Hip and groin pain in runners is a fairly common issue. Groin pain in a runner can be due to the muscles around the hip, the  tendons around the hip, the bones that make up the hip and the labrum. Many hip and groin injuries are minor and you can continue running after a brief recovery period. As we will discuss, other causes of hip and groin pain in a runner will require prompt and immediate attention.

Common Causes of Hip or Groin Pain In Runners.

Hip or groin pain in runners is usually a sign of overuse, or overtraining.   Most hip issues are not the result of a single injury.  Runners can develop groin pain from training too little or too much.  Changes in the surface or trails that you run can also contribute to the onset of hip pain.  The most worrisome causes of hip and groin pain in runners occurs due to increasings your training activity too rapidly.  Too many miles, too quickly will lead to a stress fracture.

Adductor Strain:

groin pain running adductor strainThe adductor muscles attach to the pelvis and the inside portion of the thigh.  They work to stabilize your leg with any side to side motion. Runners who typically stay on the road might have hip pain after hilly trail race. So a change from your normal running course or pattern can cause some of the muscles around the hip to bother you. Trail runs or running on uneven terrain puts stress on many muscles around the hip.  If you are not prepared will make your adductor muscles work harder than usual.   running on uneven terrain, or on a path with a significant slope then your adductors are working harder than they are used to.  This will cause pain along the inner thigh, and sometimes up near the pelvic attachment.   Adductor muscle strains usually subside within a few weeks.  Stretching and adductor strengthening are the key to minimizing the risk of developing a chronic long term issue with them.  Running is usually well tolerated, just stay on a flat surface for a while until they calm down.  It is worth noting, I have had a few runners over the years who have mistakenly thought that they had an adductor strain when in fact they had deep groin pain due to a stress fracture.  So if you are unsure, see a sports medicine doc sooner rather than later.

Hip Flexors as a cause of hip pain and popping.

hip pain and popping in a runner psoas tendonThe long hip flexor, or the Psoas tendon crosses in front of the hip joint and attaches to the top of the femur.  The psoas tendon can be a cause of pain in the front of the hip in runners.  It is more common in thin females.  That’s due to the shape of their pelvis and the fact that the psoas is usually elevated off of the front of the hip joint by a small fat pad.  In very thin women that fat is not present and the psoas tendon will start to pop as it moves over the front of the hip. The Psoas tendon is the most common reason that a runner will experience snapping or popping in the front of their hip.

The treatment of a snapping hip tendon is usually accomplished with physical therapy.  If you have had pain and snapping for a while then you may develop an area of inflammation.  If that area stays inflamed despite PT you may require an injection.  The injection is usually performed using an Ultrasound machine, which can also confirm that the psoas is the cause of the snapping and popping.  On very rare occasion, a surgeon will need to release the psoas tendon from the femur if it continues to snap and pop despite therapy and injections.

Femoral Neck Stress Fractures

groin pain runner femoral neck stress fractureStress fractures occur when a bone is exposed to too much load or stress.  Runners who try to increase their mileage too quickly can develop stress fractures. Stress fractures of the foot and tibia are more common than femoral neck stress fractures.  Femoral neck stress fractures, however, are far more worrisome.

Femoral neck stress fractures occur more commonly in women. They are particularly more common in very active thin women. These women typically have altered menstrual cycles too.   Many will have low vitamin D levels which might contribute to the development of stress fractures.

We worry a lot about a femoral neck stress fracture in runners with complaints of groin pain.   If a runner develops groin pain that persists from the first step of a run through the last step, you should consider being examined by a Sports Medicine doc.

Many runners delay seeing a doctor because they think that they only have a muscle strain.  They don’t think that they should be able to walk with a stress fracture in their hip.  That is not true.  Most runners with femoral neck stress fractures come walking into the office.  They are not on crutches.

A potential femoral neck stress fracture in a runner is considered an urgent issue.  We will immediately place you on crutches and you should not put any weight on your leg.  We will usually order a test called a bone scan or an MRI to confirm that a stress fracture exists.  A normal plain X-ray does NOT rule out a femoral neck stress fracture.

Whether or not a femoral neck stress fracture require surgery depends on the type of fracture and its location.  Some fractures will heal with crutch walking, some fractures will require a few screws to hold the fracture together.  Most femoral neck stress fractures heal very well.  Most runners will be able to return to an active running career within a few months after the fracture has healed.

Hip and groin pain in runners is common.  Most cases will resolve on their own or with the help of a trainer or physical therapist.  Deep groin pain with each and every step requires urgent evaluation for a stress fracture.

In other posts we have  discussed other common causes of hip pain.   FAI and labral tears of the hip can also be responsible for hip pain in runners.  Although, FAI is a more common cause of hip pain in athletes involved in cutting, pivoting and twisting sports such as soccer.



About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very “social” patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles — all geared to improve your quality of life.
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