A FEW YEARS AGO I wrote an article about what I call “Runner’s Hip.” I named it this after a few runners came to my office with similar symptoms in a short amount of time. Since then, I have been digging a bit deeper and working on a program to simplify the assessment and to improve the overall results with a quick recovery. Today I would like to share where I am so far.
In my research I have not yet found anyone using the term “Runner’s Hip” and through my research I have found that there are a lot of people that don’t run but have similar symptoms. So, regardless of whether you are a runner or not, the location of the symptoms combined with particular movement patterns and areas of tension are consistent. Specific areas of weakness are also consistently found in what I still refer to as “Runner’s Hip.” I also still call it this because I have seen in my practice that these symptoms are found in runners more often than non-runners.
But, to be clear, my staff and I have also noticed these symptoms with dancers, rowers, office workers and salespeople that drive a lot. I have also noticed it in a higher percentage of women than men, but again it can be found in all populations and ages.
The patients we have seen with “Runner’s Hip” have been diagnosed with many different diagnoses like IT band syndrome, hip pain, gluteus weakness, lower back pain and SI joint pain. Although the diagnosis is different, the similarities are pain (or increased symptoms) when side bending to the opposite side of the symptoms, tension/pain in the iliacus muscle and weakness or difficulty activating their gluteus muscle and/or controlling their pelvis. The lack of control in the pelvis typically stems from postural issues and hip joint positional difference on their painful side.
Here’s how it all came together.
Several years ago I discovered that people with one sided butt / hip pain responded to a particular stretch which I named the “Reciprocal Pelvic Tilt.” (I will write about that in a separate article for another day) I had a patient that was not responding to my typical strategies and out of frustration and desperation I tried stretching him. Due to his lack of flexibility I had to hold his opposite leg down which is a movement commonly used by PTs. The difference was why, when and and how I use it. I do not use it to stretch the painful or restricted side, as it is commonly used but instead bring the painful side up. So in the picture below I am treating the “right” hip. The left leg down is merely an anchor for the opposite side.
About 10 years after the RPT discovery I was blessed to learn more about the effectiveness of this stretch when treating Runner’s Hip.
This started when I had a patient that came to my clinic with “hip and thigh pain” that started while working out, specifically running faster during a training session. The pain didn’t go away so she went to her physician and was diagnosed “IT band syndrome.”
This particular runner talked about a “deep pain” in the hip/pelvis and that she “couldn’t get to it” through traditional methods of icing, resting or stretching.
One day I was doing some “deep tissue work,” but she kept saying that I wasn’t “digging hard enough.” So I gripped my fingers on her pelvic bone and pushed really hard with my thumbs into the muscles on the outer part of her upper thigh. This technique worked, but not because of the “deep tissue work,” it was the location of my fingers that I had used to “anchor” my hands along the pelvic bone. This led to the discovery of the true problem: the iliacus muscle. I have refined my technique and now zero in immediately on that muscle.
The iliacus muscle joins with another muscle called the psoas to make up the iliopsoas muscle. The focus of this article is on the iliacus muscle.
Over this past year I have learned that in addition to tension in the iliacus, there is typically tension along the outside of the thigh and more often than not there are also areas of tension in the quadratus lumborum (a muscle in the lower back region). I have experimented leaving the iliacus alone and working around it, but the results are simply not as good. So, I am still convinced this is a key to the success of treating Runner’s hip.
I have also noticed how patient’s glutes and piriformis muscles are not as tense after I work on their iliacus, which leads me to think the symptoms in the buttock region are coming from inside the pelvis where the iliacus is, not the outside where the glutes are.
At Goodemote Physical Therapy we do a lot of manual therapy and have seen how important it is and how our results are improved by doing manual work. We have also improved our manual techniques so we are able to alleviate the pain much faster by going directly to the painful muscle groups and have taken steps to educating the patient on how they can do the same at home.
I noticed a pattern in walking and running which caused more severe symptoms in my patients. One of the first things I noticed was that when someone walked with their toe pointing away from the midline their symptoms were more extreme. The vast majority of patients have a toeing out on the painful side. There are some people with toeing out on both sides, but even they have more pronounced toeing out on the painful side.
We are also finding most have postural issues (i.e. slouching) with externally rotated hips on the symptomatic side (i.e. toes going out at rest). Poor posture and rotated hips contributes to this condition and must be addressed for lasting relief.
Runner’s Hip is also associated with weakness in the painful side. Besides running, our patients often describe pain or difficulty with activities such as going up stairs or hills and pain with prolonged sitting. There are a lot of patients that also have pain or difficulty transitioning from in and out of cars. These difficulties seem to stem from the postural habits and positioning of the hip and often are what interfere with progress unless they are addressed.
I have a few specific tests that I use to confirm my suspicions and to demonstrate to the patient their weakness. These test positions become exercises and are crucial for patients to improve and restore their activities, including running. Testing strength typically reveals weakness with the inability to hold an erect posture while lifting the thighs. The iliacus has a role of stabilizing the pelvis while the psoas lifts the thigh bone and we have very few patients that are able to do this without compensating.
In addition we have noticed that due to faulty mechanics our patients struggle to engage the gluteus muscles, especially when we keep them in a position where their iliacus is needed to keep the pelvis stable. This applies to all positions from lying down to sitting and even when standing or walking. Basic activation exercises in a variety of positions is my starting point for treating my patients. As the patient gains strength the shift goes to partial weight bearing and then to full weight bearing exercises. I have developed a whole sequence of movements for strengthening in the targeted area. I have been using this program for the last several months and the speed of recovery is notably faster.
What is fun about this process is noticing how common a condition like this is and at Goodemote PT we like to guide our patients to their own unique solution. Although I have worked for a few years to come up with a program that everyone can do, the reality is that everyone is unique and require different treatments to suit individual needs. Fortunately this process has helped us to identify quickly if we can help and there are similarities that help us provide quick results.
If you are wondering if you have the condition and simply can’t figure it out on your own then please contact us so we can assess and guide you on what you individually need to do. Or you can email if you have any questions. My email address is This email address is being protected from spambots. You need JavaScript enabled to view it. and our office number is 518-306-6894.
Thank you for reading my article. I hope it was helpful!
