Hip Flexor Pain in Runners
There’s nothing quite as frustrating as being unable to run due to pain or discomfort, especially when it disrupts your ability to stay consistent in your training routine.
One of the most common complaints we see in our runners is hip flexor pain and tightness.
This kind of pain is located on the front side of the hip and typically occurs shortly after or towards the end of a run depending on the individual.
It can feel especially tight when running up hills, increasing your speed, or as you begin to fatigue and lose proper form.
Where does this pain come from?
The primary muscle that helps in hip flexion is the iliopsoas, which is the muscle that we feel is painful and/or tight.
The pain is typically felt on the anterior (front) side of the hip along the lower portion of the iliopsoas muscle and tendon.
In order to understand why the pain occurs, it’s worth taking a look at the anatomy…
The anatomy of the iliopsoas:
The iliopsoas is actually made up of 3 muscles including the iliacus, the psoas major, and the psoas minor muscles.
The psoas major originates from the T12-L4 vertebral bodies and inserts on the lesser trochanter of the femur.
The psoas minor originates from the T12 and L1 vertebral bodies and inserts on the iliopubic eminence (towards the inferior end of the pubic bone).
The iliacus originates from the iliac fossa, which is on the inner side of the pelvic bowl, and inserts on the lesser trochanter of the femur.
Here’s an image that shows each muscle and their attachments to help you visualize the uniqueness of the iliopsoas muscle.
The iliopsoas is made up of 3 muscles; the iliacus, psoas major, and psoas minor muscles
Now that you have a better idea as to what the iliopsoas looks like it’s important to understand the role that posture plays with regards to the iliopsoas.
How does posture impact the iliopsoas?
The position of the spine, pelvis, and femur essentially determine the position, or length, of the iliopsoas muscle.
For example, if we wanted to fully stretch the iliopsoas we would extend our hip by placing our leg behind us and then extend our spine by bending backward (we don’t typically recommend this stretch, more on this later).
As it relates to running posture, one of the common findings in runners with anterior hip pain is that they tend to have a slightly lordotic (extended) curve in their lumbar spine and an anteriorly tilted pelvis causing the iliopsoas to be in a stretched position at toe off.
Here’s an image that shows the postural findings mentioned above:
In the image on the left you can see the extension in the lower back and the slightly downward tilt of the pelvis, which often results in a heel strike type of gait pattern. The image on the right demonstrates a more neutral lumbar spine and pelvis position, which often results in more of a midfoot strike.
The real cause of hip flexor pain during running:
As you can see above, a common cause of hip flexor pain during running is this extended posture shown above.
The excessive extension in the lumbar spine in addition to the anterior pelvic tilt causes the iliopsoas to be lengthened and overly worked during your running gait.
The upper portion of the iliopsoas (that connects to the vertebral bodies) ends up becoming a primary stabilizer for the trunk. Or in other words, the iliopsoas is taking over the job of the core due to the position of the lumbar spine in relation to the pelvis.
The other issue with this posture is that it causes the iliopsoas to be at a maximal length at the toe-off position, which over the course of a run can create significant strain on the tissues.
In addition, there’s a higher chance that runners with this type of posture will also demonstrate more of a heel-strike pattern with a fully extended leg vs a mid-foot strike pattern with a slight bend in the knee at first contact.
How do you fix hip flexor pain during running?
There are a few aspects to solving hip flexor pain during running and they fall under 3 categories:
Manual Therapy
Active Rehabilitation
Running Mechanics
Manual therapy for hip flexor pain:
I’m sure at some point you’ve heard that a “psoas release” can be a game changer when it comes to hip flexor pain.
This is true - manual therapy can be a fantastic tool at helping to reduce the pain and improve the function of the iliopsoas, which can be crucial to successful rehabilitation of hip flexor pain.
Soft-tissue techniques like myofascial release can help to treat myofascial adhesions and trigger points that prevent the iliopsoas from functioning as it should. (If you want to read more about myofascial adhesions and trigger points visit our last blog)
However, manual therapy alone won’t solve the problem. It’s best used when paired with active rehabilitation that helps to correct the functional issues involved in the cause of hip flexor pain.
Active rehabilitation for hip flexor pain:
One of the best times to get some active rehab is directly following manual therapy when the pain level has been reduced and function has been improved.
Active rehab for hip flexor pain is aimed at fixing the functional components of the issue.
In this case, the functional component is the ability of the core to maintain a more neutral spine and pelvis in order to reduce the strain on the iliopsoas during your running gait.
Here’s an example of an exercise we use to help our patients learn to utilize their core to maintain neutral posture while placing load on the iliopsoas.
As you can see, this exercise shares the workload of maintaining neutrality in the lumbar spine and pelvis between the core and the iliopsoas.
As a result, you should feel much less strain specifically in the iliopsoas as it is no longer working to do both the job of core/pelvis stabilization and hip flexion.
You can pair these exercises with stretches that help to activate the right muscles and maintain good posture while adequately lengthening tissue.
Here’s an example of a hip flexor stretch that we show our patients:
Running mechanics for hip flexor pain:
Manual therapy and active rehabilitation are crucial for helping to resolve the pain, but it’s important to remember that the goal is to be able to RUN without pain.
That means we have to fix the way we run!
We typically perform a running gait analysis for our patients, which means that we’ll have them take a video from the side and from the back while running so that we can better understand their individual running mechanics.
This type of analysis helps us to combine the findings from our in-office exam to see if it correlates with the findings from their gait analysis in order to provide the most specific and individualized care that we can.
Our recommendations are always focused on slight changes that can help to correct patterns that might be causing or contributing to the pain our patients are experiencing.
In this case, focusing on maintaining a more neutral pelvic position while running can make a significant impact. The cue for this is actually to think about relieving the tension in your lower back, which will help to reduce the overall extension in the lumbar spine and pelvis, and in turn helps to maintain a more neutral position.
This cue helps to correct the postural findings that we mentioned above, which helps to improve gait mechanics and take the stress off the iliopsoas muscle during running!
There you have it!
Hip flexor pain doesn’t have to hold you back from doing what you love.
Are you experiencing pain of some kind that’s preventing you from doing the things you want to do?
We’re here to help!
Interested in seeking care at Momenta Chiropractic? You can schedule an appointment via our online booking system. We’ll help guide you through your recovery process to get you back to moving like you used to.
