Here’s Why You Have Chronic Hip Pain

How Physical Therapy Can Help

Jacksonville’s Gate River Run, the country’s largest 15K, is coming up in less than three months (March 2, 2024.) Over 20,000 runners will participate; if you’re one of them, you’re probably getting ready to start your training program right after the holidays.

However, chronic hip pain prevents many runners from training consistently and performing at their best during competitions. It’s a very common problem with a couple of medical causes. Physical therapy can help identify and alleviate the sources of pain.

When someone with chronic hip pain comes in, I first evaluate how their core, hip, and leg muscles interact. I ask the patient to take off their shoes and observe them in bare feet and shorts so I can see both their legs at work. I ask them to do a single-leg stand to see how their muscles work at stabilization. I ask them to do squats to see which muscles are the strongest and weakest. I ask them to walk and move around the office to get an idea of their stride.

With these observations, along with some other strength testing, I can identify the source of chronic hip pain. The first culprit I look for is muscle imbalance. Both the front of your legs (the quadriceps muscles) and the back of your legs (the hamstrings and glutes) must be in the proper balance to avoid hip and knee pain. If a runner has been training and strengthening the quads and hamstrings and not the glutes, doing a lot of stationary cycling for example, they’ll often be in pain and at risk of pulling the hamstring when they push to finish a run. They’ll need to cross-train to strengthen their glutes to get back into balance.

I identify and evaluate muscle restrictions and work on releasing muscles that are tight.  Graston therapy helps, along with stretches like Happy Baby and Child’s Pose

If you are experiencing pain in the front of your hip along with clicking, locking, or catching of your hip joint, you may have underlying damage to the labrum, the tissue that helps the socket hold the femur. Labral damage can come from repetitive motions or changes in your gait that create abnormal stress on the hip joint. I can recommend exercises that strengthen the glutes, pelvic floor, deep core, hip flexors, and hamstring muscles and correct obvious gait problems that may be causing your hip pain.

Another cause of hip pain is the runner’s posture. The correct posture for distance running is a fairly straight form. Your eyes should be focused on the ground about 10 to 20 feet ahead of you. Your ribcage should be over your pelvis, which allows you to access your pelvic floor and deep core muscles and to breathe deeply and naturally. As runners get fatigued, they often lean backward, pulling rather than pushing themselves along.

If your rib cage is behind your pelvis, it can put a strain on ligaments and, over time, cause bony growths in the hip joint to occur, which will be very painful. 

When I work with a patient with chronic hip pain, I work on stretching and strengthening the muscles that are out of balance. We work on core mechanics, which will help with all movement, not just running.  If a patient comes in for therapy a couple of times a week and is diligent about doing their stretching and strengthening homework, we can see real improvement in hip pain within 4 – 6 weeks. By eight weeks, we’ll have corrected the issues causing chronic hip pain and set new movement habits that will keep it away. 

Most patients will feel significantly better, just in time to train for the Gate River Run. 

To learn more about fixing your chronic hip pain and to book an evaluation, visit

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