If you’re dealing with hip pain, you’re far from alone.
In fact, around 7 to 14% of all running injuries hit the hip or pelvis area, according to The Journal of Strength & Conditioning Research. That’s a big chunk of us runners.
But here’s the upside: most of this stuff is fixable.
Over the years—coaching others and working through my own issues—I’ve seen that hip pain usually comes down to training habits, weak links in the chain, or overdoing it without enough support work.
You just need to figure out the real cause and get to work.
So let’s break it down.
1. Trochanteric Bursitis – That Outer Hip Burn
Ever feel a sharp sting or dull ache on the outside of your hip, especially when you press on that bony spot?
That’s likely trochanteric bursitis. It’s basically when the little cushioning sacs (bursae) on the side of your hip get inflamed—usually from overuse or rubbing by tight muscles, like your IT band.
This is common in runners—especially those who ramp up too fast or always train on sloped roads.
Why it Happens
A lot of the time, it’s not just the bursa. It’s a whole chain of problems.
If your glutes are weak or your hips lack stability, your form breaks down. That makes tendons and muscles rub where they shouldn’t, which inflames the area.
A sports doc I trust once said that a lot of women get diagnosed with bursitis when the real culprit is overworked glute tendons sitting right next to the bursa. Basically, when your stabilizers aren’t doing their job, everything else pays the price.
Also, running on cambered (sloped) roads or changing your gait suddenly can spark it.
How It Feels
- Sharp pain on the outer hip that can turn into a deep ache
- Hurts to lie on that side or go up stairs
- You might feel it down the outside of your thigh
- Tenderness or slight swelling on the side of the hip
What to Do About It
Step one: chill out the inflammation.
That means cutting back mileage (or full rest if needed), avoiding hills or sloped roads, and icing the area after workouts. I usually go with 10–15 minutes of ice post-run.
An anti-inflammatory can help short-term—but don’t mask the pain just to keep running. That’s a fast track to making things worse.
Next, fix what caused it.
Start stretching the IT band and outer hip (a standing crossover stretch or figure-four stretch is money). But more importantly, strengthen your glutes.
I’m talking side-leg raises, clamshells, band walks. One of my athletes nicknamed her resistance band “the pain noodle” because it burned so good—but she’s pain-free now.
I’ve also seen other runners bounce back with a combo of yoga, crab walks, and lots of consistent strength work.
The key? Don’t rush it.
Most cases clear up with rest and smart rehab, but it can take a few weeks. When you’re ready to run again, ease back in and keep doing strength work twice a week.
Don’t drop it the moment the pain goes away.
And hey, if nothing’s improving after a few weeks, get it checked out.
Sometimes you need a cortisone shot or a pro to look at your stride. But most of the time? This is something you can fix with smarter training and stronger hips.
2. Iliotibial Band Syndrome (ITBS)
Let’s talk about one of the most annoying—and sneaky—sources of hip pain for runners: IT band syndrome.
If you’ve ever felt a stabbing pain on the outside of your knee or that deep, nagging ache near your outer hip, this one’s for you.
Here’s the deal.
The IT band is this thick strap of tissue that runs down the outside of your leg—from your hip to your knee. It’s not a muscle. You can’t really stretch it.
But it can still flare up like crazy. And when it does, it feels like your knee is being stabbed every time your foot hits the ground. Sometimes, the pain even crawls up toward the hip.
Most runners think of ITBS as a knee thing, but it often starts higher up—at the hip. Weak glutes, especially the glute medius, can force the IT band to pick up the slack.
That’s when the problems start. Too much friction, too much tension, and boom—hello pain. Downhill runs and slanted roads? Those make it worse. Trust me, I’ve been there.
Why it happens:
ITBS is classic overuse.
Too much running, not enough recovery, worn-out shoes, and a lot of terrain imbalance.
And here’s the pattern—tight TFL (a small hip muscle) + weak glutes = overloaded IT band. Add in too much cambered road or track running, and you’re on the fast track to pain.
The symptoms:
You’ll usually feel a sharp or stabbing pain on the outer knee—right around mile 2 or 3 of your run. It might ease off when you stop, but the next day, it comes back.
Sometimes it clicks or snaps near the hip. Walking downstairs or running downhill? That’s when it bites hardest.
The fix:
Rule number one—don’t ignore it.
If you catch ITBS early, you can get back to pain-free running in a few weeks. But if you push through, you’re in for a long haul. Here’s the protocol I use with my runners:
- Back off your mileage. Cut it by 30–50%. If every run hurts, take a week or two off completely [runnersblueprint.com].
- Avoid downhill and sloped roads for now.
- Start a foam rolling and stretching routine. You can’t stretch the IT band itself, but you can loosen up the muscles around it. Roll out your quads, glutes, and outer thighs gently. I like the standing IT band stretch too—cross one leg behind the other and lean sideways.
- Strengthen your hips. This is where the magic happens. Hit your glute medius, glute max, and rotators. Clamshells, side-lying leg lifts, single-leg squats, and step-downs are the holy grail. Research backs this up—glute strength reduces strain on the IT band.
3. Muscle Strains and Tendinitis
Not all hip pain starts in the joint.
A lot of it comes from the muscles and tendons wrapped around it—especially if you’re pushing hard, training more, or skipping the strength work you know you should be doing.
Let’s talk about the big three troublemakers: your hip flexors, hamstrings, and adductors (inner thigh/groin area).
These are prime targets for runners—especially if your glutes are asleep or your training load jumps too fast.
Hip Flexor Trouble
If you’ve ever felt a sharp, stabby pain at the front of your hip or deep in your groin, it might be your hip flexors waving a white flag.
These little guys (mainly your iliopsoas) are responsible for lifting your knees every time you run. When they’re weak or locked up tight, they get overworked and inflamed.
I’ve seen it with athletes ramping up their mileage too fast or adding hill sprints without the strength to back it up.
One study found that tight or weak hip flexors are a common cause of hip pain in athletes, especially due to the repetitive motion of running. No surprise there.
Hamstring Strain
Now, if the pain’s in your butt or right under your sit bone, it could be a hamstring strain.
Usually pops up when you’re sprinting or powering up hills. You’ll notice it when you try to stretch or accelerate—it bites back hard. I’ve had runners describe it as a snap or a pop mid-sprint.
Not fun.
Groin Strain or “Sports Hernia”
Pain deeper in the inner thigh?
It might be an adductor strain—or what’s often called a sports hernia. Basically, a tear in your lower ab muscles or groin tendons.
It won’t bulge like a regular hernia, but it still hurts like hell.
Sprinting and quick direction changes are common culprits here. One runner I coached had this flare up just from stepping awkwardly during a tempo run. Took weeks to settle.
Why It Happens
Most of the time, this stuff comes down to one thing: imbalance. When one muscle group does all the work because the opposing group isn’t pulling its weight, something eventually gives.
Think of it like this: if your glutes and hamstrings are weak, your quads and hip flexors pick up the slack.
Keep piling on speed workouts or hill repeats, and you’ve got a recipe for strains and tendinitis.
I read a Reddit thread where a runner added intervals too fast and wound up with hip flexor tendinitis. He said it got so bad he couldn’t even lift his leg to put on pants. His PT traced it back to—you guessed it—weak glutes and a soft core.
What It Feels Like
A muscle strain usually comes with a sharp, sudden pain.
You might feel or hear a “pop.” It could swell, bruise, or make the muscle feel weak or shaky—like your leg’s not firing right.
Tendinitis, on the other hand, is sneakier.
It starts as a dull ache that builds over time, especially after your runs.
The pain’s usually right where the tendon connects to bone. It stiffens up after sitting—ever get up from a chair and limp for a few steps? That’s a cranky tendon talking.
What To Do About It
If it’s an acute strain, hit it with RICE (Rest, Ice, Compression, Elevation) for the first couple of days.
Don’t run through it. Ice for 10-15 minutes a few times a day.
If it’s swollen, use a compression wrap and elevate your leg.
After a few days, start moving again—but easy. Gentle mobility work. Heat instead of ice. Walk. Let blood flow do its thing.
For tendinitis or minor strains, rest doesn’t mean lying on the couch all day—but you do need to scale back.
Ditch speedwork and hills. Switch to cross-training like cycling, swimming, or pool running—just avoid anything that flares it up.
Once the pain settles, start rehabbing with strength work.
Eccentric exercises (where the muscle lengthens under tension) are gold for tendons. I’m talking Nordic hamstring curls for hamstrings, slow-lowering lunges for hip flexors.
And don’t sleep on core training—a strong midsection takes pressure off your hips.
Keep stretching too. Gentle dynamic stretches for your quads, hip flexors, and hammies can help prevent scar tissue from locking things up.
4. Weak Glutes & Muscle Imbalances
Let’s not sugarcoat this: weak glutes and muscle imbalances are sneaky culprits behind a lot of hip pain in runners.
I already brushed over it earlier, but this deserves its own spotlight because I’ve seen it ruin seasons — including mine.
Your hips aren’t just a hinge—they’re like a four-way intersection. You’ve got muscles in the front (hip flexors and quads), the back (glutes and hamstrings), the inner thighs (adductors), and the outer hips (like your glute med).
When everything’s firing right, your hips stay stable. But if one side gets lazy—say, your glutes are snoozing from too much desk time—another group jumps in to cover.
That imbalance? That’s how pain shows up.
For runners, the classic pattern is weak glutes and core mixed with tight hip flexors and quads. Some call it lower cross syndrome. I call it runner’s butt gone wrong.
Back in my early marathon days, I had constant low back and hip soreness after long runs. At first, I chalked it up to mileage.
But truth is, my glutes weren’t pulling their weight, so my lower back and hip flexors stepped in and got overworked. Once I started hammering glute bridges, clamshells, and core work, it felt like someone turned the pain dial down.
Another red flag?
Imbalances between your left and right side. One hip weaker than the other? You might overstride, compensate, and overload one leg.
I once coached a runner who kept battling right hip pain. Turns out, her right leg was literally a centimeter shorter.
A simple shoe insert plus a glute-focused strength plan? Boom—pain gone after two years of struggle.
It’s not just about strength either.
Modern life sets us up to fail—sitting all day shuts your glutes off and tightens your hips.
Add in running without strength work, and it’s no wonder your stabilizer muscles wave the white flag once mileage goes up.
I read a great quote from a physical therapist in Runner’s World who said, “Running on weak hips is like doing a tug-of-war under load.” That nailed it. Every step becomes a mini battle of muscles pulling in the wrong direction.
Signs to Watch For
You might not feel the imbalance right away.
But if you’re dealing with chronic tightness in your hip flexors, always lose form when you’re tired, or notice that one side wobbles more than the other—those are warning signs.
Try a single-leg squat or bridge. If one side folds like a house of cards, that’s the side begging for more strength.
I have my athletes do a simple test: stand on one leg for 30 seconds. If you’re flailing on one side and solid on the other, you’ve found your weak link.
The Fix: Get Strong. Stay Strong.
The fix isn’t complicated—but it does take effort. Strength training is your best defense.
No gym? No excuses.
A living room, resistance band, or a set of dumbbells will do just fine.
Start with the basics: squats, lunges, deadlifts, glute bridges, and step-ups. These build full-body strength. Then zero in on weak zones:
- Clamshells and monster walks (glute med)
- Side planks (lateral core)
- Bird-dogs (glutes and lower back)
Two sessions a week during your training cycle is a solid goal.
And trust me—you don’t need hour-long workouts. Even 20–30 minutes of consistent, focused strength work can make a huge difference.
Also, add in single-leg work. Think: single-leg squats, single-leg deadlifts. Why? Because running is a one-leg-at-a-time sport.
These moves challenge your balance, coordination, and hip stability.
I still remember the first time I tried single-leg deadlifts—my balance was trash.
But that wobble? That was feedback. It told me I had work to do.
Stretch Smart, Not Just More
Flexibility matters too—but don’t fall into the “just stretch more” trap.
Stretch what’s tight—hip flexors, quads, hamstrings—but strength should be the focus, especially if you’ve got outer hip pain or tendon irritation.
I’ve seen athletes stretch their hip flexors for months hoping the pain would fade.
But the real fix? Strengthen the glutes. When your glutes do their job, the flexors stop getting overworked.
Sometimes, feeling “tight” is your body protecting a weak muscle. And strengthening that muscle is what actually makes it feel better.
5. Bad Running Form Can Wreck Your Hips
Let’s talk about form—because if your hips are barking after every run, there’s a good chance your mechanics are part of the problem.
Most runners don’t even realize their form is off until the pain sets in.
But trust me, I’ve been there.
Running with sloppy form is like driving a car with the wheels out of alignment—you might get away with it for a while, but sooner or later, something’s gonna wear out.
My Story (Because Yep, I Messed This Up Too)
A few years back, I started feeling this pinchy, nagging pain in my right hip and groin every time I pushed the pace.
At first, I blamed the shoes.
Then the trail.
Then the weather.
But the truth? I was overstriding and heel-striking like crazy while trying to run faster. My long stride was jamming my femur into the socket.
What fixed it? I shortened my stride, bumped up my cadence, and boom—pain gone.
It was a smack-in-the-face reminder: how you run matters. A lot.
Why Form Breaks You Down
Running is repetitive—thousands of steps in a single run.
If your form is off by even a little, that error gets multiplied over time.
It’s not just about pain in the hips. It can snowball into knee trouble, shin splints, or even lower back strain. Like a crooked door hinge—eventually, it sticks or breaks.
Often, the real issue is upstream: weak core, weak glutes, or just poor habits built over time. And when you’re tired? That’s when form really starts to crumble.
If your hip pain only shows up at the end of long runs or after speedwork, your form’s probably falling apart when fatigue sets in.
The Fix: Small Tweaks, Big Gains
Here’s what I coach my runners to focus on:
- Run Tall with a Slight Forward Lean (from the ankles, not the waist). Picture a string pulling you up from your head. Keep your pelvis neutral—don’t stick your butt out or slouch. That gentle lean helps use gravity to move you forward, not your lower back.
- Crank Up Your Cadence. Aim for around 170–180 steps per minute. It doesn’t have to be perfect, but a quicker turnover usually means less overstriding. I like doing 30-second drills mid-run where I count steps—try it. It’s a game-changer.
- Land Under Your Body. You don’t need to be a forefoot striker. Just make sure your foot isn’t landing way out in front. Think “light feet” or imagine the ground is on fire. Quick, snappy steps. Let gravity do the work.
- Engage Core & Glutes. Your core stabilizes your spine and pelvis. Engage your lower abs like someone’s about to punch you. Glutes? They’re your power source. I’ll even sneak a hand to my backside mid-run to check if my glutes are firing with each push-off (just… not in public).
- Upper Body Check. Relax those shoulders. Arms should swing naturally, elbows around 90 degrees. Too much torso twisting can throw your hips off. Look ahead—not down—so your posture doesn’t collapse.
6. Overtraining & Sudden Increases
One of the first things I ask when a runner tells me, “David, I didn’t fall or twist anything—so why the heck does my hip hurt?” is this: “Show me your training log.”
Nine times out of ten, it’s the usual suspect—overtraining.
You feel great, start piling on miles, maybe throw in some hill sprints or speedwork because you’re fired up… and then boom—your hip starts barking.
You think it came out of nowhere, but really?
It’s been creeping up quietly for weeks.
Why This Happens
Your body needs time to catch up with your training ambitions.
Muscles, tendons, bones—they all adapt slower than your heart and lungs. So even if your fitness feels strong, your hips might be hanging on for dear life.
I’ve seen this play out a hundred times:
- A runner goes from 10 miles a week to 30 overnight.
- They toss in tempo runs and hills all at once.
- Or they grab a random marathon plan off the internet and go full throttle from day one.
And guess what? That’s a recipe for breakdown.
One review published in the Journal of Strength & Conditioning Research flagged training errors—especially sudden mileage spikes and poor recovery—as major causes of running injuries.
That tracks with what Runner’s World found too: around two-thirds of hip stress fractures come from pushing too hard, too soon.
What It Feels Like
Hip pain from overtraining can show up in all sorts of ways:
- Tendonitis
- Muscle strain
- Or worst-case: a stress fracture
One red flag?
Bilateral pain—both hips feeling sore, or your hip + another area (like your knee or shin) nagging at the same time. That’s your body saying, “Hey, you’re overcooking it.”
And if the pain kicks in right after a big training jump—especially if you’re feeling run-down, sleeping poorly, or dragging through workouts—you might be staring down overtraining syndrome.
What to Do About It
Here’s the real fix—and yeah, it’s not flashy:
Back off. Rest. Rebuild smarter.
If your pain is sharp or deep, especially bone-deep, hit pause.
I’d rather you take 10 days off than end up sidelined for 10 weeks with a stress fracture (Runner’s World warns how fast those can escalate if ignored).
At a minimum, cut your volume in half. Skip the intervals and hill sprints for now. Let the fire cool.
Use this downtime to look at the bigger picture:
- Were you following the “10% rule”?
- Did you include cutback weeks every 3-4 weeks?
- Are you listening to those early warning signs?
Honestly, I’ve ignored them too.
That tightness that lingered after a long run? I brushed it off. Until it turned into something bigger. Now, I’ve learned—don’t be a hero, be consistent.
7. Stress Fracture of the Hip
Alright, now we’re entering serious territory.
A stress fracture in the hip—usually in the femoral neck or head—isn’t just another tight muscle or sore tendon.
This one’s a bone issue. A small crack that builds up from repetitive pounding, often without enough recovery in between.
It’s one of those overuse injuries runners really fear—and for good reason.
Even though it’s less common than stuff like tendonitis or muscle pulls, it still happens.
Especially to distance runners logging big mileage or cranking up intensity without giving their body the time or fuel to bounce back. I’ve seen it more than a few times in marathoners who tried to ramp up too fast.
What It Feels Like
It usually starts with this subtle ache deep in your groin or the front of the hip.
At first, it might only show up late in a run.
A week later, it kicks in earlier. Then maybe you feel it walking, climbing stairs, or even just standing still. Eventually, it becomes this deep, dull throb that haunts you at night.
If your hip pain wakes you up?
That’s a giant red flag. Stop guessing—get it checked.
Why It Happens
Your bones aren’t static.
They rebuild and remodel based on the stress you put them through—that’s called Wolff’s Law.
But if you keep stacking on stress (like increasing mileage too quickly) without giving your body the nutrients or time to recover, you set yourself up for breakdown.
First comes bone swelling (a stress reaction), and if you keep pushing, it turns into a crack.
According to Runner’s World, around two-thirds of hip stress fractures in runners are linked to sudden jumps in mileage.
I’m not surprised.
Most of the athletes I’ve coached through this either doubled their long run or cut their rest days right before it hit.
Who’s More at Risk?
There are some common patterns:
- Women, especially those with irregular periods or low bone density.
- Low body weight or a history of disordered eating.
- Poor nutrition, especially lacking calcium or vitamin D.
- High training volume, like marathoners or ultra runners logging huge weeks.
In women, something called RED-S (Relative Energy Deficiency in Sport) is a big warning sign.
It messes with energy levels, menstrual cycles, and bone health. But don’t think men are immune—guys who underfuel while training hard are at risk too.
How to Spot It
The pain is usually right in the groin or front of the hip.
It might shoot into your thigh.
It gets worse the more you move—running, walking, jumping—and feels better with rest, at least early on.
But here’s the clue: the pain shows up earlier and earlier in each run, and sticks around longer afterward. If you’re limping up stairs or hurting while walking, it could be serious.
And if it throbs while you’re lying in bed? Don’t wait.
There’s a quick check called the hop test.
If hopping on one leg sends a sharp pain into your hip, that could mean a stress fracture.
But seriously—don’t overdo this test. Let a sports doc take it from here.
What to Do
First rule: stop running.
Don’t try to “run through it.”
This isn’t shin splints—it’s a bone injury. See a doctor, preferably a sports orthopedist. They’ll likely order an X-ray, and possibly an MRI or bone scan, since early fractures don’t always show up on regular scans.
Treatment is simple, but not easy: rest.
Usually 6 to 8 weeks of zero impact. No running, no jumping, no “but I feel fine.” You’ve got to treat it like a broken bone.
Sometimes they’ll let you bike or swim if it doesn’t hurt, but that’s up to your doc.
Deep water running can be gold here. Think of your “cast” as your willpower. You have to protect that bone even though you can’t see the damage.
Nutrition Matters
Your bones can’t heal on wishful thinking.
This is the time to eat more, not less.
Forget the diet. Your body needs calories, calcium, vitamin D, and protein to rebuild. Some doctors even run blood tests to check your vitamin D levels and recommend supplements if needed.
I always tell my athletes to bump up their protein intake during injury. Bones are living tissue, and they need building blocks to heal—just like muscles.
Coming Back
Once the doc clears you—usually with a repeat scan and no pain—you’ll ease back in slowly.
Start with walking.
Then some walk/run intervals.
Then very gradual build-ups. I usually follow the 10% rule, adding no more than 10% distance per week, and make sure runners take at least two full rest days between runs early on.
Physical therapy helps here. A good PT will check your gait, form, and strength. You might find out that weak glutes or poor stride mechanics contributed to the injury in the first place.
How to Avoid It
- Increase mileage gradually—don’t double your long runs.
- Eat like an athlete. Fuel your training.
- Get your vitamin D and calcium checked if you’re at risk.
- If you’re a woman with irregular cycles or super low body fat, talk to a doc about RED-S.
- And most importantly: don’t ignore the whispers.
Your body always talks. It starts with a whisper—a dull ache, a nagging soreness.
If you blow that off, it’ll start shouting. And when bones start screaming, you’re looking at weeks or months on the bench.
8. Hip Impingement (FAI)
Ever feel a sharp pinch deep in the front of your hip—especially when you’re lifting your knee high, sitting too long, or doing squats?
That could be hip impingement.
The technical term is Femoroacetabular Impingement (FAI), but let’s keep it simple: your hip socket and femur aren’t getting along.
Some runners are born with hips that aren’t shaped quite right. Others develop this from years of intense movement—like sprinting, hill running, or smashing squats in CrossFit.
The bones can literally pinch the soft tissue inside the hip joint when you move a certain way.
There are two types:
- Cam impingement: Your femur (thigh bone) has an extra bump, and it rubs.
- Pincer impingement: Your hip socket has extra bone, and it digs into things.
Some unlucky folks get both.
That pinch adds up over time and can mess up the cartilage or even tear the labrum (more on that later). According to RunnersWorld.com, FAI is one of the top reasons younger adults end up with early hip arthritis—especially active folks in their 20s to 40s.
How It Shows Up
You’ll usually feel it right in the front of the hip or groin.
It can stab or just ache like hell after running hills, doing speed drills, or sitting for hours.
One giveaway is the FADIR test: pull your knee toward your opposite shoulder—if that sparks the pain, bingo.
I coached a guy who swore stretching would help his hip pain. Problem was, every time he did deep lunges or squats, it made things worse. His groin felt stiff and achy, and it clicked sometimes too.
We figured out that shortening his stride, skipping deep squats, and focusing on single-leg strength helped keep things in check.
Eventually, he did go in for surgery because the bony growth was too much—but that’s not always the path.
How to Handle It Without Surgery
If you’re dealing with FAI, here’s what you can actually do before jumping into a hospital gown:
- Avoid Painful Movements. Skip the deep squats, pigeon pose, knees-to-chest stretches, or anything that shoves your hip into the pinch zone. If hill repeats make it worse, swap them for flat runs. Don’t try to “stretch it out”—that’s how you aggravate it.
- Move Where It Feels Good. A lot of runners with FAI also have tight hips, weak glutes, or stiff ankles. Loosening up your hip flexors and glutes (without pushing into pain) might give the joint a bit more room. Work on ankle mobility and core control too. I’ve seen people unlock better movement just by fixing their form from the ground up.
- Strengthen Smart. Stronger glutes help pull the femur back into the socket, which can reduce pinching. Core work matters too—especially the deep lower abs. That keeps your pelvis from tilting or your back from over-arching during runs. One PT I trust always includes this kind of work when dealing with FAI patients.
What I Tell My Athletes
If you’re running with mild FAI, you can still train smart.
Just dial back the things that piss off your hip—no deep bounding drills, fewer high knees, limit hill sprints.
Add more low-impact cross-training like cycling or swimming if needed.
And don’t try to play doctor—groin pain can come from all kinds of things, and not every pinch is FAI.
But if you’ve got that specific, persistent front-of-hip pain that worsens with deep movement, go get it looked at. You’ll train better when you actually know what you’re dealing with.
9. Labral Tear (Torn Hip Cartilage)
Let’s talk about one of the trickiest hip injuries I’ve seen runners deal with—a labral tear.
That little ring of cartilage around the hip socket (the labrum) is like a seal and shock absorber for the joint.
When it gets torn, things get messy: sharp pain, weird clicking or catching, and that unstable “my hip’s not right” kind of feeling.
This one isn’t your run-of-the-mill soreness.
It’s more serious and often needs a doc’s help, but I’m including it here because I’ve seen too many runners ignore the signs until it’s too late.
If you’ve had deep groin pain that just won’t quit, this might be the hidden culprit.
How It Happens
Tears can come from a bad fall, a car crash, or years of pounding pavement with bad movement patterns.
For runners, it’s usually overuse and something called FAI—femoroacetabular impingement—which is just a fancy way of saying the bones in your hip joint don’t move well together.
Over time, that constant grind can wear down the labrum.
I once coached a runner—Phoebe, 35, ultra-fit and training for long distances—who had everything from glute tendon pain to bursitis. After months of frustration, she finally got an MRI.
The verdict?
A complex labral tear. Looking back, it was probably a slow build-up: one issue weakening another until the labrum couldn’t hold up anymore.
And it’s not always dramatic.
Sometimes just twisting your leg while your foot is planted (like changing direction during drills or trail running) is enough to cause a tear—especially if you already have joint tightness or instability.
How It Feels
The pain usually settles deep in the groin.
Some runners feel it constantly; others say it comes and goes. The big red flags are clicking, catching, or that odd locking feeling—like the hip gets stuck mid-move.
Running becomes painful, especially when driving the knee forward or twisting.
And here’s something I’ve noticed with athletes I’ve worked with: the pain often gets worse after the run, once the joint cools down. That stiffness post-run? It’s inflammation kicking in.
Phoebe described it like this: “It starts as a dull ache while running, but when I stop, the whole area gets angry.” That’s classic labral behavior.
You might also feel weakness, or like the hip is giving out on you. Since the labrum plays a role in joint stability, a tear can leave things feeling wobbly or unreliable.
What to Do About It
Small tears?
Sometimes they can be managed without surgery.
Bigger ones? You might end up on the operating table. Here’s the usual roadmap:
Conservative Treatment
- Physical Therapy is your first line of defense—especially hip strength work focused on the glutes and core.
- Activity modification helps too: ease off things that aggravate it (hill sprints, deep squats, etc.).
- Anti-inflammatories and rest can calm things down short term.
- Some folks try corticosteroid injections into the joint. Phoebe did two—neither helped. That’s pretty common if the tear is still being pinched during movement.
The goal here isn’t to “heal” the tear completely—it’s to stabilize the joint enough that the tear stops bugging you day to day.
When Surgery Makes Sense
If PT and rest don’t cut it after a few months—or you’re dealing with daily locking and pain—you might need arthroscopic surgery.
That’s where the surgeon goes in through tiny incisions, stitches up the labrum if it’s detached, or trims the damaged parts.
Most importantly, they’ll usually smooth out any bone irregularities (FAI stuff) while they’re in there.
That step matters if you want to avoid tearing it again.
I’ve seen good outcomes with this.
10. Piriformis Syndrome: The Literal Pain in the Butt
Let’s get one thing straight—not all hip pain comes from the hip joint itself. Sometimes it’s a sneaky nerve problem pretending to be a muscle issue.
One of the biggest culprits? Piriformis syndrome.
That little deep muscle in your butt—the piriformis—can clamp down on the sciatic nerve, and when it does, oh man, you’ll feel it.
Pain in your glutes, hip, even down the back of your leg. Classic sciatic pain—but coming from outside the spine.
What Causes It?
The piriformis helps rotate and stabilize the hip, but when your glutes are weak or you’re hammering hills and speedwork without proper strength, it can get ticked off.
Tighten up. Spasm. And when it does?
It presses right into the sciatic nerve that runs underneath—or in some people, straight through—it. Some folks are built in a way that makes this more likely, especially if their nerve pierces the muscle belly.
I had it after a brutal trail marathon—one of those events where the climbs never ended and the downhills burned.
My glutes were shot, and the next day, boom. Deep ache in my left butt cheek. Zing down the hamstring. Sitting felt like torture. Driving was worse. My piriformis had basically thrown a tantrum and latched onto the nerve like a pitbull.
What It Feels Like
Here’s what you’ll notice:
- A deep, annoying ache right in the middle of one glute.
- Shooting or burning pain that might run down the back of your thigh, even into your calf or foot.
- Tingling, especially after sitting on hard surfaces or when your wallet’s in the back pocket (guys—ditch the wallet back there).
Uphill runs might make it worse.
And while it can feel like disc-related sciatica, piriformis syndrome usually doesn’t get worse with back movements.
One telltale sign?
Pressing into the piriformis muscle (just behind the hip) feels super tender. If your back feels fine, but your butt’s screaming—that’s your sign.
How to Deal With It (And Get Back on the Road)
1. Stretch & Release
You’ve got to get that piriformis to chill out.
Best way?
Start with the figure-4 stretch—lie on your back, cross one ankle over the other knee, and pull that leg toward your chest. You’ll feel it right where it hurts.
Self-massage also helps.
I’ve sat on a tennis ball, gritting my teeth, just to loosen that thing up. It’s a “hurts-so-good” kind of pain.
But don’t go too hard—poke the nerve too much and it gets angrier.
A little heat (warm compress or heating pad) can also help the muscle let go. I remember lying on the couch with a hot pack on my butt while my wife laughed at me—but hey, it worked.
2. Nerve Glides (a.k.a. Sciatic Flossing)
If the nerve feels stuck or keeps zinging down the leg, try some nerve glides.
One move I use is lying on your back, raising your leg into a gentle hamstring stretch, and flexing and pointing your foot.
It gets the sciatic nerve moving without irritating it. A physical therapist can teach you these properly—and it’s worth learning.
3. Strengthen the Right Muscles
Once the pain’s down, don’t just jump back into normal running.
Build up your glutes—especially glute max and med. A tight piriformis often means other muscles aren’t doing their job.
Add bridges, clamshells, lateral band walks, hip thrusts—you name it.
And don’t forget the core. I added deep squats and bird-dogs once I was pain-free, and they really helped stabilize my hips so the piriformis wasn’t doing all the work.
4. Tweak Your Training
Take a break from the stuff that’s lighting the nerve up—hills, track sprints, anything explosive.
Flat and easy is your friend. If even that hurts? Pull back.
I took a full week off running and did easy cycling instead, and it helped me turn a corner. Don’t let your pride push you into prolonging the pain—nerve stuff can be stubborn.
Most cases will calm down with the above within a few days to a few weeks.
If not? Get checked out to rule out anything deeper like a lumbar spine issue.
In rare cases, runners get relief with corticosteroid or even botox injections—but honestly, that’s the last resort. Usually, a smart combo of stretching, glute strengthening, and rest does the trick.
11. Osteoarthritis (Wear-and-Tear Arthritis)
Let’s talk about one of the first things people think of when you say “hip pain” — arthritis.
You’d be surprised how many non-runners instantly assume running ruins joints.
But truth is, it doesn’t. In fact, research (RunnersWorld.com cites several studies) shows that long-term runners aren’t more likely to get hip arthritis than non-runners.
Still, some of us—especially older runners or those with a history of hip injuries—can end up dealing with osteoarthritis in the hip.
And it’s no joke.
We’re talking about cartilage wearing down, bone-on-bone rubbing, and a hip that just feels stiff and angry more often than not.
Why It Happens
Age plays a role—no getting around that.
The older we get, the more miles our joints rack up.
Genetics also matter. Some folks are just more prone to joint issues no matter how careful they are. And if you’ve had an injury in that area—like a labral tear or a fracture—arthritis can set in faster.
If you had something like untreated FAI (femoroacetabular impingement) and kept pushing through it, those years of stress can catch up to you in your 40s or 50s.
I’ve seen it in runners I’ve coached—and honestly, I wouldn’t be surprised if my own body gives me that wake-up call someday.
Here’s the irony: moderate running can protect your joints.
One study found that recreational runners have lower rates of hip and knee arthritis than sedentary folks. That’s probably because regular running keeps your weight in check and your joints moving.
But pounding out 100+ mile weeks for decades? That’s when the risk starts creeping up—especially if your form’s off or you’ve had injuries.
If you’re over 50 and notice that dull groin ache, or if your hips feel like concrete in the morning but loosen up as the day goes on, arthritis might be the reason.
Common Symptoms
- Deep ache in the groin, butt, or front of the hip
- Stiffness, especially in the morning or after sitting
- Less range of motion — the hip doesn’t rotate or spread like it used to
- Grinding/crunching sounds (yep, crepitus is real)
- Pain tends to be worse with weight-bearing activities or cold/damp weather
- You might feel better during the run, but pay for it later—classic arthritis pattern
I’ve had runners tell me the first few miles feel awful—like rusted hinges.
But then the hip warms up, moves easier, and they start enjoying it again. Until they cool down, and the ache returns like a bad houseguest.
So… What Can You Do About It?
There’s no magic pill that brings back cartilage (yet), but that doesn’t mean it’s game over. You can manage arthritis and still enjoy running—if you play it smart.
1. Tweak Your Training
- Cut down on the pavement. Trails, treadmills, and soft tracks are your friends.
- Reduce intensity and volume if needed. Instead of 6 hard days, try 3-4 run days and 2-3 cross-training days (bike, swim, row, whatever keeps you moving).
- Many arthritic runners do better with shorter, more frequent runs—like 3–4 miles most days, instead of one long 12-miler that wrecks the hip for a week.
2. Build Strength Where It Matters
- Glutes, hips, quads, core—they all support your hip joint.
- I don’t care how many miles you run, if those muscles are weak, your joint takes the beating.
- Machines, bands, or bodyweight—just avoid anything that causes sharp pain.
- Add dynamic warmups (think leg swings and hip circles) to get things moving before your runs.
3. Keep Your Range of Motion
- Gentle daily stretches can help, but don’t force it.
- Avoid deep lunges or painful yoga poses that jack up your joint.
- Stay loose, but respect your limits.
4. Lose a Few Pounds (If You Need To)
- Every pound you drop takes several pounds of pressure off your hip with every step.
- I’ve seen big improvements in hip pain when runners shed just 5–10 pounds—not for vanity, but for relief.
5. Smart Use of Meds and Supplements
- NSAIDs like ibuprofen can help on flare-up days—but don’t make them a daily habit.
- Talk to a doctor before popping pills too often.
- Supplements like glucosamine, chondroitin, and omega-3s? Hit or miss, but if they’re safe and help you, go for it.
6. Advanced Options
- Cortisone shots = short-term relief (weeks to months).
- PRP and hyaluronic acid injections are being explored more—ask your doc.
- Physical therapy can make a huge difference. A good PT will tailor exercises and use techniques like ultrasound to help you move better and hurt less.
And yeah, if it gets bad—like you’re limping through life and not just runs—you might start talking hip replacement.
But here’s the good news: I know multiple runners who’ve had the surgery and come back strong. One guy even ran a marathon post-replacement.
That’s not a promise, but it is possible with proper rehab.
12. Rare but Serious Hip Issues (Don’t Panic, Just Be Informed)
Look, most hip pain in runners isn’t life-threatening.
But just in case you’re one of the rare exceptions, let’s quickly run through a few outliers that doctors keep an eye out for.
- Avascular Necrosis (AVN): This is serious stuff—when blood flow to the femoral head (top of your thigh bone) gets cut off, bone tissue starts dying. It’s not a running injury—it’s more linked to heavy steroid use, alcohol abuse, or trauma. If you’ve got it, chances are you already know something’s up. The pain is deep and constant, and it eventually leads to joint collapse. You don’t run through this—you see a doctor fast.
- Slipped Capital Femoral Epiphysis (SCFE): This mostly hits teens. If your kid (or a young runner you coach) is complaining of hip pain and walking funny, this might be it. It’s a growth plate issue, not a running overuse thing.
- Labrum Cysts or Tumors: I’ve never seen this personally, but they’re out there. If your hip hurts constantly—day and night—and doesn’t change with activity, you need imaging to rule out something more serious.
- Septic Arthritis: If your hip flares up big-time and you’ve got a fever, chills, or you feel sick in general—don’t mess around. Get to the ER. This could be an infection inside the joint. Rare, yes—but emergencies don’t give warnings.
- Hernias: If your groin aches and there’s a bulge (especially when coughing or lifting), it could be an inguinal hernia. Pain sometimes radiates toward the hip, and runners often misread it.
- Meralgia Paresthetica: Say that three times fast. It’s basically nerve compression near your outer thigh. Might feel like buzzing, tingling, or numbness. Not a hip joint issue, but it can mimic one. Think tight waistbands, weight gain, or awkward running belts.
Bottom line: 95% of hip pain is from the usual suspects—strain, tightness, overuse, ITBS.
But if you’ve got weird symptoms—like fever, intense nighttime pain, or you suddenly can’t bear weight—get checked out.
I always say, it’s better to get reassurance than to let something serious slip under the radar.
Track Your Hip Pain Like a Coach (Because Data Doesn’t Lie)
Here’s one of the most underrated tools for injury recovery: your own training log.
I don’t mean just logging miles and calling it a day.
I’m talking about tracking what really matters when something feels off—your pain, your stress, your recovery, your shoes, your terrain, your life.
Use This System:
- Log the run: Distance, pace, terrain (pavement, trail, treadmill), and the shoes you wore. Shoes matter more than people think.
- Note the pain (if any): When did it show up? Early miles? After sitting all day? Was it sharp or dull? Gone after warming up or still there later that night?
- Record life stuff: Bad sleep? Stressful week? New gym routine? These things can stack up and break you down.
- Track strength and cross-training: Especially if you just started something new—like plyometrics or squats. Pain the next day? There’s your clue.
- Look for patterns: After a few weeks, go back and connect the dots. You might notice the hip flares up every time you run over 30 miles in a week. Or maybe speed workouts on road surfaces trigger it. Sometimes it’s post-squat soreness that lingers too long.
I once coached a runner who had mystery hip pain every few weeks. We combed through her training log and noticed it always hit right before her period.
Turns out, hormone shifts were likely playing a role. She started backing off during that window—just easier miles or a rest day—and boom: no more flare-ups. Logs work.
Even more important: Tracking helps you see progress. Maybe you went from “hip hurts after 3 miles” to “no pain until mile 6.” That’s a win.
If things aren’t getting better despite rest, rehab, and modifications, that’s also valuable. It’s a sign to dig deeper—or bring the log to a pro who can help.
Pro Tip: Add a “Body Check-in” section in your journal. One line. How’d your hip feel today? Don’t overthink it—just note it. Future you (or your PT) will thank you.
Now it’s your turn: apply what you’ve learned to your own situation.
And if you need extra help or have questions, don’t hesitate to reach out to running coaches, physical therapists, or a running community (online forums are full of people who’ve been where you are).
You’re not alone in this.
Here’s to many happy, healthy miles ahead. Train smart, listen to your body, and never lose the joy of running. You’ve got this!
