A Combo Cardio/Strength Workout Youll Love to Do injury that plagues many athletes, especially us runners. But determining what’s causing your pain can be tricky. If you’re experiencing hip pain, we’ve got everything you need to know about hip injuries, including how to treat and prevent them.
But first, here’s a quick refresher on hip anatomy: The hip is a basic ball-and-socket joint. The ball is the femoral head—a knob on the top of the thigh bone—and the socket is an indentation in the pelvic bone. There is cartilage lining the joint (called the labrum) and ligaments that attach the pelvic and thigh bones. Numerous muscles attach around the hip, too, moving the joint through the basic motions of flexion (bending), extension (extending the leg behind you), abduction (lifting the leg away from the body), adduction (moving the leg inward), internal rotation, and external rotation.
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Marathon Training Basics, stress fractures, and osteoarthritis. Less commonly, labral (cartilage) tears, bursitis, and hip impingement may cause pain.
Here’s a little more about each and what you need to know about treatment and prevention.
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These account for about a third of all hip pain in runners. Strains, or pulls, often occur in the top of the hamstrings, the iliopsoas, the rectus femoris, and the adductors, while the gluteal tendons are prime targets for chronic damage and inflammation. Both are generally a function of muscle imbalances, which are typically caused by a lack of side-to-side training. “If [these muscles] are weak, they are constantly doing a tug of war, under load, while contracting,” says American Physical Therapy Association spokesperson Robert Gillanders, PT, DPT. That tug is exacerbated by big jumps in training volume or intensity.
Spot It: Muscle strains and tendinopathy both cause moderately sharp localized pain, swelling, weakness, and stiffness, says Janet Hamilton, CSCS, an exercise physiologist with Running Strong in Atlanta. They typically develop slowly, but if you trip on the trail, muscle and tendon tears can happen in a second, causing strong, piercing pain as well as bruising.
Treat It: Ice for 10 minutes, several times a day, and limit activity until your symptoms subside, then ease back into normal-distance runs. Mild muscle strains can take three to six weeks to fully heal. Tendons can take six weeks to several months. Avoid nonsteroidal anti-inflammatories (like ibuprofen) if possible, since inflammation actually prompts healing, Hamilton says. Significant tears require surgery.
Prevent It: Strength-train at least twice a week with an emphasis on eccentric lower-body exercises (like slowing the lowering phase of your squats to three or four seconds) to improve your muscles’ and tendons’ ability to lengthen under tension without pulling apart.
2. Hip Impingement
Femoroacetabular impingement (FAI) is a mismatch in the shape of the femur (ball) and the acetabulum (socket), which causes them to beat up the joint’s protective cartilage (labrum) and, over time, contribute to degenerative osteoarthritis. FAI is a leading cause of hip pain for athletes in their 20s and 30s.
Spot It: Start with the FADIR test: Lie flat on your back, draw your knee toward your chest, gently press your knee across your body, then rotate your foot as far out and away as possible. A pinch in the front of your hip is a sign of possible impingement, but you’ll need an MRI from an orthopedist to confirm.
Treat It: Correcting muscle weaknesses and abnormal movement patterns through physical therapy can curb discomfort. Physical therapy can also determine a safe range of motion to avoid pinched positions when running or cross-training. In some cases, surgery is needed.
Prevent It: FAI is believed to be partially genetic. But core and hip strength work like monster walks, single-leg deadlifts, and dead bugs will give your body more control and power to protect the hip and help prevent injury.
“Wear and tear” arthritis is less common in active marathoners than it is in the general population, according to research from the Rothman Orthopaedic Institute (loading the joint may improve its health by strengthening the surrounding muscles). But in runners with structural hip abnormalities such as FAI, osteoarthritis in the hip can crop up as early as age 40, says Peter Moley, MD, a physiatrist with New York’s Hospital for Special Surgery.
Spot It: Joint stiffness, poor range of motion, and at least three months of deep, aching pain after sitting or running or at the end of the day are common symptoms, says Scott Paluska, MD, a sports medicine specialist at the University of Illinois at Urbana-Champaign. X-rays can confirm suspected arthritis.
Treat It: Most flare-ups will abate with RICE. In the long run, low-impact strength-training, and switching to softer running surfaces (treadmill, grass, sand, track, pool) can strengthen the supporting muscles without excessively loading the joint and causing pain and further joint damage, says Paul Sorace, MS, CSCS, a fellow of the American College of Sports Medicine. Even a softer shock-absorbing insole can help.
To further head off hip pain and eventual replacement, many doctors offer injections such as steroids, or regenerative treatments. In platelet-rich plasma (PRP) therapy, doctors inject your own blood, minus the red blood cells, into the joint. In stem cell therapy, they use cells from your bone marrow. Some patients experience improvement with these therapies, but more research is needed to prove their effectiveness—and to get insurance to chip in, says Harrison Youmans, MD, a sports medicine specialist with Orlando Health.
Prevent It: Treating any existing hip injuries or imbalances is key. Try to maintain a healthy weight to further reduce stress on the hip joint.
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4. Labral Tear
A torn labrum is most commonly caused by FAI in younger runners, as it places them at a higher risk for injury or increased wear and tear, says Kristin Morrison PT, DPT, COMT, my therapist at IMPACT Physical Therapy in Chicago. Hip dysplasia, a genetic condition in which the hip socket is too shallow to fully cover the femur, can also tear the labrum.
Spot It: Labral tears can cause sharp or dull groin pain and a limited range of motion. You may hear a clicking as the loose labrum moves over bone, says Youmans.
Treat It: American Runners Likely to Podium in Tokyo (fire hydrants, stir-the-pots), says Shane J. Nho, MD, director of the Hip Preservation Center at Rush University Medical Center in Chicago. Steroid injections can curb the pain; if they don’t, you may need surgery.
Prevent It: Warm up the muscles protecting the joint with monster walks, single-leg bridges, deadlifts, and clam shells to help reduce midrun grinding.
More than a dozen little fluid-filled sacs, called bursae, are a cushion between your hip bones and neighboring soft tissues. Repetitive motion, along with muscle imbalances or poor form, can inflame any one of them. Issues most often arise at the side of the hip, and are four times more common in women, says Paluska. The iliopsoas bursa (the front of the hip) is another prime target for inflammation.
Spot It: Inflamed bursae ache, feel warm and tender to touch, and get angrier with hill running or sprinting. The most common diagnostic method: injecting the bursa that’s suspected to be inflamed with numbing lidocaine. If the pain goes away, there’s your answer. MRIs are a less invasive but more time- and cost-intensive tool.
Treat It: Visit a physical therapist who specializes in running to see if strength deficits, faulty running gait, inadequate balance, or all of the above are to blame for the inflammation. When paired with corrective exercises, RICE and injections can help ease inflammation. In stubborn cases, surgeons can remove the swollen bursa. It will grow back after several months.
Prevent It: Strengthen your hips in all planes of motion with single-leg deadlifts, monster walks, high-knee raises, fire hydrants, and lying inner-thigh lifts.
6. Stress Fracture
About two-thirds of hip stress fractures in runners are caused by excessive mileage, and the injury is significantly more common in women. Because stress fractures develop slowly, they can take a long time to diagnose; untreated, they may develop into full breaks.
Spot It: Pain is usually sharp when walking, running, or jumping, and may feel dull the rest of the day. “It is not uncommon for it to present symptoms at rest and at night,” says Moley. You’ll need an X-ray and likely an MRI to confirm a stress fracture.
Treat It: Rest for four to six weeks and do low-impact exercise like cycling and swimming for another four to six. Then ease back into walking and running, Hamilton says.
Prevent It: Ramp up your mileage or intensity gradually, sticking with a “no more than 10 percent increase per week” rule. A bone-mineral density test can help determine if you need improved nutrition (more calcium and vitamin D) or medications to reduce your risk of breaks.
Hip Pain Prevention Protocol
To prevent any hip injury, strengthening and stretching your hip flexors is key. And while stretching your hip flexors can be difficult, here are two that work well:
- Lie on your back on the edge of a table or high bed, and drop your outside leg off the edge.
- Lunge with your back leg fully extended. Lift arms up overhead and extend slightly backward if possible.
Adding leg lifts into your routine is an easy way to strengthen your hip flexors—you can add in weights or a resistance band to make this exercise harder. To maximize strength throughout the hip, do leg raises in each direction—back, forward, in, and out.
Issues in the hips are often related to weak glutes. Strengthening your gluteal muscles with squats and exercises like bridge pose can help. Finally, foam rolling daily will help keep your hip flexors loose and relaxed and less prone to injury.