Cause of Hip Injuries From Running

Hip injuries from running is one of the injurious consequences of a heel strike running style, mainly because the lower legs require greater stability by the hips. In addition, cushioned running shoes may also add mechanical demands on the hips during heel strike running as thick under-heel cushioning is related to encouraging a more forceful heel strike, including over-striding and greater braking forces, all of which takes its toll in the hips.
Hip Injuries From Running

Cause of Hip Injuries From Running

We’ve heard that regular running shoes are linked to foot pain, such as plantar fasciitis. They are even linked to shin splints and runners knee pain. But now, regular running shoes are linked to hip running injuries. We have also heard that hip weakness can lead to hip injuries, or is this really true? Do we really need exceptionally strong hips to run? We do if you land with a heel strike, but not if you land with a forefoot strike, a running style that involves less impact production.

Hip running injuries are high in joggers primarily because of the type of shoes they wear for running.

In most cases,  thick heeled running shoes result in bad running form, encouraging a runner to heel strike and contribute to hip running injuries by altering hip-joint kinematics, especially in female runners.

Obviously advancements in shoe technology does little to protect the hip-joint in female runners because they are more prone to hip running injuries compared to men. Interestingly, in habitually barefooted populations, hip running injuries are uncommon between both genders.

As it turns out, hip running injuries may not be due to hip weakness after-all, rather bad running form.

From an evolutionary perspective, humans evolved to run with a forefoot strike and have not yet evolved to heel strike in running shoes. Therefore, our musculoskeletal system has not yet adapted to the repetitive high-impact forces of heel strike running.

To minimize the rapid impact at heel strike, runners wear athletic footwear with excessive padding under the heel which has been suggested to dampen impact by 10%. However, cushioned heeled running shoes changes the way we evolved to run.

Heel Strikers May Need Stronger Hips, But Forefoot Strikers Don’t

Most studies on hip running injuries involved participants who were heel strikers, not forefoot strikers. These studies suggests that hip strength is linked to hip running injuries, in heel strikers. But what about forefoot strikers?

Previous studies showed that heel strikers with knee injuries had significantly weak hip abductors. In such studies, mechanics and muscle strength are often measured together because it is assumed strong muscles equates to good running mechanics. However, Ethiopian and Kenyan distance runners, especially the females, also have weak hip abductors, but most of these runners are forefoot strikers.

Perhaps the mechanics of heel strike running in high heeled running shoes requires greater limb control via stronger hip muscles. For instance, greater limb control may be needed in heel strike running because the legs work harder to carry the posterior position of the center of mass at every step. This means that at heel strike, the center of mass if behind initial foot strike position.

Because the mechanics of forefoot running are different in that the center of mass is kept in front of the heel, hip weakness can be tolerated, suggesting that hip strength and mechanics are not related in forefoot running.

Hip running injuries low in forefoot running
Hip running injuries are low in habitual forefoot runners from Ethiopia and Kenya.

As mentioned above, East African runners have weak hips too. They also ran barefoot for many, many years, therefore you would think all that barefoot running would grant them stronger hips, but this is not so. And again, running hip injuries is uncommon in these runners. From this, it is reasonable to expect that strong hips are not required in forefoot running.

The Take Home Message

There is a strong relationship between heeled running shoes and heel strike running. There is also a strong relationship between heel strike running and hip running injuries. That is because shoe companies continue to manufacture footwear that cause runners to run with a slurry of abnormal mechanics that exaggerate joint angles, particularly at the hip and increase running impact loads to the hip as well.

Conversely, there appears to be no relationship between barefoot-forefoot running and hip running injuries. When it comes to addressing the role of hip strength in hip running injury prevention, think of the slender legs of East African runners and their forefoot running style -make the connection that there’s probably a good chance that low hip strength must be technically feasible in forefoot running.

 More From Run Forefoot:


Gering et al. Knee and hip joint biomechanics are gender-specific in runners with high running mileage. Int J Sports Med, 2014;35(2):153-6.

Schmitz et al. Do novice runners have weak hips and bad running form? Gait & Posture, 2014; 40:86-86.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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