The hips are the cornerstone of every runner’s body. Comprising an array of muscle groups—from the all-powerful glutes to the smaller hip flexors and adductors—your hips propel every stride, stabilize the thighs, and (quite literally) keep the knee on the right track, physical therapist John Sauer, D.P.T., O.C.S., an endurance program manager with Athletico Physical Therapy, tells SELF.

2016 — More editing, more! Added some better information about pain being a poor indicator, and the role of myofascial trigger points. This article has become extremely busy in the last couple months — about 4,000 readers per day, as described here — so I am really polishing it and making sure that it’s the best possible answer to people’s fears about back pain.


Symptoms of the neuropathies above would include burning sensation in leg areas where these nerves are housed as well as lack of coordination of these leg muscles. Other symptoms include muscle wasting, pain, and twitching, cramps, and spasms in these nerves. Treatment focuses on isolating the underlying cause of the nerve disorder and addressing it using medications such as injected glucocorticoids and/or physical
Your hip flexors and psoas muscles help drive your legs up when you are running. To stretch these muscles, kneel on the floor and then step out forward with your left leg so that your left foot is on the floor. With your back straight, lean forward so that your weight is on the front foot and you feel a stretch in the hip of the back leg. Perform the stretch on both sides.
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Located deep in the front of the hip and connecting the leg, pelvis, and abdomen, the hip flexors— surprise, surprise— flex the hip. But despite being some of the most powerful muscles in our bodies (with a clearly important role), it’s easy to neglect our poor hip flexors— often without even knowing it. It turns out just working at a desk all day (guilty!) can really weaken hip flexors since they tend to shorten up while in a seated position. This tightness disrupts good posture and is a common cause of lower back pain. Weakened hip flexors can also increase the risk of foot, ankle, and knee injuries (especially among runners) Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, VT. Clinical Journal of Sport Medicine, 2005 Jan; 15 (1): 14-21.. So be sure to get up, stand up every hour or so! And giving the hip flexors some extra attention is not just about injury prevention. Adding power to workouts, working toward greater flexibility, and getting speedier while running is also, as they say, all in the hips The effect of walking speed on muscle function and mechanical energetics. Neptune, R.R., Sasaki, K., and Kautz, S.A. Department of Mechanical Engineering, The University of Texas, Austin, TX. Gait & Posture, 2008 Jul; 28 (1): 135-43..
However, runners are infamous for imbalances in their hip muscles. The most common weak ones are the hip abductors, the muscles on the side of your butt responsible for moving your leg out away from your body to the side. Lev Kalika, D.C., clinical director of New York Dynamic Neuromuscular Rehabilitation & Physical Therapy, tells SELF that since most runners run, run, and only run, they are constantly training their hip flexors and extensors through a very small range of motion. That can lead the hips to be unstable on the less-frequent occasions when you bring your knee all the way to your chest or thrust your hips forward.
“As a result, they’re at greater risk of injury,” says physical therapist Ioonna Félix, clinical supervisor at the Hospital for Special Surgery’s Sports Rehabilitation and Performance Center in New York City. Many times, those injuries manifest themselves in ways that seem entirely separate from your hips, like IT band issues, low-back pain, or plantar fasciitis.
• Spinal stenosis. Literally meaning "spinal narrowing," spinal stenosis can occur when changes in arthritis lead to bony overgrowth of the vertebrae and thickening of the ligaments. This can occur with osteoarthritis or ankylosing spondylitis. If a significant overgrowth occurs, it can cause the spinal column to narrow and press on the nerves housed within. Because the affected nerves have many functions, the condition may cause diverse problems in the lower body, including back pain, pain or numbness in the legs, constipation or urinary incontinence.

Sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement may occur when one leg is longer or weaker than the other, or with arthritis in the hip or knee problems. Autoimmune diseases, such as ankylosingspondyloarthropathy, and biomechanical conditions, such as wearing a walking boot following foot/ankle surgery or non-supportive footwear, can lead to degenerative sacroiliitis.


This pose is one of the most comfy ones for the lower back and hips. It will also stretch your neck, shoulders, and chest. Lie on your back and hug your knees into your chest. Breathe in deeply, and then exhale completely, lowering both legs to the floor on your left (keep your knees higher than your hips). Position your arms out to your sides, or place your left forearm on your right thigh (as pictured) to encourage a deep stretch, relaxing both shoulders to the floor. Shift your gaze over your right shoulder. Close your eyes, take 10 deep breaths, and then release. Repeat to your other side.
How to: Stand with your feet hip-distance apart. Your feet should be flat, and your legs should be straight. Step your right back behind your body, keeping your hips parallel, and stretch your right hand up overhead at the same time. Step back up to starting position. That's one rep. Repeat eight times on each side. Do three to four sets before moving on to the next move, resting for 30 seconds in between each set.
Piriformis syndrome is a type of neurological injury that is caused by compression of the sciatic nerve. The piriformis muscle sits deep within the buttock, behind the gluteus maximus. It starts at the lower spine and connects to the femur muscle. This nerve can become compressed from swelling of the piriformis muscle due to injury or muscle spasms or inflammation. Piriformis syndrome causes symptoms including pain in the back of the thigh, pain in the back of knee, buttock pain, pain in the calf, pain in sciatic nerve branches (pain in the nerves of leg and the buttocks, then), shooting pain in the legs, and hip pain after sitting.
That’s a problem. “Elongated periods of sitting sends messages to certain muscles to stay turned on, which keeps other muscles turned off,” says Beachbody fitness expert Cody Braun. “This creates an imbalance, which can immobilize your hips.” Your hips are built to move in almost any direction, explains Braun, and when they’re stiff, they don’t just make exercise more difficult; they also make you more prone to pain in surrounding joints — including the oft-troublesome lower back.
How to do it: With your bar on the floor in front of you, place your feet slightly narrower than hip-width apart. Make sure the bar is as close to your shins as possible, and position your hands on the bar, just outside your shins. With your shins perpendicular to the floor, flex your hamstrings and lift your butt up and back, extending your legs so they’re nearly straight, with only a slight bend in the knee. Slide the bar up and toward the shins. Then, bend your knees slightly and proceed to lift the bar all the way off the floor in a straight line. Extend your hips fully at the top and stand tall with neck relaxed, arms straight. Pinch your shoulder blades together, squeezing your abs and glutes. Keeping the bar close to your body and with a straight back, reverse the movement. That’s one rep.
People understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain ominousness,10 and some of the worst causes are actually the least painful (especially in the early stages). For instance, someone could experience the symptoms of cauda equinae syndrome, and be in real danger of a serious and permanent injury to their spine, but have surprisingly little pain — even none at all in some cases!
These issues tend to be more rampant in women because they generally have wider pelvises than men, Ali Kotek, M.A., A.T.C., P.E.S., a performance enhancement specialist and fellow endurance program manager at Athletico, tells SELF. So to keep the thighs vertical, rather than angled in toward each other, the outer hips have to be even stronger. That’s especially true for women who are bounding from one foot to the other as they run down trails and treadmill belts.
The sacroiliac joint connects the lower spine to the pelvis and any injury or strain to this area can cause a lot of back, hip, groin, and sciatic pain. Sacroiliac joint dysfunction (SJD) can cause not only radiating lower back pain but can also severe pain in the hip area including hip pain at night when sleeping and hip pain when sitting. Often the pain resembles that of a hip injury it is so severe. SJD can also cause severe pain in the groin area. Women may also notice pain running along the distribution of the sciatic nerve. Treatment for sacroiliac joint dysfunction includes rest, anti-inflammatory drugs, and sciatic nerve massage.

MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs usually aren’t a deal,2 most back pain goes away on its own,3 and trigger points (“muscle knots”) are common and can be alarmingly intense but aren’t dangerous.4 Most patients are much better off when they feel confident about these things. The power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs,6 which undermines that valuable confidence.


Downward facing dog can help stretch and strengthen your feet, calves, hamstrings, lower back, shoulders, neck, and hands. Begin on your hands and knees with your shoulders directly above your wrists and your hips directly above your knees. Spread your fingers wide and press your palms into the floor. Now lift your hips and push back with your hands to form an upside down V with your body. Work your heels toward the floor, and let your head hang to relieve any tension you’re holding in your neck. Take 8-10 breaths, and then release.
Sacroiliitis is an inflammation of one or both of the sacroiliac joints, the spot where the lower spine connects to the pelvis. Sacroiliitis can cause pain in the buttocks, lower back, and may even extend down one or both legs. The pain can worsen with prolonged standing or climbing stairs. Sacroiliitis can be caused by arthritis, injury, pregnancy, or infection.
To achieve this stretch, start out on your hands and knees. Slowly widen your knees out as far as they can go, and make sure to keep your lower legs in line with your knees. Your lower legs and feet should be parallel with one another. Next, ease your upper body forward on your forearms and reach forward until you feel the stretch. Hold this pose for about 10 seconds.
Ligaments connecting your back to your pelvis: Straining the ligaments around your buttocks and pelvis may result in this type of pain. This area can also be referred to as the sacro-iliac joint. Due to this area linking your lower back and hip you may feel your pain from your lower back through to your hip. Treatment in this presentation should be primarily to the ligament that is strained and addressing posture as well as back stretching exercises when indicated.
To avoid hip flexor pain, you should pay more attention to these muscles, Dr. Siegrist explains. When you are seated, your knees are bent and your hip muscles are flexed and often tighten up or become shortened. “Because we spend so much of our time in a seated position with the hip flexed, the hip flexor has the potential to shorten up. Then, when you are in a hurry because you are running to catch a bus or a plane, or you trip and fall, the muscle could become stretched. Here’s this stiff, brittle muscle that all of a sudden gets extended, and you could set yourself up for strain or some hip flexor pain.”
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