Running is one of the most accessible and rewarding forms of exercise. Whether you are training for a marathon, doing Couch to 5K, or simply enjoying weekend runs, it offers huge physical and mental health benefits.
But when hip pain strikes, it can be frustrating, confusing and sometimes serious.
In a recent Complete Physio podcast, Chris Myers and experienced hip surgeon Mr Jerome Davidson from London Bridge Orthopaedics discussed two of the most common hip problems seen in runners: femoral neck stress fracture and lateral hip pain, often linked to gluteal tendinopathy.
As Jerome explained: “These injuries are always there to catch you out.”
Understanding the difference between these conditions is vital, as one can usually be managed with rehabilitation, while the other may require urgent imaging and specialist care.
Key Takeaways
- Hip pain in runners should never be ignored, especially if it causes limping or worsens quickly.
- Groin pain during or after running may indicate a stress reaction or stress fracture.
- X-rays can miss early bone stress injuries – MRI is often the best scan.
- Pain on the outside of the hip is commonly related to gluteal tendon overload.
- Many tendon-related hip problems improve with the right rehab plan, but recovery often takes 3+ months.
- Early diagnosis and expert guidance can prevent small problems becoming major setbacks.
The Complete Physio and London Bridge Orthopaedics Partnership
One of the things that really sets Complete Physio apart, in terms of exceptional care, is the close working relationship we have with the consultants at London Bridge Orthopaedics.
Rather than working in isolation, our physiotherapists and orthopaedic specialists collaborate regularly to create a joined-up approach to patient care, where communication between surgeon, physiotherapist and patient is seamless throughout the rehab journey.
For patients, this means quicker access to specialist opinions, clearer treatment pathways and rehabilitation programmes that are closely aligned with medical and surgical decision-making.
This collaborative model is relatively unique in private practice and allows us to deliver highly personalised, evidence-based care that consistently improves patient experience, recovery and long-term outcomes.
Why Do Runners Get Hip Pain?
Running places repetitive load through the hips, pelvis and lower limbs. Usually, the body adapts well to this stress. However, problems can develop when training load increases faster than the body can recover.
This often happens when someone:
- Suddenly increases mileage
- Starts hill training or speed work
- Returns to running after time off
- Begins running from a low fitness base
- Is under-fuelling or recovering poorly
- Has reduced bone density or hormonal issues
Two conditions commonly seen in clinic are:
- Femoral neck stress reactions / stress fractures
- Lateral hip pain (gluteal tendinopathy / greater trochanteric pain syndrome)
Stress Fractures in Runners – The One You Must Not Miss!
A stress fracture is not usually caused by one dramatic injury. Instead, it develops when repeated loading overwhelms the bone’s ability to repair itself.
At the hip, this most commonly affects the femoral neck – the narrow section of bone between the ball of the hip joint and the shaft of the thigh bone.
What Is a Stress Reaction?
Bone stress injuries exist on a spectrum:
- Stress reaction – early bone irritation and inflammation
- Stress fracture – microscopic cracks within the bone
- Displaced fracture – a full break where the bone shifts position
Jerome described it clearly: “At the start of that is a reaction in the bone where the bone is not happy.”
Catching the injury early at the stress reaction stage is ideal, as treatment is simpler and surgery can often be avoided.
Common Symptoms
Be suspicious if you have:
- Deep groin pain while running
- Pain worsening after exercise
- Limping after a run
- Pain hopping on one leg
- Pain with walking or weight-bearing
- Symptoms that keep returning when you try to run again
Jerome noted that runners often say: “I did a run, it was okay during, but that night or the next day they start limping.”
If a runner develops sudden groin pain and starts limping, it should be assessed urgently.
Why X-rays Can Miss It
Many people assume a normal X-ray means there is no fracture. Unfortunately, early stress reactions often do not show on X-ray.
Jerome made the point strongly: “For these kinds of injuries it just doesn’t help you. It actually hinders you because you get reassurance.”
MRI is considered the gold-standard investigation because it can detect bone oedema and early stress injury before a visible crack develops.
Who Is More at Risk?
Risk factors for femoral stress fractures include:
- Rapid increases in training load
- Low energy availability / under-fuelling
- Previous eating disorders
- Irregular menstrual cycles
- Osteopenia or osteoporosis
- Vitamin D deficiency
- Low body weight
- Previous stress fractures
These factors are particularly relevant in endurance athletes and recreational runners alike.
Treatment for femoral stress fractures
Treatment depends on severity, but often includes:
- Immediate reduction in loading
- Crutches or partial weight-bearing
- MRI-led decision making
- Bone health screening
- Nutritional review
- Gradual rehab and return-to-run planning
Jerome emphasised that this is also a chance to look at the bigger picture: “It’s an opportunity to make changes to their bone health for the better for the rest of their lives.”
More severe fractures, especially those on the “tension side” of the femoral neck, may need surgery due to higher risk of displacement.
Lateral Hip Pain in Runners
Pain on the outside of the hip is another common issue.
It is often labelled:
- Trochanteric bursitis
- Gluteal tendinopathy
- Greater trochanteric pain syndrome (GTPS)
These terms describe related conditions around the bony prominence on the side of the hip.
What Causes It?
The gluteus medius and minimus tendons attach here and help stabilise the pelvis during running, walking and single-leg balance.
If tendon capacity is exceeded, irritation develops.
Jerome explained: “It is a muscle that has to work very hard all the time, and you can’t really rest it.”
Research now suggests many cases previously labelled “bursitis” are more accurately diagnosed as tendon-related problems.
Typical Symptoms
- Pain on the outside of the hip
- Pain lying on that side in bed
- Pain with stairs or hills
- Pain after running
- Tenderness over the bony side of the hip
- Morning stiffness
Unlike stress fractures, this pain is usually more lateral than deep groin pain.
Why Rest Alone Often Fails
Many runners stop running for a few weeks, feel better, then restart, only for symptoms to return.
Why?
Because pain settles, but tendon capacity has not improved.
The underlying issue is usually not simply inflammation. It is a tendon that needs progressive loading and strengthening.
As Jerome said: “Once it’s become painful, it’s very difficult to undo.”
Best Treatment for Lateral Hip Pain
The most effective management usually includes:
1. Load Modification
Reduce aggravating running volume or intensity temporarily.
2. Strength Rehabilitation
A progressive strength rehabilitation programme is one of the most important parts of recovering from lateral hip pain and many running-related injuries.
The aim is not simply to reduce pain, but to improve the overall load capacity of the lower limb so the body can tolerate running demands more effectively.
A progressive programme targeting:
- Gluteals
- Adductors
- Quadriceps
- Calf complex
- Single-leg control
- Running mechanics
At Complete Physio, we also offer specialised Strength and Conditioning support as part of the rehabilitation process.
This allows patients to progress beyond basic rehabilitation exercises into higher-level strength, power and performance work that directly translates to running and sport.
3. Education
Understanding that recovery takes time is essential.
Jerome was clear on expectations: “This problem takes quite a long time to settle down.”
Many runners need 8–12+ weeks of consistent rehab.
4. Shockwave Therapy for Gluteal Tendinopathy
Shockwave therapy is commonly used for chronic gluteal tendinopathy and other stubborn tendon conditions.
The treatment works by delivering acoustic energy into the affected tissue, helping to stimulate healing responses, improve blood flow and reduce pain sensitivity within the tendon.
Research has shown good outcomes for greater trochanteric pain syndrome when shockwave therapy is combined with an appropriate rehabilitation programme (Rompe et al., 2009).
At Complete Physio, shockwave is delivered by highly experienced clinicians who understand how to integrate it into a broader rehab strategy, rather than using it as a standalone treatment.
This is particularly important for runners, where improving tendon load capacity and movement mechanics remains the key to long-term recovery.
5. Ultrasound-Guided Injection Therapy
For patients with very reactive or highly painful tendon presentations, ultrasound-guided injection therapy can sometimes provide an important “window of opportunity” to progress rehabilitation more comfortably.
Image-guided injections allow treatment to be delivered with precision to the correct anatomical structure, improving accuracy and helping guide overall management.
Importantly, injections are not viewed as a quick fix, but as part of a wider treatment plan that includes progressive strengthening, load management and return-to-running guidance.
At Complete Physio, injections are closely integrated with physiotherapy rehabilitation, helping ensure that pain relief is used productively to improve strength, movement and overall tendon function.
Jerome summed it up well: “The injection doesn’t cure the problem. The injection just takes away their pain temporarily, allowing a window for rehabilitation”
A More Integrated and Cost-Effective Approach for Self-Pay Patients
One of the major advantages for self-pay patients is that these treatments are available within Complete Physio’s integrated clinic environment, often at a significantly more cost-effective price point compared to many large private hospitals.
Patients are able to access specialist physiotherapy, diagnostic expertise, shockwave therapy and ultrasound-guided injection treatments within the same coordinated service, helping streamline care and avoid unnecessary delays or multiple appointments across different providers.
When Should You See a Physio?
Seek assessment if:
- Hip pain changes your gait
- You are limping
- Pain persists more than 1-2 weeks
- You cannot run without symptoms returning
- Pain wakes you at night
- Pain is in the groin
- You have a history of stress fractures or bone health concerns
Early diagnosis often means a faster recovery.
Specialist Hip and Groin Physiotherapy at Complete Physio
At Complete Physio, we are fortunate to have a number of highly experienced hip and groin specialist physiotherapists.
Specifically Yasmin Palfrey and Alex Manos both have extensive experience assessing and treating a wide range of hip conditions, from running-related tendon pain and femoral stress injuries to complex groin presentations and post-operative rehabilitation.
Their expertise combines detailed biomechanical assessment, evidence-based rehabilitation and close collaboration with leading orthopaedic consultants to ensure patients receive highly personalised care.
Whether you are training for a marathon, returning to exercise after injury or managing long-standing hip pain, our experienced lower limb Physios across all our locations, will provide structured rehabilitation plans designed to restore strength, and long-term performance.
Why I Refer Patients to Complete Physio
One of the reasons I regularly refer patients to Complete Physio is the depth of expertise and the genuinely integrated approach they provide for hip and groin rehabilitation.
As a hip surgeon, it is important for me to know that when I refer a patient for physiotherapy, they will receive highly specialist assessment, evidence-based rehabilitation and ongoing clinical reasoning throughout their recovery journey. Complete Physio consistently provides that level of care.
Their team includes dedicated hip and groin specialists who understand the complexity of running-related injuries and the demands placed on athletes and active individuals.
The ability to combine expert physiotherapy with diagnostic ultrasound, ultrasound-guided injection therapy, shockwave therapy, detailed running analysis and advanced performance testing, allows for a far more complete understanding of why a patient has developed pain in the first place.
From my perspective as a surgeon, the close communication between Complete Physio and the consultants at London Bridge Orthopaedics is also incredibly valuable. We are able to discuss imaging findings, rehabilitation progress and treatment plans directly, ensuring patients receive coordinated care rather than fragmented opinions from separate providers.
Ultimately, I refer patients to Complete Physio because I know they will receive exceptional care from clinicians who understand not only how to treat hip pain, but how to get people safely and successfully back to the activities that matter to them.
Final Thoughts
Hip pain in runners is common, but it should not be dismissed as “just tight hip flexors” or something to run through.
Groin pain may indicate a stress fracture and needs urgent attention. Outer hip pain is often highly treatable, but requires the right rehabilitation rather than endless rest.
As Jerome highlighted throughout the podcast, getting the diagnosis right early can make all the difference.
If you are struggling with hip pain, our expert team at Complete Physio can help with diagnosis, imaging referrals, rehabilitation and return-to-run planning.
Need help with pain, injury recovery or a diagnosis? Book an appointment with one of London’s top physios today.
References
- Brinks, A., van Rijn, R.M., Willemsen, S.P., Bohnen, A.M., Verhaar, J.A., Koes, B.W. and Bierma-Zeinstra, S.M., 2011. Corticosteroid injections for greater trochanteric pain syndrome: a randomized controlled trial in primary care. The Annals of Family Medicine, 9(3), pp.226-234.
- Grimaldi, A. and Fearon, A. (2015) ‘Gluteal tendinopathy: integrating pathomechanics and clinical features in its management’, Journal of Orthopaedic & Sports Physical Therapy, 45(11), pp. 910–922.
- Neubauer, T., Brand, J., Lidder, S. and Krawany, M., 2016. Stress fractures of the femoral neck in runners: a review. Research in Sports Medicine, 24(3), pp.283-297.
- Ramon, S., Russo, S., Santoboni, F., Lucenteforte, G., Di Luise, C., Rocio de Unzurrunzaga, M.D., Vetrano, M., Albano, M., Baldini, R., Cugat, R. and Stella, G., 2020. Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome. J Bone Joint Surg Am, 102, pp.1305-11
Don’t let pain hold you back, book now!
