Hip Pain in Runners: Common Causes and How to Fix Them

You've built up your weekly mileage, the routine feels good, and then a nagging ache appears on the outside of your hip. It might be a dull throb after a long run, a sharp twinge on the stairs, or pain that stops you rolling onto that side at night. Hip pain is one of the most common reasons runners come to see us, and the good news is that most cases respond well to sensible management.

The hip is a busy junction. It connects your pelvis, spine, thigh and core, and every running stride passes through it many hundreds of times. When something in that chain is overloaded or under-strengthened, the hip often tells you first. Here's what tends to be behind it.

Pain on the outside of the hip: gluteal tendinopathy

If your pain sits on the bony point on the outside of the hip and is tender to press, gluteal tendinopathy is a leading suspect. It involves the tendons of the gluteus medius and minimus, the muscles that keep your pelvis level each time one foot leaves the ground.

It's particularly common in runners who have recently increased mileage or hill work, and in women around and after the menopause. Typical clues include:

• Pain lying on the affected side at night
• Aching after sitting cross-legged or with legs crossed at the knee
• Pain climbing stairs or standing on one leg

Many people are told it's "bursitis" and rest it, or are given stretches. Stretching the outside of the hip can actually aggravate a compressed tendon. Instead, tendons generally respond to progressive loading: gradually building strength in the hip abductors, while reducing compression by avoiding crossed legs and hip-hitching postures. For stubborn cases that have lingered for months, shockwave therapy can be a useful addition alongside exercise.

Pain at the front of the hip or groin

Pain at the front can come from the hip flexors (such as the iliopsoas), the adductors in the inner thigh, or occasionally the joint itself. Hip flexor strain often shows up in runners doing lots of speed work or hill sprints, where the leg is driven forward with more force. It tends to feel tight and pinching when you lift your knee.

Deep, pinching groin pain, especially with clicking, catching or a feeling of stiffness after sitting, can point towards the hip joint, sometimes related to femoroacetabular impingement. This is worth having properly assessed rather than pushing through, because the management differs from a simple muscle strain.

Pain that starts elsewhere

Sometimes the hip is simply where you feel the problem. Lower back stiffness, sacroiliac joint irritation and even weakness in the calf or foot can shift how load travels up the leg. A runner whose pelvis drops on each landing, or who has a very short stride with a heavy heel strike, may overload the hip without any local damage.

This is one reason a thorough assessment matters. Treating the sore spot alone often means the pain returns as soon as you build your training back up.

What helps: a practical approach

Complete rest rarely solves hip pain for long. Tissues need load to recover, just the right amount of it. A sensible starting plan looks like this:

1. Adjust, don't stop. Reduce mileage, hills and speed sessions to a level that doesn't leave you sore the next morning. Swapping some runs for cycling or swimming keeps fitness ticking over.
2. Strengthen the hip and pelvis. Side-lying or standing hip abduction, single-leg bridges, step-ups and slow single-leg squats are good foundations. Do them consistently, two to three times a week, and progress the load gradually. Strength and conditioning work is often the most important part of recovery.
3. Check your training pattern. Sudden jumps in distance, back-to-back hard days and too little recovery are common triggers. If you're building towards a race, our marathon and running preparation support can help structure that progression around your hips.
4. Look at daily habits. Sitting with crossed legs, standing with your weight hung on one hip, and long unbroken desk hours can all keep a sensitive hip irritated.
5. Consider cadence and stride. Taking slightly shorter, quicker steps can reduce the load through the hip for some runners, though it should be tried gradually.

Expect progress over weeks rather than days. Tendon and joint-related pain in particular can take two to three months of consistent work to settle fully.

When to get it looked at

See someone sooner if your hip pain follows a fall or sudden injury, you can't put weight through the leg, the pain is constant and unrelated to activity, or you feel generally unwell. Otherwise, if pain has lasted more than two to three weeks, keeps returning, or is limiting your running or sleep, it's sensible to have it assessed.

At our Vauxhall clinic, our physiotherapists will take a full history, examine how your hip, pelvis and back are working together, and build a plan around your running goals. If you're covered by Bupa, AXA or Vitality, we can talk you through how to use your policy. If your hip has been holding you back, we'd be glad to help you get back to running comfortably.