Runners' bodies undergo a lot of pounding that can lead to medical conditions that cause hip or thigh pain. Diagnosis can be challenging because more than one condition can be present at a given time.

A patient can help his or her doctor make an accurate diagnosis by noting the pattern of symptoms, including exact location of pain, when it occurs, and what makes it go away.


Greater trochanteric bursitis (Hip bursitis)
This type of bursitis tends to cause tenderness and pain on the outside of the hip. As symptoms progress, pain may radiate down the outside of the thigh and occasionally to the buttock, groin and low back.

The greater trochanter is a bony prominence on the femur (thighbone). The trochanteric bursa is a small, fluid-filled sac that serves as both a cushion and lubricant between the greater trochanter and the iliotibial (IT) band, a thick piece of connective tissue that extends from the hip to the top of the tibia (shinbone).

In runners, the trochanteric bursa can undergo frequent "mini-traumas." Over time, the bursa becomes inflamed, causing painful symptoms. A tight IT band can exacerbate hip bursitis.

Read more: Iliotibial Band Syndrome

Stress fracture in the hip
A traumatic bone break is caused by a one-time injury, but a stress fracture is caused by repetitive strain on a bone. The impact of jogging can cause a small crack to develop in the femoral head (hip). Runners who have osteoporosis are at a greater risk of stress fractures.

The pain of a stress fracture will gradually increase and become more pronounced. Pain is more noticeable during and after activity and less noticeable after sleeping, when the bone has had time to rest. Pressing down on the skin over the hip may cause pain.

See All About Stress Fractures

If a stress fracture is suspected but not confirmed, a doctor may recommend beginning non-surgical treatment right away. A definitive diagnosis may require advanced imaging, such as and MRI or bone scan.


Injury to the Hip and Thigh Muscles

A mild strain can cause a person to feel stiff and sore but he or she will still be able to walk and jog (though it may be a little uncomfortable). This type of muscle strain, defined by small tears in the muscle, may be caused by overuse or lack of conditioning. This condition usually needs only a week or two for recovery.

In contrast, a severe muscle strain, defined by a full rupture of the muscle, may occur suddenly. The injury can be quite painful and cause immediate swelling followed by bruising. A person with a severe muscle strain may not be able to walk normally and may require months to recover.

For runners, the gluteus medius, hamstrings, quadriceps, and groin muscles of the hips and thighs are all susceptible to injuries.

Gluteus medius muscle
The gluteus medius is one of the most commonly injured muscles in runners and typically develops from overuse. A person with a strained gluteus medius may feel dull, achy pain on the outside of the hip and buttock and may find it uncomfortable to lie down on the affected side.

The gluteus medius travels over the outside of the hip joint. Because they are located in the same area, inflammation or injury affecting the gluteus medius can affect the greater trochanteric bursa, and vice versa. The top of the iliotibial (IT) band, which also travels over the outside of the hip joint, may be involved as well.

Hamstring muscles
Runners, especially those who do sprint workouts, may strain the muscles at the back of their thighs, called the hamstring muscles. Traumatic injury to the hamstrings can happen when a runner pushes push off from the ground, forcing the muscle to bear a significant load while fully or almost fully extended. The athlete may feel a distinct sharp pain or "pop" and be forced to stop running. A more mild strain may not be felt until the next day, when the runner wakes up feeling stiff and sore at the back of the leg.

See Acute Hamstring Tears

Pain and stiffness at the front of the thighs indicated injury to one or more of the quadriceps muscles. Like other muscles, the quadriceps muscles can become strained from overuse if they are not properly conditioned. On the other hand, a sudden injury can occur if the runner suddenly accelerates or stops short.

Groin muscles
The muscles at the inside of the thigh are called the adductor muscles, or groin muscles. These muscles are less likely to be injured during jogging than while sprinting and making fast turns (e.g. playing sports such as soccer or football).

Many mild to moderate groin muscle injuries can be self-diagnosed and treated. If a runner with persistent groin pain and seeks medical attention, a doctor may want to rule other possible conditions with similar symptoms, such as a hernia, a pinched nerve, and tears to the hip joint's labrum.

See Understanding Sports Hernia (Athletic Pubalgia)

Treatment for a pulled muscle typically involves rest and anti-inflammatory medications. Once symptoms abate, runners should ease back into an exercise routine that includes strengthening exercises and gentle stretching.

See Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours

If a painful hip or thigh does not get better with rest within two or three weeks, or if pain is severe, medical attention is warranted. Rarely, when there is a severe muscle tear, is surgery recommended.

Dr. Andrew Cole has 30 years of experience specializing in spine and joint pain management. Dr. Cole has held numerous medical appointments throughout his career, and recently served as the Executive Director of Rehabilitation & Performance Medicine Enterprise for Swedish Health Services and as Medical Director of Ambulatory Musculoskeletal Services for Swedish Medical Group.