Hip Pain While Running: What It Is and How Physio Helps

Outer hip pain is one of those running injuries that tends to sneak up on you. It often starts as a mild ache you can run through, until you can't. If you've noticed pain on the outer side of your hip or buttock that gets worse the further or faster you run, there's a good chance your hip stabilisers are telling you they need some attention.

Here's a real case study from our sports physio clinic in Palmerston North, walking you through why this injury happens, how we assess it, and the rehabilitation approach that got one runner back to full training.
Why Runners Get Outer Hip Pain
The muscles on the outer side of your hip, are your single-leg stabilisers. Every time your foot hits the ground during a run, you're landing on one leg. In that split second, your outer hip muscles fire to stop your pelvis from dropping to the side and keep your whole lower limb aligned. That's significant work, repeated thousands of times per run. When you're a new runner, increasing your mileage, or pushing your pace, those muscles have to work harder than they're used to. When the demand exceeds what the muscle can cope with, overload and pain follow.

How the Injury Presented
Our patient had been building up her running and starting to increase her pace when the outer hip pain began. It was the classic presentation: pain on the outer hip that increased with running, noticeably worse when running faster or further than usual.

This is something our sports physiotherapist in Palmerston North sees regularly in recreational runners, particularly those who are new to running or are progressing their training quickly.

How We Assessed the Injury
Outer hip pain in runners can come from a few different structures, so a careful assessment is important before starting treatment. We looked at:

• Footwear — the shoes she was running in. Highly cushioned or unstable shoes can affect how load travels through the lower limb and increase demand on the hip stabilisers.
• Single-leg stability — this is the key test for this type of injury. We asked her to stand on one leg, perform lunges, and do single-leg impact work like hopping. All of these reproduced her hip pain, confirming that the outer hip stabilisers were being overloaded.

The single-leg stability tests are particularly telling because they replicate what the hip is doing during every stride of a run. If you can't stabilise on one leg without pain, those muscles aren't ready for the repeated loading of running.

The Treatment Plan
Phase 1: Release the Overloaded Muscle. With the outer hip muscles in an overloaded state, the first priority was to reduce tension and calm the irritated tissue. We used:

• Soft tissue massage — hands-on release work through the outer hip and gluteal muscles to reduce tightness and improve tissue quality
• Dry needling — targeted needling through the hip muscles to address areas of tension and promote healing in the overloaded tissue

Phase 2: Strengthen the Hip Stabilisers. Releasing tight muscles is part of the answer, but it won't solve the underlying problem. The hip stabilisers need to get stronger, strong enough to handle the load of running without overloading. This is the most important part of the rehabilitation.
Her strengthening programme included:

• Standing Clamshells — standing on one leg with the other knee bent and foot on the wall and opening the knee against resistance to isolate and strengthen the glute medius, one of the primary hip stabilisers, while also having to stabilize the pelvis
• Side planks — building endurance in the lateral hip muscles in a position that challenges the whole stabiliser chain
• Step-downs — standing on a step on one leg and slowly tapping the other foot down to the floor. This is essentially a single-leg squat and is one of the most effective exercises for developing the stability needed for running.
• Hip hitching exercises — targeting the muscles that control pelvic movement and reinforcing control through the hip

This combination progressively loaded the hip stabilisers in ways that directly carry over to running, so that by the time she returned to full training, her muscles were ready for it.
Phase 3: Modify Training and Return to Running. One of the most reassuring things about this type of injury is that, in most cases, you don't have to stop running completely. Smart adjustments allow you to stay active while the hip gets stronger.
We advised her to:

• Move to softer surfaces — shifting temporarily from pavement to grass or trail reduces impact load through the hip with every stride
• Reduce her pace — running faster increases the stabilisation demand on the hip. A slower pace meant she could keep training without aggravating the injury.
• Reduce her distance — shorter runs while the hip was still building strength, with a clear plan to build distance back up before increasing pace.

This modified approach meant she could stay active and maintain her fitness throughout recovery, which is far better for both recovery and motivation than stopping cold.

The Result
With consistent strengthening and modified training, her outer hip pain resolved fully, and she returned to running at her target pace. She also understood what had caused the injury and had the tools to prevent it from happening again as she continued to build her running.

Running with Hip Pain? Don't Just Push Through It
​Outer hip pain in runners rarely goes away on its own if you keep training the same way. The muscle needs to get stronger, and that requires a targeted strengthening programme, not just rest.

If you're in Palmerston North and dealing with hip pain while running, the team at Better Bodies Physio can assess your stability, identify what's driving the issue, and build a rehabilitation plan that keeps you running as much as possible while you recover. 

Book an appointment with our sports physiotherapist in Palmerston North today and get back to full training.

​Related Conditions
Hip Pain Physiotherapy
Sports Injury Physiotherapy