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Hip Pain Running

Hip Pain Running

Hip pain when running is a common complaint that refers to burning, aching, and sharp pain in or around the hip joint. The intensity of the hip pain ranges from mild to severe, depending on the cause of the pain. Hip pain when running occurs in the structures surrounding the hip joint or within the hip joint itself.

Hip pain when running frequently occurs in athletes, especially runners, as a result of overuse injuries that cause a stress fracture or inflammation of hip tendons, ligaments, muscles, and hamstring tendinopathy. It is is often difficult to pinpoint because it is not always felt in the hip; it also occurs in the thigh or groin, at the back in the buttock, and on the outer side of the hip. Once identified, the hip pain location provides the best clues about the cause of pain.

A lady holding her hip after running

What Is The Hip Joint?

The hip joint is an intricate ball and socket type of synovial joint, the top of the thigh bone being the ball (the femoral head) that sits inside the cup-shaped, hollow socket (acetabulum) in the pelvic bone. The hip joint stays together by soft tissue structures that are secured to bones by flexible, strong cords similar to a rope called tendons. These tendons, muscles, and ligaments support the hip movement by forming a capsule around the hip joint. The hip joint is lubricated by tiny fluid-filled sacs, called bursae, for muscles and tendons to move smoothly [1].

What Are The Common Causes Of Hip Pain Running?

The most common cause of hip injuries is running for too long or overdoing several exercises that strain or inflame tendons in the hip joint. The most causes of hip injuries include:

1. Inflammation Of The Bursae:

Hip pain when running occurs due to the inflammation of the bursae as a result of minor trauma to the area and overtraining. Inflamed bursae can cause swelling, sharp pain, stiffness, and tenderness of the hip joint.

When the Greater Trochanteric Bursae become inflamed, the condition is called trochanteric bursitis, which causes deep aching pain in the lateral hip that worsens at night.

When the Iliopsoas Bursae (present beneath the iliopsoas muscle) becomes inflamed, the condition is called iliopsoas bursitis that results in the tenderness of the groin area. Iliopsoas bursitis results in sharp pain radiating down to the knee (causing knee pain) or front of the thigh [2].

2. Labral Cartilage Tears:

The outside rim of the hip socket is surrounded by the ring of cartilage, known as the labrum. The labrum keeps the ball of the thigh bone in place and cushions and stabilizes the hip joint. Repetitive activities, like running, cause labral tears. Labral tears cause an aching pain accompanied by a clicking sound when a person moves [3].

3. Osteoarthritis:

In hip osteoarthritis, the cartilage that surrounds the hip joint breaks down and becomes brittle, resulting in the pain and inflammation of the hip joint. The degeneration of cartilage with age narrows down the space between the bones of the hip joint, causing less cushioning of hip bones. It can be accompanied by knee pain [4].

4. Stress Fracture:

A stress fracture occurs as a result of using incorrect footwear, incorrect training, and overtraining, damaging the neck of the femur. A stress fracture can be a partial or complete break in the bone that is described as groin pain whenever a person performs weight-bearing activities. Moreover, muscle strength imbalances in your hip region can also lead to issues [5].

5. Iliotibial Band Syndrome:

Overuse and repetitive movements can sometimes cause tightness or irritation of the iliotibial band (IT band), called IT band syndrome. IT band syndrome causes pain in the hip, thigh, and knee accompanied by a popping sound when you move.

How Is Hip Pain When Running Diagnosed?

The source of hip pain when running should properly be diagnosed by a sports medicine healthcare provider or a primary care healthcare provider. Diagnosis includes a physical examination, medical history of the patient, and imaging tests, such as MRI or x-ray.

1. Medical History: 

Medical history involves asking questions to the patient, such as:

  • Have you experienced any recent sports injuries?
  • Do you experience other symptoms like swelling or fever?
  • Is your hip pain better when you rest or move?
  • Abnormality in gluteals and piriformis?
  • Do you have any family history of arthritis or joint pain?

2. Physical Examination:

Physical examination involves examining the hip, lower back, and legs to assess the cause of pain. Examination of patient’s gait, ability to bear weight, and the range of motion of hips.

3. Imaging Tests: 

Specific imaging tests, such as x-rays and MRIs are used to confirm the diagnosis of hip pain when running. For example, an x-ray can reveal structural changes associated with hip osteoarthritis and hip fractures. An ultrasound is also used to confirm the diagnosis of bursitis [6].

Treatment Options For Hip Pain:

The healthcare provider decides treatment options based on the diagnosis of hip pain when running. However, the patient’s treatment plan must include self-care, medications, and physical therapy.

1. Self-Care Strategies:

The following self-care strategies can help relieve hip pain when running:

  • Using assistive devices, such as a walker or cane to improve mobility.
  • Avoid activities that exacerbate hip pain, such as climbing stairs.
  • Using the RICE protocol (rest, ice, compression, and elevation) to reduce swelling and pain.

2. Medications:

Over-the-counter anti-inflammatory (NSAIDs) and oral medications, can relieve hip pain when running, especially if it is associated with bursitis, osteoarthritis, or labral tears. If a patient has severe hip pain due to an infected hip joint or hip fracture, opioids may be prescribed.

3. Physical Therapy:

The cause of hip pain when running can be managed by physical therapy. A physical therapist (physiotherapist) uses strengthening exercises to improve flexibility, and mobility such as hip flexor stretches (for glutes),  pelvic tilts, and hamstring stretches.

In addition, physical therapy also includes ultrasound, heat, flexibility, and ice to soothe inflammation within the hip joint [7].

Prevention Of Hip Pain When Running:

The following are some preventive tips to manage hip pain:

  • Warm-up before a strenuous session of exercise or workout
  • Wear the correct footwear for your gait.
  • Maintain a good posture while standing, sitting, and walking. A good posture helps your posture function normally.
  • Perform adductor squeeze exercise (hold bent or straight knee)
  • Develop an exercise routine for maintaining bone and muscle strength.
  • Eat a balanced and healthy diet to maintain bone health.

Conclusion:

Hip pain when running can result from overtraining, running injuries, and other health conditions, including IT band syndrome, stress fractures, osteoarthritis, and labral cartilage tears. Hip pain is more common in runners and athletes as a result of repetitive activities. Typically, it is easy to manage hip pain through RICE protocol, but sometimes, medications and physical therapy become necessary.

A model of a hip that has been hurt running

References:

  1. Heckmann N, Tezuka T, Bodner RJ, Dorr LD. Functional Anatomy of the Hip Joint. J Arthroplasty 2021;36:374–8. https://doi.org/https://doi.org/10.1016/j.arth.2020.07.065.

  2. Tyler TF, Fukunaga T, Gellert J. Rehabilitation of soft tissue injuries of the hip and pelvis. Int J Sports Phys Ther 2014;9:785–97.

  3. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105–17. https://doi.org/10.1007/s12178-009-9052-9.

  4. Lespasio MJ, Sultan AA, Piuzzi NS, Khlopas A, Husni ME, Muschler GF, et al. Hip Osteoarthritis: A Primer. Perm J 2018;22:89–94. https://doi.org/10.7812/TPP/17-084.

  5. Bateman L, Vuppala S, Porada P, Carter W, Baijnath C, Burman K, et al. Medical management in the acute hip fracture patient: a comprehensive review for the internist. Ochsner J 2012;12:101–10.

  6. Plante M, Wallace R, Busconi BD. Clinical Diagnosis of Hip Pain. Clin Sports Med 2011;30:225–38. https://doi.org/10.1016/j.csm.2010.12.003.

  7. Wilson J, Furukawa M. Evaluation of the Patient with Hip Pain – American Family Physician. Am Fam Physician 2014:27-34.

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