your mass multiplied by gravity, but also the compressive forces created around your hip by the many powerful muscles acting across it.

These muscles include the Gluteus Maximus and its two smaller siblings (gluteus minimus and medius), one of the quadriceps, some other hip flexors, the hamstrings and the adductor muscles, but to name a few.

The hip joint and muscles

All of these muscles, the hip joint itself, and the ligaments which support the joint can all be the cause of hip pain.

Then there’s the bursa – small fluid filled sacs that exist to prevent friction between the moving parts in the hip. There are several of these around the hip and any additional pressure can cause them to become inflamed and painful.

Did I mention the hip joint was a can of worms?!

Causes of Hip Pain when Running

Described below are a few of the major causes of hip pain:

1) Trochanteric bursitis - This is an inflamed bursa on the outer aspect of the hip bone. It is painful to lie on, can give pain on foot strike during walking and running, and may hurt to touch.

This is caused by a direct trauma usually, but may also be the result of repeated friction at the hip from overtraining or a muscle imbalance around the hip.

Tip: Apply regular ice as described in previous bulletins, modify training, and stretch out the muscles around the hip and thigh.

2) Deep Hip Pain - This is a symptom and not a diagnosis. If the pain over the front of the hip has been long-standing and is becoming more frequent or constant then this may be a sign of osteoarthritis in the hip joint.

The pain may also be associated with a loss of movement at this joint, in inwards rotation and knee-to-chest movement. There may be a history of previous trauma.

Tip: Don’t panic if this is the case – a healthy joint is a mobile joint. Continue to stretch out the hip, keep it strong, and modify your activity to decrease the load. Keep hydrated to maintain a good level of cushioning fluid in the joint space.

3) Snapping hip - This sounds more serious than it actually is. This condition is characterised by a snapping sensation, and often an audible 'popping' noise, when the hip is flexed and extended.

There are several causes for snapping hip syndrome, but most involve tendons catching on bony prominences and "snapping" over them when the hip is moved.

The three main causes are Iliotibial Band (ITB) Snap, Iliopsoas Tendon Snap (a tendon at the front of the hip joint), and a Hip Labral Tear. The third cause is the least common but would be the most difficult to treat, as it involves a tear in the hip cartilage.

Advice for Junior Runners

Finally, a word of advice for the younger athlete. Although rare (about 50 in 100,000 children per year) slipped upper femoral epiphysis is one of the most common adolescent hip disorders and is due to a slippage of the growth plate at the upper end of the thigh bone (femur).

It is more common in boys of 10-17 years of age, but can occur in girls with a peak age of 12 years. It may present as pain in the adolescent knee with a distinct absence of knee problems. If in doubt see your GP or physiotherapist for a full assessment.

Other problems around the hip can include buttock pain, which will be explored in next months’ sports injury bulletin.

Until then, enjoy your running!

Ross

Ross Clifford MCSP is a practising Physiotherapist with a specialist interest in sport and exercise Physiotherapy. He also holds a Sports Science degree and has taught in the area of Sports Injuries. He is a keen runner and cyclist.