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By Mr Jerome Davidson, Consultant Hip Surgeon, in collaboration with Complete Physio
Running is one of the most effective and accessible ways to stay fit and healthy. Whether you are training for a marathon, returning to exercise after time away, or simply enjoying regular weekly runs, it offers enormous physical and mental benefits.
But when hip pain develops, it can quickly interrupt progress and become difficult to manage without the right support.
In my practice at London Bridge Orthopaedics, I regularly see runners with hip pain.
During a recent Podcast with Chris Myers at Complete Physio, we explored the two presentations we commonly encounter:
These two problems can look similar at first glance, but they require very different management. That is why early diagnosis, the right imaging and a joined-up treatment plan are so important.
One of the most important diagnoses in runners is a stress reaction or stress fracture of the femoral neck.
This is not usually caused by a dramatic fall or sudden trauma. Instead, it develops gradually when repeated loading exceeds the bone’s ability to recover and remodel.
That might happen in:
As we discussed with Complete Physio, it is all relative to the individual. A training load that is manageable for one runner may overload another.
Bone stress injuries occur on a spectrum.
At the early stage is a stress reaction, where the bone becomes irritated and inflamed but has not yet cracked.
If loading continues, this may progress into:
I often explain this simply: the bone is warning you before it breaks.
Recognising those warning signs early can make all the difference.
Chris highlighted an important clinical point during our discussion – “many runners say they completed the run, but later that evening or the next day began limping.”
That pattern should never be ignored.
Many patients attend A\&E or urgent care, have an X-ray, and are reassured when it is normal.
Unfortunately, early stress reactions frequently do not show on X-ray.
MRI is usually the most accurate investigation because it can detect bone oedema and early stress injury before a fracture line is visible (Arendt et al., 2003).
This is why persistent groin pain in a runner often needs further assessment, even if initial X-rays are clear.
Whenever I diagnose a stress injury, I also think about why it happened.
Risk factors may include:
At London Bridge Orthopaedics, we often investigate these areas further with blood tests or bone density scanning where appropriate.
Chris also made an excellent point during our conversation, that runners need more than a training plan. They also need a recovery plan, nutrition strategy and access to good rehabilitation support.
The second major presentation we discussed was pain on the outside of the hip.
This is often labelled:
These terms describe pain around the bony prominence on the side of the hip, where the gluteal tendons attach.
The gluteus medius and minimus muscles play a key role in:
Because they work hard with every stride, they can become overloaded if training demand exceeds tendon capacity.
Common complaints include:
Unlike stress fractures, this pain is usually more lateral than deep in the groin.
Modern research suggests many of these cases are tendon-related rather than isolated bursitis (Grimaldi and Fearon, 2015).
One of the most useful points raised by Chris was that many runners stop running for a few weeks, feel better, then restart, only for the pain to come straight back.
That happens because:
This is where specialist physiotherapy becomes central to recovery.
For many runners, physiotherapy is the difference between simply managing symptoms and making a full, long-term return to running.
Successful rehabilitation requires a structured programme that progressively restores strength, movement quality, load tolerance and confidence.
This is where Complete Physio excels.
Their team includes dedicated hip and groin specialists who work with everyone from recreational runners to elite athletes.
What sets them apart is their ability to combine expert physiotherapy with advanced diagnostic and rehabilitation technologies, including musculoskeletal ultrasound, running analysis, force plate testing, specialised Strength and Conditioning, shockwave therapy and ultrasound-guided injection treatments.
This allows them not only to diagnose and treat the injury, but also to identify the biomechanical, strength and loading factors that may have contributed to it.
The result is a highly personalised rehabilitation programme designed not just to get patients out of pain, but to reduce the risk of recurrence and optimise long-term performance.
At Complete Physio, treatment focuses on:
Temporarily reducing mileage, hills or intensity while symptoms settle.
Not just glute exercises, but a full lower limb programme including:
Gradually rebuilding tolerance without repeated flare-ups.
This structured progression is often what turns an ongoing problem into a successful recovery.
This is an important question.
Tendon-related lateral hip pain often takes 8–12 weeks or more to fully settle. In many cases, three months is a more realistic expectation than three weeks.
That does not mean no progress occurs before then, it means meaningful tendon adaptation takes time.
Sometimes, yes.
For patients with persistent gluteal tendinopathy or greater trochanteric pain syndrome, rehabilitation remains the cornerstone of treatment.
However, there are occasions when additional interventions can help accelerate progress and improve comfort during recovery.
Complete Physio offers both focused shockwave therapy and ultrasound-guided injection treatments delivered by highly experienced clinicians, and at very affordable prices.
Shockwave therapy has a growing evidence base for chronic tendon conditions and can help stimulate healing responses, reduce pain sensitivity and improve tendon function when used alongside a structured rehabilitation programme. (Rompe et al., 2009).
It can be particularly helpful for patients who have plateaued despite exercise-based treatment.
Similarly, ultrasound-guided injections can provide significant symptom relief in carefully selected cases.
The use of ultrasound allows treatment to be delivered with exceptional accuracy, ensuring the correct structure is targeted and improving both safety and effectiveness.
Importantly, these treatments are never viewed as standalone solutions. Instead, they are integrated into a broader rehabilitation plan, creating a valuable opportunity for patients to progress strength and conditioning work with reduced pain.
At London Bridge Orthopaedics, my role may involve diagnosis, imaging interpretation, surgical decision-making where necessary, and ruling out serious pathology.
Complete Physio then plays a vital role in restoring strength, movement quality, confidence and a safe return to running.
For patients, this close working relationship means faster access to specialist opinions, clearer treatment pathways and a more efficient route from diagnosis to rehabilitation and, where necessary, surgical intervention.
This ensures that patients receive coordinated, joined-up care throughout their recovery journey.
This multidisciplinary approach is still relatively uncommon in private healthcare and is one of the reasons patients consistently achieve excellent outcomes.
At Complete Physio, we work closely with a number of leading orthopaedic consultants, and Mr Jerome Davidson is one of our trusted referral partners for patients with complex hip conditions.
Jerome is a highly experienced Consultant Hip Surgeon with a particular interest in both young adult hip disorders and complex hip pathology. His expertise in diagnosing and managing stress fractures, hip impingement, tendon disorders and degenerative hip conditions makes him an invaluable resource for both our clinicians and patients.
However, it is not just Jerome’s expertise that makes the partnership so valuable.
As part of London Bridge Orthopaedics, patients have access to an exceptional multidisciplinary team, state-of-the-art imaging facilities, specialist radiologists and some of London’s leading musculoskeletal consultants.
The quality of care, attention to detail and patient-centred approach offered throughout the organisation aligns closely with our own values at Complete Physio.
If you are a runner with hip pain, do not assume it is “just tightness” or something to push through.
Groin pain, limping or pain with impact should be assessed promptly.
Outer hip pain is very common and highly treatable, but it usually requires the right rehab plan rather than endless rest or repeated quick fixes.
If hip pain is affecting your running, London Bridge Orthopaedics and Complete Physio can help you get the right diagnosis and the right plan to move forward.
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