The hips are key for running. Unfortunately, many runners suffer from hip pain–especially women who have had babies. In most cases, you do not want to run with hip pain. I share how to prevent hip pain in runners, and what to do if you suffer from hip pain when running.
Talk with many female runners and there is a good chance they have many things in common including hip flexor pain. Why? That’s what I am going to unpack here: why do our hips hurt when running?—especially when running while pregnant or postpartum. Short answer: the weight of the baby can pull our hips forward causing imbalances.
One of my athletes discovered about six weeks out from her marathon that she was pregnant with her third child. Did I mention we were going for a Boston qualifying time? She fought nausea and fatigue but stayed consistent in her training.
Related: The Benefits of Massage for Runners
Until about three weeks out from her race, her hips hurt when running. Then her quad started to hurt. She had to cut some runs short and miss some workouts. I sent her to see my massage therapist, Sandra. Sandra immediately identified that her quads and hurts hip when running due to the pressure of her growing uterus.
My athlete’s diligent work, Sandra’s skills, and my schedule adjustments were able to keep her hip flexor pain at bay—and guess what? She qualified for Boston! 13 weeks pregnant!
Because hip pain while running is common—especially in women—I got with doctor of physical therapy, Sarah Colón, aka “The Hip Doc”, to further our understanding of the role hips play when we run and how to keep them healthy and strong.
- Is it OK to run with hip flexor pain?
- How do you stop hip flexor pain when running?
- What is runners hip?
- Can running cause hip flexor strain?
- Why are hips important in running?
- The Anatomy of the Hip
- What are common causes of hip pain in runners?
- The 5 Best Hip Strengthening Exercises for Runners
- How do you prevent running hip injuries?
So, let’s get going!
Is it OK to run with hip flexor pain?
In most cases, hip pain when running is not something you should ignore. It is advised to rest and not run or taper your running until your symptoms subside and you are pain-free. I know most runners do not want to hear this…
Related: The 12 Best Supplements for Runners
How do you stop hip flexor pain when running?
If you have hip flexor pain when running, the fastest way to heal a hip injury is to rest, ice, load, and NOT stretch.
According to Colón, follow these 4 steps if you have hip pain when running.
- Rest. Practice relative rest from the aggravating activity.
- Load. Perform Eccentric hip flexion (see instructions below) doing 2 sets of 15 reps twice a day with as heavy resistance as you can tolerate without pain.
- Ice. Ice throughout the day for 15-20 minutes. Follow by heat when you can.
- Don’t stretch! Do NOT stretch if symptoms are within 6 weeks of onset. This is the acute phase and while it may feel good at the moment, you can increase the tensional load placed on the hip flexor, and increased, repetitive tension may be the culprit of why this started in the first place.
When you resume running, warm up your hip flexors and help reduce hip pain after running by doing active stretches specifically targeted toward that area, such as lunge stretches.
Adding in a side bend to the opposite side you are stretching is magic.
What is runners hip?
Runner’s hip is hip bursitis, an inflammation of the bursa sac (a sac of fluid that works to reduce friction between bodily tissues) of your hip. Runner’s hip is a common running injury typically caused by overuse.
Can running cause hip flexor strain?
Yes, running can cause a hip flexor strain—particularly distance running where runners may do too much too soon, not run easy enough on their recovery days, and skimp on sleep and nutrition.
For a lot of distance runners, tight hip flexors cause posture and recruitment problems which over time can lead to weak glutes and hip injury.
Why are hips important in running?
The hips are a driving force in our running, quite literally. Our core balances on our hips, and “the hips are the fulcrums of the leg levers driving our bodies forward,” writes Runner’s World. If your hips aren’t working right, your legs can’t provide your best power and speed.
Let’s take a closer look at the hip and its important role in our running stride.
The Anatomy of the Hip
The hip joint sits inside a 3-D rectangle composed of walls of different muscle groups, explains Colón.
- The front = hip flexors
- Back = glutes and lumbar paraspinals
- Outside = external/internal rotator groups and glute med
- Inside = adductors and pelvic floor
- Top = abdominals
- Bottom = lower portion of the leg and all the musculature
To support the inner contents of the rectangle (aka our hip), we want each side of the rectangle to be firing at the appropriate times as we run and have equal contribution to lumbopelvic stability throughout our stride. If the front of the rectangle, the hip flexor is over or under-active in comparison to the rest of the box, we can start to see the presence of running injuries such as tendinopathy, tendinitis, hip flexor strains or even avulsion fractures.
What are common causes of hip pain in runners?
Hip pain when running is caused when there is an imbalance in how our hips move.
Since this is a blog for moms who run, let’s look at common causes of hip pain in female runners related to pregnancy and postpartum, according to Colón.
Hip pain during pregnancy
The pelvis can take on a more anterior pelvic tilt due to the need of supporting the anterior weight of the baby. This causes a relative forward tilt to the “rectangle” creating tight and over-recruited hip flexors and long and weak glutes.
While running, we might over recruit the front side of the rectangle a.k.a. our hip flexor so we start to develop hip flexor overuse i.e. tendinitis or hip flexor strains.
Hip pain during early postpartum
Again, our pelvis is used to sitting into the anterior tipped position creating tight/strong hip flexors and weak/long glutes.
In early postpartum, we now may have added weakness or poor endurance to the pelvic floor musculature. This will cause an even larger demand on the hip flexors to turn on to create stability in running and then again overuse injuries.
Also, if you are breastfeeding and running, women who are breastfeeding can have continued laxity through their joints for up to ~6 months after breastfeeding has stopped.
This will create a relative increased demand on all muscles to pick up the impact of the joints through the lumbar spine and hips to create a relatively stable lumbopelvic region to run successfully.
More energy will be utilized for the same amount of running that the person completed pre-pregnancy vs. postpartum.
Related: How to Start Running Postpartum
Hip pain post- postpartum
For this runner, maybe the general recruitment of all muscles around the rectangle is good! They are stronger than early post-partum and pregnancy and can generally run a “normal” amount and speed for themselves but once they start to increase speeds or longer runs they don’t have the muscle performance yet.
If they are doing speed training the hip flexors are again the most confident to turn on and the other muscle groups are not there quite yet. If it’s distance, it is the same thing–the other muscles don’t have the endurance quite yet to push distance.
With speed training, postpartum runners may also try to increase their stride length vs. their cadence. This will cause an increased stretch than the concentric phase or work through the hip flexor than it is previously used to. This can overstress the hip flexor relatively.
The 5 Best Hip Strengthening Exercises for Runners
These hip strengthening exercises work to create stability through the pelvis and cause the whole lumbopelvic system to recruit to decrease hip flexor recruitment. Also, a plus, these hip-strengthening exercises can be done in a standing or lying positions in the comfort of your own home.
Eccentric hip flexion (with band)
- Hook band around the leg of a sturdy piece of furniture.
- Lay down with knees bent and hook top of the foot inside the band.
- Bend your knee and it towards your chin. Lower back down to the starting position.
- Repeat 2 by 15.
Resisted hip flexion (with band)
- Hook band around the leg of a sturdy piece of furniture.
- Stand with good posture, feet shoulder-width apart.
- Put your foot through the band so that it wraps to the front of your lower leg.
- Reach your leg forward keeping your knee straight. Slowly bring your leg back to the start.
- Repeat 3 by 20.
Seated foot taps (over an object)
- Put an object such as a weight on the floor next to your feet.
- Sitting with your legs straight in front of you, lift one leg up and tap the other side.
Watch a video of these hip exercises for runners here.
Single leg bridge with hip rotation
- Lie down on your back with your legs bent.
- Lift up your bottom on one side by squeezing your glutes.
- When lifted, twist your knee so that it is at the side of your body. Then return to start.
Prone Hip Extension
- Lie on your stomach with your legs straight out.
- With your hips pressed against the ground, tense your glutes and lift your leg straight up. Return back down.
- Ensure both your hips stay rooted to the ground.
- Repeat 3 by 10 times.
Watch a video of these hip exercises for runners here.
Hip bridges and dead bugs are also great exercises for healthy hips and pelvic floor.
How do you prevent running hip injuries?
Strong hips are key to healthy running. Here are some tips to have healthy hips and prevent hip pain while running.
6 Tips to Prevent Hip Injury in Runners
Strengthen your hips.
Perform the above hip strengthening exercises. Do this routine two times a week.
Be sure to eat before you run, during longer workouts, and refuel after running. Aim to include protein, healthy fats, and carbs in all your meals and snacks.
Related: How to Fuel for Marathon Training
Consider a joint supplement.
A joint supplement that combines collagen and glucosamine chondroitin can improve your joint health. I love Previnex’s Joint Health plus includes Boswellin which is a clinically proven anti-inflammatory.
Their supplement has been shown to decrease joint pain in as little as a week. Save 15 percent with my code TMR15 (and if you aren’t happy, get your money back!).
You are only as good as your recovery. So be sure to run easy on your easy days. (This is a controlled, comfortable, conversational pace). Sleep well—at least 7-8 hours a night. Take rest days at least once a week or as needed.
Related: The Importance of Sleep for Runners
Ice and rest at the first sign of pain.
If you experience hip pain when running, act fast and don’t wait for it to turn into a full-blown injury. Take a rest day or two, and ice multiple times a day.
When the pain has resolved, try a walk before a test run of a couple of miles. If the pain stays below level 3 or does not worsen, you can progress.
If you want guidance with your training, including returning to running after injury, check out my run coaching services. Also, be sure to check out my free training plans:
- Postpartum Training Plan
- After a Break Training Plan
- 5k Training Plans
- 10k Training Plans
- Half Marathon Training Plans
- Marathon Training Plans
- Strength Training Plan