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Your Hip Pain Didn't Start in Your Hip — A Runner's Guide
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Your hip pain didn't start in your hip.

I stopped running because the pain was too much to push through. Stretching my hip and strengthening my hip, on their own, never fixed it. Here's what actually did — and how you can try the same approach.

Running along the waterfront

What actually stopped me from running

As a PT of 13+ years and a runner of 20+ years, when hip pain hit me, it had a say in everything. It decided how far I could go, whether I could sit through a car ride, whether I'd sleep through the night. I did what every runner is told to do: stretch the hip, strengthen the hip, rest, repeat.

It helped a little. Then it stopped helping. The pain kept coming back, and I kept running out of ideas that lived only in the hip.

The hip was where the pain lived. It wasn't where the problem started.

When I finally got serious about my spine — how it moved, where it was stiff, how it loaded when I ran — the hip pain started to calm down before I'd done a single hip exercise. That order turned out to matter more than any single stretch or strength move I'd tried.

Founder of Versatile Physical Therapy and Wellness
Dr. Aleka Chouramanis, PT, DPT, Cert. MDTFounder & spine/hip specialist, credentialed through the McKenzie Institute.

The order matters

Hip mobility and hip strength are both necessary. They're just not where the work starts if the hip is still angry. Here's the sequence that changed things for me, and for the runners I coach through it now.

1
Calm it down

Restore spine mobility first

A stiff or guarded spine changes how force travels down into the hip with every stride. Freeing that up is often what lets an angry hip settle — before you've asked the hip to do any work at all.

2
Unlock it

Then restore hip mobility

Once the pain has quieted down, the hip joint usually has range it's been protecting. This is where mobility work finally sticks, instead of aggravating a joint that was still guarding itself.

3
Build it

Then build hip strength

Strength is what lets the hip hold up to mileage long-term. It's the last step, not the first — built on a joint that already moves well and isn't in a flare.

Working through a mobility check

Hip pain can be frustrating, especially when you're trying everything. If it's not improving, it's most likely that the root cause is being missed.

Three things to try this week

These are three of the moves I actually use with runners working through this sequence. Go in order, and back off anything that increases your pain — these are meant to calm things down, not push through them.

Prone on elbows spine mobility exercise 1 · spine mobility

Prone on Elbows

Lie face down and prop yourself up on your forearms, letting your low back relax and gently sag.

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Hold for at least 3 minutes, then rest back down. This is often the gentlest entry point for waking up spine mobility — start here before anything else. This may increase low back discomfort. If so, that's ok. Get more comfortable with this by practicing it 3x per day until it feels more comfortable prior to moving onto the Prone Press-Up. That comes out to 9 total minutes per day and can be the start to making a huge impact.

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Prone press-up spine mobility exercise 2 · spine mobility

Prone Press-Up

From the same starting position, press through your hands to straighten your arms and lift your chest higher, keeping your hips down on the surface.

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Move slowly through a comfortable range for 5 reps then 10 reps at least 2x per day. This is the natural progression once Prone on Elbows feels easy. It may feel awkward to do this movement initially and it may be uncomfortable on the low back. I've had lots of practice so I demonstrate the full range in my video below. Try a shorter range of motion (not extending the elbows as much) to ease into it. If this is still not as tolerable, then practice prone on elbows (exercise 1) 3x per day for another week!

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Side plank clam hip strength exercise 3 · hip strength

Side Plank Clam

Prop up on one forearm with knees bent, hips stacked and lifted off the floor.

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From there, open the top knee like a clamshell while keeping your hips level. Complete 3 sets of 8 reps per side to improve hip mobility and strength. Save this one for once your spine work has taken the edge off - strength will actually begin to stick and make more sense for the hip once the pain calms down.

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These are general starting points, not a diagnosis. If a drill sharpens your pain rather than easing it, stop and get eyes on your specific case before continuing.

Want a plan built around your hip, not a generic one?

This sequence is the framework. The specifics — how stiff your spine actually is, what your hip can and can't tolerate right now, how to build back into running — are worth getting assessed. That's what Dr. Aleka Chouramanis helps runners and triathletes with everyday. We can see if this makes sense for you too.

Dr. Aleka Chouramanis finishing a triathlon Book a Call
See how a similar framework helped this runner solve hip pain and run the Boston Marathon pain-free