Hip Pain: Causes, Prevention, and When to Seek Help During Exercise

Why do hip exercises hurt?

Hip pain during exercise is a common issue that can stem from a variety of factors, ranging from biomechanical imbalances and improper form to overuse injuries or underlying anatomical conditions affecting the hip joint and surrounding musculature.

Understanding the Hip Joint and Its Vulnerabilities

The hip is a complex ball-and-socket joint, designed for both extensive mobility and significant stability, supporting the upper body and facilitating lower limb movement. Its intricate network of bones, cartilage, ligaments, tendons, and muscles makes it susceptible to pain when subjected to improper forces, overuse, or pre-existing conditions. Pain during hip exercises is often a signal that something is amiss with this delicate balance.

Common Causes of Hip Pain During Exercise

Identifying the specific cause of hip pain is crucial for effective management and prevention. Here are the most common culprits:

Muscular Imbalances and Weakness The hip is surrounded by powerful muscle groups, and imbalances within these can significantly alter joint mechanics and lead to pain.

• Weak Gluteal Muscles: Particularly the gluteus medius and minimus, which are crucial for hip abduction and external rotation, and for stabilizing the pelvis during single-leg activities. Weakness here can lead to excessive hip adduction and internal rotation during movements like squats or lunges, placing strain on the IT band, knees, and hip joint.
• Tight Hip Flexors: Prolonged sitting or insufficient stretching can lead to overly tight hip flexors (iliopsoas, rectus femoris). This can pull the pelvis into an anterior tilt, compromising glute activation and increasing compression within the hip joint, especially during exercises that extend the hip.
• Tight Adductors: Overly tight inner thigh muscles can restrict hip abduction and external rotation, altering gait and squat mechanics.
• Core Weakness: A weak core compromises pelvic stability, forcing the hip muscles to compensate and potentially leading to overuse or strain.

Improper Exercise Form and Technique Suboptimal movement patterns are a leading cause of exercise-induced hip pain.

• Squats and Lunges:
  • Knee Valgus (Knees Caving In): Often due to weak glutes, this places rotational stress on the hip.
  • Excessive Anterior Pelvic Tilt: Can compress the front of the hip joint.
  • Insufficient Hip Hinge: Leading to excessive knee flexion and less glute activation.
• Deadlifts:
  • Rounding the Lower Back: Places undue stress on the entire kinetic chain, including the hips.
  • Initiating with the Knees: Rather than hinging at the hips, can put strain on the hip flexors.
• Leg Press: Going too deep can cause the pelvis to tuck under (posterior pelvic tilt), leading to spinal rounding and hip impingement.
• High-Impact Activities: Running, jumping, or plyometrics without adequate strength, stability, or proper landing mechanics can overload the hip joint and surrounding structures.

Overuse Injuries and Overtraining Repetitive stress without adequate recovery can lead to inflammatory conditions and tissue damage.

• Tendinopathy: Inflammation or degeneration of tendons around the hip, such as gluteal tendinopathy (lateral hip pain), hip flexor tendinopathy (front of hip), or adductor tendinopathy (groin pain).
• Bursitis: Inflammation of the bursae, fluid-filled sacs that reduce friction. Common types include trochanteric bursitis (outer hip) and iliopsoas bursitis (front of hip/groin).
• Stress Fractures: Though less common, repetitive impact or excessive loading can lead to small cracks in the femoral neck, causing deep, aching pain.

Specific Anatomical or Pathological Conditions Sometimes, hip pain during exercise is a symptom of an underlying medical condition.

• Femoroacetabular Impingement (FAI): A structural abnormality where extra bone grows along one or both of the bones that form the hip joint, causing them to rub against each other during movement. This can lead to labral tears and cartilage damage.
• Hip Labral Tear: A tear in the ring of cartilage (labrum) that lines the hip socket. Can cause clicking, catching, and sharp pain.
• Osteoarthritis: Degeneration of the articular cartilage in the hip joint, leading to pain, stiffness, and reduced range of motion, especially with activity.
• Piriformis Syndrome: The piriformis muscle, located deep in the buttock, can compress the sciatic nerve, causing pain that radiates down the leg, often exacerbated by hip external rotation or sitting.
• Sacroiliac (SI) Joint Dysfunction: Pain originating from the joint connecting the sacrum and ilium, which can refer pain to the hip and groin.
• Referred Pain: Pain in the hip area can sometimes originate from other regions, such as the lower back (lumbar radiculopathy) or even the knee.

When to Be Concerned and Seek Professional Help

While some mild, temporary soreness after exercise is normal, certain symptoms warrant immediate attention from a healthcare professional (e.g., physician, physical therapist, sports medicine specialist).

• Sharp, sudden, or severe pain during or after exercise.
• Pain that persists for more than a few days, despite rest and self-care.
• Pain accompanied by clicking, catching, or locking sensations in the joint.
• Swelling, bruising, or deformity around the hip.
• Inability to bear weight on the affected leg or a noticeable limp.
• Numbness, tingling, or weakness radiating down the leg.
• Pain that worsens at night or disrupts sleep.
• Pain following a specific trauma or fall.

Strategies for Preventing Hip Pain During Exercise

Proactive measures can significantly reduce the risk of hip pain and improve exercise performance.

• Prioritize Proper Warm-up and Cool-down: Prepare your muscles and joints for activity and aid recovery. Dynamic stretches before, static stretches after.
• Focus on Form Over Weight: Master the correct technique for each exercise before increasing resistance or intensity. Consider filming yourself or working with a qualified trainer.
• Address Muscular Imbalances:
  • Strengthen Weak Glutes: Incorporate exercises like glute bridges, clam shells, band walks, and single-leg deadlifts.
  • Stretch Tight Hip Flexors: Perform lunging hip flexor stretches regularly.
  • Strengthen Core: Include planks, bird-dogs, and anti-rotation exercises.
• Gradual Progression: Avoid increasing training volume, intensity, or new exercises too quickly. Allow your body time to adapt.
• Incorporate Mobility and Stability Drills: Include exercises that improve hip range of motion and joint stability, such as hip CARs (Controlled Articular Rotations) and single-leg balance exercises.
• Listen to Your Body: Differentiate between muscle fatigue and pain. If an exercise causes sharp or persistent pain, stop immediately and assess.
• Vary Your Workouts: Avoid repetitive movements that can lead to overuse injuries. Incorporate different types of exercise to work muscles in varied ways.
• Ensure Adequate Recovery: Allow sufficient rest days between intense workouts for tissue repair and adaptation.

By understanding the common causes of hip pain and implementing preventative strategies, you can continue to engage in hip-strengthening exercises safely and effectively, contributing to overall strength, mobility, and long-term joint health.