Runner Therapy: Problems With Your Hip Flexor

Question: “Recently while running, spinning or jogging I’ve been getting a pain from the front top of my leg almost from my groin around to the front and around to my hip. Lunges help to stretch but what else should I do to stretch and help heal?”

Pain during running in the hip can be a lot of things. It can be the actual hip joint, the pelvis, or the spine. So it can be tricky.

In medicine we have a term for this: differential diagnosis. This means the different diagnoses a related set of symptoms can be.

So let’s go through the differential for a runner here.

1. Hip impingement syndrome: basically when something is in the way (impinging) the ball and the socket. Symptoms are in the actual hip socket which sits deep within the groin. This impingement can be soft tissue, but can also be caused by a tear in the cartilage of the socket.

2. Hip flexor tendonitis: arguably the most benign of the possibilities, this is inflammation of the hip flexor across the front of the hip crease. Generally the pain here is more superficial in nature and you may even be able to palpate the painful spots.

3. Hip or pelvic stress fracture: often a bone stress fracture can manifest in soft tissue and muscle tightness and pain across the hip crease, most notably with weight-bearing activities.

For all three of these issues, hip flexor stretches (the lunge stretch, not the exercise), and hip rotator stretches will help ease some of the tension. Remember when stretching the hip flexor that you want to feel a light stretch around the hip crease, not down by the thigh and knee. So tuck your pelvis under and tight as possible by flattening your back and dropping your tailbone down to the ground.

For the hip rotation stretch, be sure to bring you knee towards your opposite shoulder, then bring the ankle in that was as well. You should feel a stretch from your butt to your outer hip (example at right).

Both are great (and needed!) stretches for any runner. Unless you have a history of being a ballet dancer or gymnast, chances are these are two muscle groups that are seriously tight…especially for long distance runners!

Do these as often as possible holding 30 seconds at a time. Ice also several times a day 15 minutes or so.

If you are also experiencing pain riding, and the pain is on the upstroke…chances are your body’s natural amount of hip flexion is not enough for the bike you are sitting on. You are naturally impinging your hip.

Have your bike fitted by a good fitter who will do these measurements for you when finding your perfect position. In a pinch, or on a spin bike, raise your handlebars or your seat (if it is not in a correct position) so the amount you flex your hips on the upstroke stays 5-10 degrees BELOW the amount of flexibility you have available. This is a good buffer for everyone, and a good rule of thumb.

The best idea…take some time off or lower your weekly mileage to an amount where there is no pain, and see if the problem gets better. Then gradually build back up pain-free. Its a good idea to see a sports doc that specializes in runners or physical therapist that does the same. They can direct you pretty quick to the diagnosis and get you back to running pain-free as soon as possible!

Have you ever experienced a hip or hip flexor injury?  Do you feel you are flexible and do you work on your flexibility?

- Marisa

(Marisa, a MS PT SCS ATC, is a member of  iRunnerBlog’s team and writes Runner Therapy, she is a physical therapist in private practice in midtown NYC.  She one of a dozen or so therapists  in the state of NY to be board certified in sports.)