The hip joint is one of the most important joints in the human body. It allows us to walk, run, and jump. It bears our body’s weight and the force of the strong muscles of the hip and leg. Yet the hip joint is also one of our most flexible joints and allows a greater range of motion than all other joints in the body except for the shoulder.
The hip joint is the junction of where our lower limb joins the pelvis and is responsible for transferring load from our lower limb up into our trunk via the pelvis. Subsequently the hip joint needs to be strong and stable, yet mobile and limber to allow us to run smoothly and access range of movement efficiently.
It has been well proven that pelvic stability significantly impacts what happens ‘down the chain’ in the lower limb. A strong and stable pelvis can have a very positive impact on what happens at the knees and feet and ankle joints. Muscular imbalances and weakness around the hip joint and within the pelvis can cause the hip joint to be overloaded and result in inflammatory joint pain and compensation issues further down the lower limb.
We can go down a rabbit hole of the intricacies of the pelvis and its importance in harnessing efficient running mechanics, but today we are looking specifically at the hip: Hip joint pain while running.
The hip joint is a ball and socket joint and has quite a bit of anatomical variation between individuals. If we think of a typical dancers hip orientation, vs a typical distance runner's hip we would observe (both under scan and functionally) they would vary significantly. With a ball and socket joint comes mobility and sometimes with mobility (teamed with excessive or repetitive load) we get instability and also irritation. The hip joint can start to feel wear and tear while running unless we have adequate pelvic muscular strength and efficient mechanics.
Let’s just first outline what I mean by “hip joint pain”. Often when I get clients coming to see me complaining of hip pain, its actually lateral hip pain to do with a glute/hip bursa issue, and not true hip JOINT pain. We will touch on these soon but we are focusing today on anterior hip joint impingement pain.
The hip joint is a ball and socket joint synovial joint connecting the femur (thigh bone) into the acetabulum (the pelvis.) When we talk about the hip we have to consider the bones, the hip articular cartilage, the hip labrum, the muscles, ligaments, and tendons. A problem with any one of these can disrupt the smooth mechanics of this amazing joint and lead to pain when running/walking and even sitting.
Pain felt from the hip joint is in the groin. It is usually sharp on compression and rotation and may even be associated with some clunking and catching signs. Groin pain is not always hip joint pain but when I get a runner who is clocking lot's of km's and is positive for all the hip joint impingement tests in a clinical exam it is likely there could be some inflammation within/around the joint and we have to start thinking how can we de-load this joint to prevent further wear and tear...
Firstly, let's consider WHY you started getting hip joint symptoms while running?
-Anatomical joint predisposition: your own hip joint may be either very mobile or very stiff and restricted. Either of these two variants can cause wear and tear within the joint due to lack of range or hypermobile range resulting in hip joint friction or FAI (femero-acetabular impingement).
-Muscular imbalances within the pelvis. You may have strength discrepancies. The most common in runners is: tight quads, weak hip stabiliser muscles and glutes, tight hamstrings and weak lower abdominals. This can mean that the hip joint itself becomes overloaded due to the lack of or imbalanced "shock absorption" around the joint.
-Running overload (a significant increase in impact activity) - VOLUME OR TYPE of running. Eg: more than 10% of your normally weekly milage volume, or a spike in speed/impact work can result in inflammation within the joint due to an increase in hip joint forces on a joint which cannot withstand the added load.
-Postural mechanics while running: if you find you are excessively anterior tilting your hips when running, or letting your pelvis "sit down" or if you are not keeping your trunk stable and your hips square you can overload the hip joint impact and then develop joint pain. A stable trunk, level hips and a slight posterior tilt of the pelvis can capitalise on our running position so as not to compress or overload the hip joint.
-Terrain:(increase in external load) eg: going from roads to the trails where there may be more hills, more unstable surfaces and also sharp descents can mean your hip stability and hip joint load can be significantly increased resulting in anterior hip joint pain.
HOW CAN WE FIX IT?
1) De-load: if you have hip joint inflammation: sharp pain on hip compression (knee to the chest), pain on a single leg hop or a dull ache that gets worse while running, taking a few days off to cross train or even halve your impact volume for a week can really help get settle the symptoms so you can focus on strengthening the area.
2) Strengthen: starting with glute, hip flexor and adductor isolated activation exercises and progressing into function hip strength work is key to making sure your whole pelvis is strong and resilient to running loads. Eg a glute strength progression: start with 2x10 banded clams and then progress to some slow deep squats as a functional option and then onto some single leg arabesque as a more advanced exercise strength exercise. All target the glutes but in a progressive manner.
3) Mobilise and stretch: pre run dynamic stretches, post run isometric holds 10-20secs (glutes, hip flexors and inner thighs), lower back mobility exercises such as lumbar rotation knee rolls can all help loosen the hip joint to help with force distribution through the joint while running and recovering post run.
5) Running mechanics/posture: good posture when running is really important. You know that holding your shoulders and head up are important, as well as proper stride distance, but keeping your hips in line is a big factor as well. I like to cue: short stride length (fast cadence), chin up, shoulders relaxed, hips slightly forward- posterior pelvic tilt, and a slight lean forwards from the belly button). These are my favourite "efficiency" tips when asked how to run smoother with less joint impact.
6) REGULAR PILATES: a fail safe way to ensure you are getting adequate core strength, deep pelvic stability strength, mobility and length in a flow sequence. Two classes a week works best for long term running results.
In short, Shakira was on the money. The hips really don't lie. If you have been neglecting strength and mobility work, you have increased your kms or running load in any way and you have pain in the groin/ hip flexor region, don't ignore it. You can follow the above steps in de-load, restore and recover your hip function and run fast/far and happy.
Feel free to share this hip love and let me know if you have any further questions!
Ever stepped out of bed first thing in the morning and felt a shearing pain in your heel? You may have even looked down to confront the sharp toy truck or shard of glass that MUST be on the floor….there is nothing there, it’s an internally generated pain that feels like a cattle prod to the foot every time you plant your foot down.
The very likely diagnosis here is Plantar Fasciitis.
Where did it come from, AND HOW DO WE FIX IT!?
The mantra “don’t take back pain lying down” (which came into vogue in the late 90’s) could not be more accurate. I approach Pilates to overcome back pain like having your veggies. You need to get your salad (exercises) in before you can have all the dessert (pain free function) you like. It will vary from person to person depending on the nature and causes of their own specific Low Back Pain, but a holistic Pilates program to reduce pain symptoms and gain function would look like this!......
Are we talking a Chris Hemsworth 6 pack or shredded abs of any form? I’d love to say yes… but quite honestly as a runner and a physio, I am definitely more interested in function, posture and form.
We need core strength to simply live and function at a basic level, but for higher level performance (running) and injury prevention, we need optimal evenly distributed strength around the torso and pelvis.
Runners, listen up! Let's get to the core of the matter....