Runners often experience a deep, nagging ache in the hip or groin area, signaling an issue with the psoas muscle group. This group, which includes the psoas major and the iliacus (collectively known as the iliopsoas), is the body’s most powerful hip flexor. When this muscle is strained or inflamed (psoas syndrome or iliopsoas tendinopathy), the immediate question is whether to continue running. The decision depends entirely on the severity of the pain and requires careful self-assessment.
Deciding Whether to Run
The decision to run should be based on a pain assessment that acts like a traffic light system. A sharp, catching, or sudden increase in pain during the initial steps is a clear red light; stop immediately. Continuing to run with this discomfort risks turning a mild strain into a significant tear.
A yellow light means proceeding with caution. This applies if the pain is a dull ache that does not exceed a low level (1-3/10). If this mild pain remains constant or lessens as you warm up, a short test run may be acceptable. However, any pain that significantly increases or causes you to alter your natural gait signals the end of the activity. A green light is only given if you are entirely pain-free both during and after a brief, controlled run.
Understanding Psoas-Related Pain
The psoas muscle is deeply involved in running mechanics, attaching the lower spine to the femur. It enables hip flexion and helps stabilize the core and pelvis. During the swing phase of your stride, the psoas contracts to pull the leg forward. Since runners average 180 strides per minute, this muscle contracts thousands of times per hour, putting significant strain on its structure.
Psoas strain or tendinopathy usually results from overuse, often stemming from a sudden increase in training volume or intensity. Repetitive motions requiring high knee lift, such as hill running or speed work, can overload the muscle. Poor core engagement, which forces the hip flexors to compensate, or prolonged sitting, which keeps the psoas shortened, also contributes to injury risk. Symptoms include a deep ache near the hip or groin, pain when lifting the knee against resistance, or tenderness when pressing on the muscle deep within the abdomen.
Acute Management and Non-Running Activities
If pain requires you to stop running, the first step is relative rest, avoiding any activity that reproduces the pain. Apply ice to the tender area for 10 to 15 minutes several times a day to manage local inflammation. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may also be used to reduce pain and swelling initially.
Once sharp pain subsides, begin gentle mobility work, focusing on static stretches that do not aggravate the muscle. A mild kneeling hip flexor stretch can help restore length; gently lean your hips forward until a slight pull is felt. Keep the stretch controlled and avoid arching the lower back, which stresses the psoas attachment site.
You can maintain cardiovascular fitness through alternative activities that minimize psoas activation:
- Swimming, particularly with a pull buoy to restrict leg movement.
- Cycling on a stationary bike with low resistance.
- Using an elliptical machine, provided you keep the stride length short.
Strengthening and Return-to-Run Strategy
Long-term recovery requires building stability and strength in the psoas and surrounding core musculature. Initial rehabilitation should target core stability and hip rotators, as weakness in these areas often forces the psoas to compensate. Exercises like the clam shell (strengthening hip abductors) or dead bugs (improving core control) are excellent starting points.
As pain decreases, introduce specific hip flexor strengthening exercises, such as seated leg lifts or standing hip flexion against light resistance. Perform these exercises slowly and with control, ensuring you are not over-recruiting other muscles like the quadriceps. The goal is to build the psoas’s load tolerance so it can handle the repetitive demands of running without strain.
The gradual return-to-run protocol must be conservative and pain-guided. Resume running only when strength has significantly improved and you are completely pain-free during daily activities. Start with a walk/run interval, such as alternating one minute of running with two minutes of walking for a short duration. Increase the total distance or time by no more than 10% each week. Adjustments to running form, such as maintaining a slightly shorter stride and focusing on a slight forward lean, help minimize stress on the recovering psoas.