Hip pain after running

Injury question wrote:

I've got a couple of tall girls running on my xc team and both are experiencing pain at the top of the hip bone (more to the front than the back) after workouts. Both have run before and are in decent shape after summer running. Has anyone had this type of soreness before or worked with runners who experienced the same thing?

Bump

I had this type of pain for quite some time. Turned out to be a leg length discrepency in my case. I saw a chiro, he made a couple of adjustments and I did some stretching/strengthening and haven't really had the issue come up again.

My Daughter had the exact same symptoms as your runners. Initial diagnosis was tendonitis. In all my years of running I had never seen an injury in that area that didn't result from some type of direct impact. Turns out, same cause as the previous poster, leg length discrepancy. She is using a heel wedge, no orthotics yet.

I've had similar experiences with some high school age girls I coach.

Leg length discrepancy is one reason. But more often it is due to poor posture which leads to poor gluteal activation. When the glutes are inactive, the hip flexors are strained due to the lack of hip rotation around the spine, something which the glutes facilitate. This hip rotation is a sort of shock absorbing mechanism in our body such that any impact on the foot is dispersed thro out the body. If this does not occur, any joint can be made to absorb the brunt of the forces, usually the knee and/or hip area.

You might want to check out yr athletes when they run. Do they heel-strike? Do they hunch overtly as they go on longer runs? Fatigue and poor technique can result in gluteal inhibition. Hip or lower back pain or both may then occur as time goes by.

Hope this helps.

More thoughts on the issue.....

Tall girls tend to hunch their backs, esp tall teenage girls. This is partly due to their height, and partly due to the fact that they are developing breasts and the lack of upper body strength to carry that extra weight on their chest usually leads to hunching.

If they run excessive mileage, this might contribute to poor posture and gluteal shutdown. If they run from the quadriceps and iliopsoas, relying excessively on these muscles to lift their knees rather than use the hamstrings more, this may also lead to tight hips.

foomiler. great input. Do your girls exhibit pain in both hips then? What do you give them to strengthen their glutes? Interestingly I may have a similar issue although mine is growing old and developing around the waist.

Hip bursitis? ITB? Could be a lot of things. Ice, Ibruprofen, rest. Then fix the actual cause: weak quads and tight hip flexors/piriformis

1. Piriformis Stretch (on back, one leg crossed over the other in a "figure four", pull legs back toward chest)

2. Hip Flexor Stretch (think of a deep lunge, knee touching floor, lean back)

3. Hip Felxor Stretch with rear foot on chair

4. ITB stretch (stand, legs crossed, lean over)

Strength via body weight circuit:

1. Squats to failure, or 2:00

2. Pushups to failure

3. Lunges (NOT walking lunges) to failure, or 2:00

4. "fat man" pullup, ie: inverted row: Get under a bar that's a few feet off the ground, keep body straight pull self up

5. Lateral Lunges: runners have no hip/lateral stability, this will help (stand legs wide, one foot straight, one foot turned out perpendicular, lunge toward turned out foot, should feel effort in abductors/adductors

6. Planks: Hold yourself up on your elbows and toes, keep back straight. Hold for as long as you can.

Alan

I have about 5-6 girls (out of around 30 track athletes), both sprinters and distance runners, who exhibit hip pain in either one or both sides when training volume increases. When training frequency increases, more kids get into same trouble.

Usually b4 they get into trouble I have already spotted potential areas of weakness and poor posture and/or technique in at least a couple of them, even when they are simply walking or standing around. They also appear more listless than usual. Usually this coincides with too much stress at school, esp when the school has arranged too many activities in a short period of time, or when they have a series of tests coming up.

There are also girls who are required to attend extra lessons after school either as remedial lessons or make-up classes to catch up on the syllabus, and this not only increases mental stress on them, but also increases the amount of time they remain in a seated position, which usually leads to some measure of slouching. This can affect their back, neck and groin area a lot, even if they are not athletes.

Also watch out for kids who are involved in other sports. I have girls who are ballerinas, gymnasts, swimmers, dancers, etc and these are activities which make great demands on the hip and lower back regions. They are usually VERY flexible girls (180 deg straight leg centre splits!)but still they experience hip trouble in running workouts. It seems to be a case of overuse and fatigue.

The situation I face is such that when these kids get to training after an exhausting day (or days) at school, they are mentally too tired to control their movement efficiently. This can lead to poor running form and therefore hip pain. Physically, some of them are too spent to push their bodies even optimally, even when they actually feel fine initially. But as athletes they have such a strong mind and will that they often block out any discomfort quite effectively and just train thro it all.

I would agree with Runningart2004's post on the stretching exercises u could get yr kids to perform. His recommendation on the gluteal and core exercises are also very relevant. Many kids fail to activate their tranverse abdominus (TVA) when they run and this results in the trunk resting entirely on the pelvis when they stand or run. This places a lot of stress on the hip flexors, iliotibial band and even the hip external rotators (esp for those who like to stand on one leg). Tightening of any one or all of these areas can lead to hip pain.

Also if yr TVA is not activated when u run, the weight of the trunk resting on the pelvis inhibits hip rotation during stance phase, when the foot lands on the ground at ball of foot and is on the way backwards. The iliopsoas is at this point operating in a compressed position and a shearing force is applied backwards against it as the leg swings backwards. If no hip rotation occurs at this point, the runner usually tries to get propulsion by pushing off hard with the foot and hyperextending the thigh area. Imagine trying to drive the whole leg rearwards while 'locking' the leg at the hip joint area. U r virtually holding yr iliopsoas rigid while trying to rip it apart rearwards with each stride!

Having loose hips when we run is paramount. But stretching will only get us so far. It is useless being flexible only to put yourself in a position that inhibits hip mobility. All that flexibility will not be in use at all, and injury will still result.

The challenge is in getting the kids to understand and consistently apply good postural habits when they run. As I've mentioned earlier on, some of them are simply too tired after school to execute the correct postural cues, even if they really want to. The sad reality is that some of the physical problems our kids face are actually related to the stresses of modern living. (Maybe that's why the Kenyan teenage girl is running 1.54 800m at Beijing and there are no Americans in the women 800m final even! The less developed nations simply do not put so much stress on their kids in school as we do. They do not need to "keep up with the Jonses" like more affluent societies tend to do. But I digress.....)

As for exercises for glutes, I usually recommend shoulder bridges on one or two legs, sidelying leg raises for both outer and inner thighs, front and rear leg raises from supine and prone positions respectively.

I also use hip internal and external rotation exercises which I find are very effective for ITB trouble. For hip internal rotation u place resistance on yr foot when yr leg is bent at 90 deg or less. Push against the resistance outwards away from the midline of yr body. For external rotators I use 'clamshells', starting from bent leg position as above and then opening up yr knee outwards with yr feet still close together. Resistance is placed against the outside of the knees as it pushes away from yr body's midline.

In all these I stress the activation of the TVA to keep the trunk and spine in neutral position. To teach this I get my kids to lie on their backs with knees bent. When the TVA is activated, there should be no gap between yr lower back and the ground. The TVA lies deepest of all abdominal muscles at the pubic bone region and it is not easy to get it to activate. It usually takes some practice to get it. If u r in doubt, consulting a good physical therapist on TVA activation will usually help.

Again, hope some of the stuff I shared will be helpful.

Runningart2004 wrote:

Strength via body weight circuit:

1. Squats to failure, or 2:00

2. Pushups to failure

3. Lunges (NOT walking lunges) to failure, or 2:00

4. "fat man" pullup, ie: inverted row: Get under a bar that's a few feet off the ground, keep body straight pull self up

5. Lateral Lunges: runners have no hip/lateral stability, this will help (stand legs wide, one foot straight, one foot turned out perpendicular, lunge toward turned out foot, should feel effort in abductors/adductors

6. Planks: Hold yourself up on your elbows and toes, keep back straight. Hold for as long as you can.

Alan

Core strength is a good idea, but pushups and pullups will do nothing for the hip area. Also, doing squats and lunges when you have already injured your hip area doesn't seem like the smartest idea. Better to wait until the inflammation goes down before you strengthen it.

I think the push ups and pull ups are for upper body strength, to help the girls to better support their shoulders and chest area. The pullups that Runningart2004 mentioned, I feel, are particularly helpful for girls as they usually can't do the standard 'guys version.' Also this targets the rhomboids which pull back the shoulders, opening up the chest and shoulders so that the person does not round their upper backs, which contributes to poor posture.

Would also like to point out heel-striking again and overpronation upon footstrike, which can strain the IT bands. Excessively tight IT bands also inhibit normal hip rotation and increases strain on the hip region.