This article is for general information only and does not constitute medical advice. If you have persistent, severe, or worsening hip pain — or pain that prevents normal walking — consult a doctor or physiotherapist before running again.
Quick Answer
The location of your hip pain is the most useful first diagnostic clue. Outer or side-of-hip pain most likely points to gluteal tendinopathy (often mislabelled as bursitis). Front-of-hip or groin pain suggests hip flexor strain, impingement, or a labral tear. Deep buttock pain is typically piriformis syndrome or a proximal hamstring issue. A groin pain with clicking or pinching points toward hip impingement (FAI) or a labral tear. Deep groin pain that is worse at night or at rest warrants prompt medical review — this pattern can indicate a stress fracture.The running forces involved are substantial: the hip bears up to 5 times body weight during running, with gluteal muscles absorbing loads of 3× bodyweight per stride and the quadriceps up to 6×. This is why overuse injuries of the hip are so common in distance runners.
Diagnosis by Location
| Where it hurts | Most likely cause | Key feature |
|---|---|---|
| Outer/side of hip — over the bony bump | Gluteal tendinopathy / Greater trochanteric pain syndrome | Worse lying on affected side; may ache on stairs; worse after sitting |
| Outer hip with snapping or clicking | Snapping hip (IT band friction) or external coxa saltans | Audible or felt snap as IT band flicks over the greater trochanter |
| Front of hip / groin — dull ache or tightness | Hip flexor strain (iliopsoas) | Pain lifting the knee; tightness at the front after running |
| Front / groin — sharp, pinching | Hip impingement (FAI) or labral tear | Sharp pain with hip flexion, crossing legs, prolonged sitting |
| Deep buttock / behind hip | Piriformis syndrome | Deep ache in buttock; may radiate down leg; worse sitting |
| Deep groin or thigh — sharp, worsening | Femoral neck stress fracture ⚠️ | Pain at rest or night; unable to bear weight; worse with impact — see a doctor |
The Most Common Cause: Gluteal Tendinopathy (Not "Bursitis")
If your pain is on the outer side of your hip — over the bony prominence you can feel on the outside of your upper thigh — there’s a strong chance you have gluteal tendinopathy, also known as greater trochanteric pain syndrome (GTPS). This is now recognised as the most common tendinopathy affecting the lower limbs and affects up to 25% of adults at some point.
For years, this pain was almost universally diagnosed as “trochanteric bursitis” — inflammation of the fluid-filled sac over the greater trochanter. However, clinical research using MRI and ultrasound has substantially revised this understanding. Cambridge University Hospitals’ NHS Trust reports that isolated bursitis accounts for only 2% of lateral hip pain cases; 88–98% of patients have tendon pathology (gluteus medius or minimus tendinopathy or tears). The bursa is usually irritated secondarily to the tendon problem, not the primary cause. This distinction matters because the treatments differ — and some common self-treatment approaches make tendinopathy significantly worse.
Gluteal tendinopathy is approximately 4 times more common in women than men, and is most prevalent in peri- and post-menopausal women. It’s also common in runners who have increased training load quickly, added hills, or changed running surface.
What it feels like
Pain directly over the greater trochanter (the bony bump on the outer upper thigh). May spread down the outer thigh toward the knee. Often worse when lying on the affected side, climbing stairs, after prolonged sitting, or with single-leg activities. Can feel like a sharp pain on compression of the area or a more diffuse ache or burning sensation.
What to do
Load modification: Reduce running volume rather than stopping completely. Avoid hills and speed work initially. Running on softer surfaces can help — the grass vs concrete running guide covers surface impact differences.
Avoid compression positions: This is the key treatment insight that most runners don’t know. Positions that compress the gluteal tendons against the greater trochanter — such as crossing your legs, sitting with legs wide apart, standing with your hip dropped to one side (“hip hanging”), or lying with your knees pulled toward your chest — increase tendon compression and worsen the condition. Avoid them during the recovery phase.
Do not stretch the outer hip into adduction: The natural instinct when the outer hip hurts is to stretch it — crossing the leg over and pulling, or doing a piriformis-style stretch. Physiopedia and clinical guidelines both note that stretching insertional tendinopathies into hip adduction (where the leg crosses midline) significantly increases compressive load on the tendon and can worsen the condition. This is one of the most common self-treatment errors in gluteal tendinopathy.
Gradual tendon loading: The most effective treatment for gluteal tendinopathy is progressive strengthening of the gluteus medius and gluteus minimus. This begins with isometric exercises (muscle contraction without movement — e.g., pressing into a wall with the affected hip) and progresses to isotonic and dynamic exercises over several weeks. Hip abductor strengthening — side-lying leg raises, clamshells, resistance band walks — is the core of rehabilitation. Physiotherapy assessment is strongly recommended to guide this progression safely.
IT Band at the Hip: Snapping and Outer Hip Pain
The IT band (iliotibial band) runs from the pelvis all the way down to the outer knee, and it can cause hip pain at the top as well as knee pain lower down. When the IT band is tight or the hip abductors are weak, the band can snap over the greater trochanter with hip flexion and extension — producing an audible or felt “click” or “snap” on the outer hip. This is called external snapping hip, or external coxa saltans.
Repeated snapping can irritate both the bursa and the gluteal tendons in the area, contributing to lateral hip pain. IT band-related hip pain is distinct from IT band knee pain, though both originate from the same structure. It accounts for approximately 12% of running injuries overall.
What it feels like
A snapping or popping sensation on the outer hip, sometimes audible. May be painless initially but becomes painful with repeated irritation. Often worse when descending stairs or running downhill, as hip flexion and extension are more pronounced.
What to do
Reduce running volume and avoid the activities that provoke snapping. Foam rolling the IT band (along the outer thigh) can relieve tension, though avoid rolling directly over the greater trochanter itself. Hip abductor strengthening — the same exercises used for gluteal tendinopathy — addresses the underlying muscle weakness that allows the IT band to tighten compensatorily. Increasing cadence (steps per minute) can reduce hip excursion per stride and decrease IT band stress — the cadence guide covers how to adjust this.
Hip Flexor Strain: Front of Hip Pain
Pain at the front of the hip — the groin area or the crease where your thigh meets your pelvis — is often a hip flexor strain. The iliopsoas muscle (a combination of the iliacus and psoas muscles) is the primary hip flexor, responsible for lifting the knee with each stride. Runners who increase mileage or speed too quickly, add hill running, or have tight hip flexors from extended sitting can develop inflammation or small micro-tears in these muscles.
What it feels like
A dull ache or tightness at the front of the hip during or after running. Pain when lifting the knee toward the chest, climbing stairs, or stretching the hip into extension (e.g., during a lunge). May begin during a run and persist afterward, or come on gradually with accumulated mileage.
What to do
Rest from aggravating activities for several days. Ice the area for 15–20 minutes two to three times per day in the acute phase. Light hip flexor stretching is appropriate here — unlike gluteal tendinopathy, gentle stretching of the front-of-hip muscles is generally beneficial once the acute phase has passed. Core and glute strengthening reduces the load that falls on the hip flexors during running. Address any significant imbalance between hip flexor tightness and weak hip extensors (glutes) as a long-term prevention strategy. The tensor fasciae pain guide covers a related front-of-hip and outer-thigh issue that often co-occurs.
Hip Impingement (FAI) and Labral Tears
Femoroacetabular impingement (FAI) occurs when abnormal contact happens between the femoral head and the hip socket during movement — often due to bony variations (cam or pincer morphology) that cause the bones to pinch during hip flexion. Labral tears frequently occur alongside FAI, as the cartilage ring around the hip socket gets caught in this abnormal contact.
These conditions are more common in runners who have significant hip flexion as part of their gait, and in those with anatomical hip variants. Thrive Physio Plus (an Australian physiotherapy practice) notes that it was previously thought bony morphology was the primary driver — current understanding is that load management and muscle control are more important factors than the bony shape alone.
What it feels like
Sharp, pinching pain deep in the groin or front of the hip, typically during or after running. May feel like the hip “catches.” Aggravated by sitting for extended periods, crossing the legs, squatting, or bringing the knee toward the chest. Can cause a clicking or catching sensation inside the joint (distinct from the external snap of IT band snapping hip).
What to do
Avoid positions and activities that provoke the pinching sensation. Physiotherapy assessment is important — the condition responds well to targeted hip strengthening (particularly glutes and hip external rotators) and running gait modifications including cadence changes. Non-surgical treatment is preferred for labral tears; most cases improve with physiotherapy. Imaging (MRI) may be needed to confirm the diagnosis and assess labral integrity. Do not attempt to self-manage suspected FAI or labral tears over an extended period — early assessment leads to better outcomes.
Piriformis Syndrome: Deep Buttock Pain
The piriformis is a small muscle deep in the buttock that externally rotates the hip and stabilises the pelvis. The sciatic nerve either passes through or adjacent to this muscle, so when the piriformis is irritated or in spasm — from repetitive hip rotation during running — it can compress the sciatic nerve, producing deep buttock pain that may radiate down the back of the thigh (similar to sciatica).
What it feels like
A deep ache in the buttock, often described as inside the hip rather than on the surface. May radiate down the back of the thigh. Typically worse after sitting for extended periods and after running. Pressing on the buttock in the area of the piriformis muscle is usually tender.
What to do
Reduce running volume. Piriformis stretching is appropriate here and generally beneficial — lying on your back, crossing the affected ankle over the opposite knee, and gently pressing the crossed knee away stretches the piriformis. Gluteal strengthening addresses the underlying weakness that causes the piriformis to overwork. Deep tissue massage and trigger point release of the piriformis can provide significant relief. The massage and running guide covers timing recovery massage relative to training.
The Serious One: Femoral Neck Stress Fracture
Femoral neck stress fractures are uncommon but serious. They occur when cumulative repetitive loading on the femur produces a fatigue crack in the neck of the femur — the section connecting the femoral head (ball of the hip joint) to the shaft. Left unrecognised and continued to be run on, a stress fracture can convert to a complete fracture, which is a potentially devastating injury requiring surgery and months of non-weight-bearing recovery.
Stress fractures are more common in female runners (the female athlete triad — relative energy deficiency, low bone density, menstrual disruption — significantly elevates risk), runners who have dramatically increased training volume, and older runners with lower bone density. They are not visible on X-ray early in their development — MRI is required for diagnosis.
Warning signs — seek medical assessment promptly if you have these
Deep groin or inner thigh pain that worsens with running and may persist at rest. Pain that wakes you at night. Inability to bear weight or hop on the affected leg without significant pain. Pain that has been progressively worsening over several weeks despite reduced training. Do not continue running with these symptoms — see a sports medicine doctor or physiotherapist urgently.
General Treatment Principles for Running Hip Pain
What almost always helps
Reducing running volume (not necessarily stopping completely) gives tissues time to recover while maintaining some fitness. Switching to lower-impact cross-training — cycling or swimming — maintains cardiovascular conditioning without hip impact. Progressive hip strengthening, particularly of the gluteus medius and hip abductors, is the most evidence-supported long-term prevention and treatment strategy across almost all running-related hip conditions. Research cited by Thrive Physio Plus indicates strength training reduces running injury risk by up to 50%.
Addressing training errors is equally important. Most running hip injuries develop from one of three errors: too much volume too quickly, insufficient recovery between sessions, or a sudden change in terrain or intensity. The 10% rule — no more than 10% increase in weekly volume from one week to the next — reduces overuse injury risk. The running frequency guide covers how to structure training to allow adequate recovery. For older runners managing hip and joint concerns, the training for seniors guide covers age-specific recovery considerations.
When to see a physiotherapist
Physiotherapy assessment is appropriate for any hip pain that has not resolved with 2 weeks of reduced activity and basic self-care, pain that is significantly interfering with daily activities, any pain with warning signs described above, and any runner who has had the same injury recur multiple times. A running-specific physiotherapist can assess your gait, identify muscle imbalances, and guide a progressive return to full training — considerably faster than continuing to self-manage. The guide to suddenly struggling during a run covers other warning signs that warrant assessment.
Ice and anti-inflammatories
Ice (15–20 minutes, several times per day) is appropriate in the first 48 hours of an acute injury to reduce swelling and numb pain. After 48 hours, heat can help relax tight muscles. Over-the-counter NSAIDs (ibuprofen, naproxen) can reduce inflammation and pain in the short term — but they are not a long-term solution and should not be used to mask pain in order to continue running through a significant injury. They are designed for short-term use; if you need them for more than a few days, the underlying cause needs addressing.
Preventing Hip Pain from Running
The most effective prevention for running-related hip pain is hip and glute strength. Runners with weak hip abductors — particularly the gluteus medius — are at significantly elevated risk of hip injury, especially at longer distances. Side-lying hip abduction, clamshells, resistance band walks (monster walks), single-leg squats, and bridge variations are the foundation of a hip strength programme for runners. Two sessions per week of targeted hip work is sufficient for most runners.
Running on varied surfaces distributes impact stress more evenly across tissues. Exclusively road running on cambered surfaces can bias loading to one side repeatedly — a common trigger for outer hip issues. Introducing some trail or grass running helps. Adequate warm-up before hard sessions, a gradual return to training after any injury, and avoiding sudden increases in hills or speed also significantly reduce hip injury risk. The daily running consistency guide covers how progressive load management prevents overuse injuries across all distances.
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FAQ: Hip Pain After Running
Why do my hips hurt after running?
The most common causes are gluteal tendinopathy (outer hip pain), hip flexor strain (front of hip), IT band friction at the hip (outer hip with snapping), piriformis syndrome (deep buttock), or hip impingement/labral tear (front of hip with a pinching sensation). The location of your pain is the most useful clue to the cause.
Is it OK to run with hip pain?
Mild muscle ache that resolves within 24–48 hours is generally safe to run through at reduced intensity. Stop running and seek assessment if pain is sharp, if you are limping, if pain persists at rest, if it worsens during a run, or if it has been going on for more than two weeks without improvement.
What is the most common cause of outer hip pain in runners?
Gluteal tendinopathy (greater trochanteric pain syndrome) — not trochanteric bursitis, as it was previously called. Clinical research shows isolated bursitis is found in only 2% of outer hip pain cases; tendon pathology is present in 88–98%. Treatment focuses on progressive tendon loading and avoiding compression positions — not stretching the outer hip into adduction, which worsens the condition.
Should I stretch my hip if it hurts after running?
It depends on the cause. Hip flexor stretching (front of hip) is generally helpful for hip flexor strain. Piriformis stretching (deep buttock) is appropriate for piriformis syndrome. However, stretching the outer hip into adduction — the classic “cross-leg” IT band or glute stretch — should be avoided if you have gluteal tendinopathy, as it increases compressive load on the tendon and can worsen the condition. When in doubt, get a diagnosis before committing to a stretching programme.
When should I see a doctor for hip pain from running?
See a doctor or physiotherapist promptly if: you are limping, pain is present at rest or at night, the pain is sharp rather than a dull ache, the pain began with a specific incident, you cannot hop on the affected leg without significant pain, or pain has not improved after 2 weeks of rest. Femoral neck stress fractures in particular require urgent medical assessment — continuing to run risks converting a stress fracture into a complete fracture.
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