Hip Flexor Pain with Running: What to Know
Hip flexor pain is one of the most common complaints among runners, and it often comes down to how much load the body is being asked to handle relative to its current capacity. This post breaks down what the hip flexors actually do, why runners are particularly vulnerable to overuse injuries in this area, and how compensation patterns throughout the body can quietly contribute to the problem.
Understanding hip flexor pain requires looking at the whole body, not just the area that hurts. Weakness in the core, hamstrings, or even the shin muscles can shift excess demand onto the hip flexors over time.
Physical therapy helps identify where the breakdown is happening and addresses it through a combination of hands-on treatment and targeted strength work. This post covers common causes, symptoms, running form factors, and when it is time to reach out for support.
It can be frustrating when pain affects your training schedule, and confusing to know if you should push through it or if pushing through will make things worse. Hip flexor pain is common with running because we rely heavily on those muscles to help lift our legs.
In this blog, I am going to tell you everything you need to know about running with hip flexor pain.
What The Hip Flexors Actually Do
The primary role of the hip flexors is to lift your leg up by bending at the thigh. They also help with low back and pelvic stability when working with other muscles. Muscles in the body rarely, if ever, work in isolation. So, understanding that the body is all connected, it makes sense that seemingly unrelated muscles could be contributing to hip flexor function.
The hip flexors work every time we pick up our legs, so they help with walking, stair climbing, jumping, and running! Keeping the hip flexors strong is important for overall fitness, but because the body is a connected machine, we need to make sure that the core and only hip muscles are working with the hip flexors for overall lower limb function.
So if something up or down the chain isn’t doing their job, then problems can arise at the hip flexors.
Why Runners Are Prone To Hip Flexor Pain
Runners are prone to hip flexor pain because, like I said above, their main job is to lift the leg at the hip. Which is exactly how we pick up our feet to take a step.
Running is a lot of really quick steps in a row… That motion is repetitive, so problems can easily occur if proper strengthening and gradual running progressions are not in place.
This is why you shouldn’t decide out of the blue to sign up for a race that is happening tomorrow if you haven’t been running!
Sport-specific training is necessary to equip you with the strength and endurance to succeed on race day. When you don’t gradually build up strength and endurance in your hip flexors, overuse injuries can happen.
Common Causes Of Hip Flexor Pain With Running
Overuse injuries of the hip flexor include:
Hip flexor strain- This occurs when the muscle is loaded too much, and/or too quickly causing different grades of tearing in the muscle. A muscle strain can also happen acutely due to lack of strength and/or endurance. In other words, the muscle didn’t have the capacity to withstand the load you gave it.
Hip flexor tendinopathy (commonly called tendinitis)- This happens with more repetitive use. The repetitive running load put on the hip flexor tendons can cause them to get micro trauma and breakdown. The area around the tendons can then get irritated and cause an inflammatory response around the hip flexor.
Overuse injuries can also occur as a result of compensation rather than just doing too much too fast. I always say: “the body likes to work smarter, not harder.”
So if given the chance, the body will cheat, or take the path of least resistance.
When the core and/or hamstrings are weaker, that can automatically cause the low back and hip flexors to have to do more work. In response, the low back and hip flexors are at risk for overuse injuries. This is known as lower crossed syndrome.
Another compensation that can create more work for the hip flexors are weak shins. When the shin muscles that lift your toes get weak, then your hip flexors have to kick into overtime so that you don’t scuff your toes on the ground.
Are you starting to see how the whole body works together? The hip bone is connected to the knee bone…
How To Tell If Your Hip Flexors Are The Problem
Common symptoms that you may experience if your hip flexor is the problem are:
Tension in your groin
Low back pain
Aching at the top of your thighs
Pain with lifting your leg
Increased hip pain with running, walking, or stair climbing.
What Makes It Worse: How Running Form Plays A Role
If we don’t change the load on the hip flexors in some way, then symptoms are just going to continue to get worse.
The first thing I look at when working with a runner with hip flexor pain is running load progression and determining where their tissue load capacity is. If their tissue load capacity is below where they are training, then continuing to run at that duration and frequency will make things worse.
If there is more of a compensation causing the overuse on the hip flexors, then addressing the strength deficits with exercise prescription and retraining activation patterns during running is key.
Performing a running gait analysis along with a strength assessment will dictate the cuing needed. But oftentimes, just addressing strength with a home program will allow for strengthening and the body will naturally disperse the load.
Deciding which approach will work best for you is where PT comes in.
Treatment Options
When things aren’t improving on their own and your hip flexor just isn’t getting better, it's time to reach out to a PT! A PT will help get to the root of the problem and ease your symptoms with hands-on techniques to calm down the hip flexors.
Common hands-on treatment techniques that I use in conjunction with strength training include:
Stretching
Dry needling
Cupping
Muscle scraping
Muscle energy techniques
Red light therapy
Vibration therapy
Where to Find Physical Therapy for Runners in Meredith, NH
If you are located in the Lakes Region of NH, are a runner or active human, and looking for support with hip flexor pain from running, I can help!
I offer physical therapy specifically for runners in Meredith, NH and am accepting new patients.
Book a discovery call or an evaluation to get started. I would love to help you get rid of running aches and pains and improve running performance!