Lateral Hip Pain in Runners
By: Hannah Hatcher, PT, DPT
Northwest Arkansas has a very active community made up of marathoners and triathletes. To train, and train well there must be a plan to be strictly followed. There is never a one size fits all training program. Everyone’s body, its capabilities, and its “breaking points” are different. Training errors along with certain running biomechanics can place our heavy milage athletes at risk for exceeding what is called tissue load capacity where increased risk of injury occurs.
One common injury in runners is lateral hip pain diagnosed as gluteal tendinopathy or muscle strain. The hip abductor muscles located on the outside of the hip are made up of 3 muscles called the gluteus medius, gluteus minimus, and the tensor fascial lata. These 3 hip abductors assist in the control and alignment of the hip and pelvis when we run.
When running and walking contralateral pelvic drop and hip adduction occurs during what is called the loading phase of the gait cycle. In other words, as one weight bears on the left side, the pelvis will drop on the right side and the left hip/femur will fall inward towards midline. As this happens, the hip abductor muscles are contracting eccentrically to control the movement.1,2 With sudden increase in milage and demands for endurance of hip musculature during constant loading phase of gait cycle, the pelvic drop and hip adduction angle increases due to fatigue. It is in this window that injury occurs due to repetitive stress and demands of the gluteal muscles and tendons exceeding the tissue load capacity.1
Injury risk reduction and treatment for this type of condition includes gait/form retraining, manual therapy, and hip abductor strengthening. An easy way to combat lateral hip pain when running is to increase step rate/cadence so there is less time spent on the ground. Increasing running cadence by 5-10% has been shown to reduce contralateral pelvic drop and hip adduction during stance phase.3 The simplest way to increase cadence without overcomplicated measures is to take smaller steps and midfoot strike and find a comfortable pace.
Another way to improve load tolerance or gluteal tissue capacity is to work on hip abductor strengthening to recreate the eccentric loads/demands of running. The exercises of choice depend on the pain and significance of tissue damage. Rehab protocol will make progressions from simplest to most complex in a linear fashion as follows:
Isometric exercise --> small to full range pain free non weight bearing exercises --> partial to full range pain free weight bearing exercises that mimic the eccentric load of running --> Gradual loading of weight with functional activity to build up strength to gluteal tendons is heavily important to avoid reinjury --> Gradual return to normal activity.
Rehab will change depending on the duration of your symptoms, mechanism of injury, age, gender, and stage of tendinopathy. It’s important to seek guidance from a health professional. Don’t let nagging pains or injuries get the best of your spring running goals!
Written by Hannah Hatcher, PT, DPT
- Grimaldi A, Fearon A. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management. Journal of Orthopaedic & Sports Physical Therapy. 2015;45(11):910-922. doi:10.2519/jospt.2015.5829
- Heiderscheit B, McClinton S. Evaluation and Management of Hip and Pelvis Injuries. Physical Medicine and Rehabilitation Clinics of North America. 2016;27(1):1-29. doi:10.1016/j.pmr.2015.08.003
- Wille CM, Stiffler-Joachim MR, Heiderscheit BC. Influence of Step Rate on Running Mechanics. Clinical Care of the Runner. 2020:75-85. doi:10.1016/b978-0-323-67949-7.00008-2