Hip injuries in runners

Hip injuries in runners are often a result of intrinsic and extrinsic factors that challenge our complex anatomy. The hip joint mobility can accumulate a lot of stress from impact, making it much more prone to injury than other parts of the body.

Below you will find the main injuries that affect runners in the hip area.

Common hip injuries

Muscle strains and tendonitis: These types of injuries are the most common causes of hip pain, which typically result in sudden acceleration/deceleration action, direction change or lengthening contractions.

Iliotibial band syndrome: It is an injury that is generated by poor striding technique and running on uneven terrain. These symptoms are distinguished by sharp or burning pain that is intensified by an activity.

Hip Bursitis: Bursitis may affect the trochanteric, ischial or iliopectineal bursae due to repetitive activity or acute trauma with a sharp pain starting on the outside hips that can turn into a dull ache. This injury occurs when synovial fluid sacks start to absorb impacts and prevent friction between the bones and soft tissue resulting in irritation. It is common when running on uneven terrains.

Hip fractures: These are often possible in patients who have degenerative diseases such as arthritis and osteoporosis. Usually, the area of the hip that is fractured or broken is the neck of the femoral head, which joins the pelvic cavity to create your hip joint. It is a serious injury, especially in the risk groups, that can cause severe pain that prevents mobility of the leg.

Stress fractures are caused by small, repetitive injuries to the hip bone, often from overuse activity and have the potential to become a serious condition that affects women more frequently than men, the older population and new runners.

Sportsman hernia: Causes pain with exercise but does not bulge like other hernias. This refers to strains or tears of the muscles, tendons, or ligaments located in the groin region.

Symptoms of hip injuries

• Pain in and around the hip joint, sometimes radiating into the leg, buttocks or groin
• Tenonitis may feel stiff in the morning, and beginning of exercise but typically settles
• Swelling in the inflamed area (repetitive strain, bursitis, tendinitis, stress fracture)
• Brusing in area (muscle strain, stress fracture)
• Pain on walking and during exercise (muscle strain, iliotibial band syndrome, stress fractures)
• Some may have trouble sitting on crossed leg
• Trouble lifting the leg in/out of the car

Recovery strategies

Depending on what type of injury has occurred at the hip will often determine what treatment is required but a multi-factorial approach is often the preferred approach and is effective. I often recommend…

Physiotherapy: To focus on reducing pain, restoring the range of motion and strength and reducing inflammation around the hip joint which can be done via manual therapy and exercise prescription, to assess any bio-mechanical asymmetries and mentor back to running.

Strength and conditioning coach: To focus on local and global strengthening in conjunction with your rehab. Here the focus would be on gluteal strengthening, core stability and lower limb strengthening.

Running coach: In preparation for an event… working with a professional coach is always beneficial as they can create training plans to reach desired goals, spot weaknesses and provide a different perspective.

Other recovery strategies I often speak about are tendinopathies and bursitis.

Shockwave therapy: A non-invasive treatment which jumps starts the body’s ability to reduce pain and promote tissue healing.

Exercises to keep hips in good health and improve strength

Mobility exercises for runners:

• 90/90 stretch – This stetch simple yet effective stretch that can help improve your flexibility and reduce the risk of injury. It involves sitting on the floor with one leg extended in front of you at a 90-degree angle and the other leg bent at a 90-degree angle behind you. From here, you can lean forward to stretch your hips and hamstrings. Hold this position for 30 seconds and repeat on the other side. This stretch is particularly beneficial for those who sit for long periods of time or participate in activities that require a lot of lower body movement. It’s an easy addition to any warm-up or cool-down routine and can improve your overall mobility.
  
• Piriformis stretch – The Piriformis is a small muscle located deep in the buttocks that helps with hip rotation. Tightness in this muscle can lead to discomfort and pain, but consistent stretching can provide relief. To perform the Piriformis stretch, sit with one leg crossed over the other so that the ankle of the top leg is resting on the knee of the bottom leg. Slowly lean forward until you feel a stretch in the buttocks of the crossed leg. Hold for 30 seconds and repeat on the other side. Incorporating the Piriformis stretch into your routine can help alleviate discomfort and improve flexibility in the hips.
  
• Hip flexor stretch – This stretch is a simple yet effective exercise for anyone looking to improve their flexibility and reduce muscle tension in the hip area. This stretch involves bringing one knee forward, keeping the other leg behind you, and sinking down into the stretch until you feel a gentle pull in the front of your hip. As you hold the stretch, it’s essential to keep your back straight and engage your core muscles to protect your lower back. Regularly incorporating the Hip flexor stretch into your workout routine can help to alleviate tightness in your hips, improve posture, and increase your range of motion.
  
• Pigeon pose – The Pigeon pose stretch is a simple yet effective yoga pose that targets the hips and lower back muscles. It is a great way to release tension in the body and improve your flexibility. To do the Pigeon pose, begin in a downward-facing dog position, then bring your right shin forward and place it on the mat in front of you with your knee bent. Slide your left leg back and lower your hips towards the ground, keeping your torso upright. You can also release down onto your forearms or all the way down to the mat if that feels comfortable for you. Hold the pose for several breaths before switching sides.
  
• Butterfly stretch – This stretch is a simple but effective stretch to help loosen up tight hips and improve flexibility. To do the stretch, sit on the floor with the soles of your feet together and bring them as close to your body as possible. Gently press your knees down towards the floor using your elbows and hold the stretch for 30 seconds to a minute. You should feel a mild stretch in your inner thighs and hips. Make sure to keep your back straight and avoid rounding your spine. This stretch can be done before or after a workout or as part of your regular stretching routine to improve mobility and prevent injury. With consistent practice, you’ll notice a greater range of motion and less discomfort in your hips.

Strength exercises for runners:

• Deadlift – This compound exercise targets several muscle groups, including the back, glutes, hamstrings, and core. To perform a deadlift, you start by standing with your feet shoulder-width apart and the barbell placed in front of you. Next, you hinge your hips back, keep your chest out, and grasp the barbell with both hands. From there, you push through your feet, lift the bar off the ground, and stand straight. It’s important to maintain proper form throughout the exercise to avoid injury and maximize your results. Incorporating deadlifts into your fitness routine can improve your overall strength and increase muscle mass.
  
• Side lying abduction (can include resistance) – The side lying abduction exercise targets the muscles of the outer hip and can be done with or without resistance. To perform this exercise, lie on your side with your legs straight and stacked on top of each other. Lift your top leg up and away from your body, keeping it in line with your hip. You should feel a strong contraction in your outer hip muscles. To add resistance, you can place a resistance band around your ankles or hold a small weight between your feet.
  
• Bulgarian split squat – A popular exercise that targets the legs, particularly the quads, hamstrings, and glutes. It involves standing with one foot forward and the other foot behind, resting on a bench or any elevated surface. All the while, the knee of your forward leg should be directly above your ankle and your back straight. The rear leg is flexed to form a 90-degree angle. Maintaining the position, you lower your body down until your rear knee almost touches the ground. Then, push back up to the starting position.
  
• Donkey kicks – A simple yet effective exercise that targets the glutes, hamstrings, and lower back. To perform this exercise, start on all fours with your hands shoulder-width apart and your knees hip-width apart. Then, keeping your core engaged, kick one leg back and up towards the ceiling while maintaining a 90-degree angle at the knee. Repeat on the other leg and continue alternating for your desired number of reps. Donkey kicks can be done with or without weights, making it a versatile exercise that can be tailored to your fitness level.
  
• Banded lateral squat walk – This walking exercise is a great lower body exercise that targets the glutes, quads, and hips. It’s incredibly easy to perform and doesn’t require any equipment besides a resistance band. To do the exercise, start by placing a resistance band around your ankles, then get into a squatting position with your feet shoulder-width apart. From this position, take a step to the side with your left foot, then follow with your right foot, making sure to keep your knees bent and maintain tension in the band. Then, step back to the starting position and repeat the same on the right side. This exercise can help improve balance, stability, and mobility in the lower body and is suitable for all fitness levels.
  
• Front lunge – To do a front lunge, start by standing with your feet hip-width apart and your hands on your hips. Take a big step forward with your right foot, keeping your left foot planted firmly on the ground. Lower your body down until your right thigh is parallel to the ground, making sure your knee does not go beyond your toes. Your left knee should be hovering above the ground. Hold for a few seconds before pushing off with your right foot to return to the starting position. Repeat for the other leg.
  
• Glute bridges – This exercise involves lying on your back with your knees bent and feet flat on the ground, and then lifting your hips up towards the ceiling while squeezing your glutes. It may seem like a small movement, but it can help strengthen and tone your glute muscles, as well as improve overall posture and stability. Plus, the glute bridge requires no equipment and can be modified to fit your fitness level.See more

See more strength exercises for runners here.

Hip injuries in runners are very common – but it’s not the end of your running training

To conclude, hip injuries are common in runners, but it is important to remember to let your body recover from the accumulation of stress through the hip joint.

As a runner, it is important to activate your gluteal muscles prior to running to reduce the risk of common injuries and improve overall running performance.

You can book a one-to-one session with me at our Farnham physiotherapy clinic. I look forward to helping you soon.