Psoas pain is a common issue for runners, directly impacting the mechanics of running. The psoas muscle, part of the iliopsoas complex, is a primary hip flexor fundamental for locomotion. When this muscle group becomes strained, tight, or irritated, it significantly disrupts a runner’s training schedule. Understanding the role and nature of psoas pain is the first step toward determining if continuing to run is advisable. This guide covers recognizing the injury, making an immediate running decision, and planning a safe return to activity.
Understanding Psoas Pain
The iliopsoas complex is composed of the psoas major and the iliacus muscles. The psoas major originates along the lower spine’s vertebrae, running down to join the iliacus, which originates on the inside of the pelvis. Together, they cross the hip joint to attach to the inner thigh bone, responsible for lifting the knee toward the chest during the swing phase of running.
Repetitive hip flexion and extension, inherent to running, places considerable strain on this muscle unit, particularly during faster running speeds where hip flexor activation increases. Psoas pain, often referred to as psoas syndrome or iliopsoas tendinopathy, typically presents as a deep ache in the front of the hip or groin area. This discomfort can sometimes radiate to the lower back, buttocks, or pelvis due to the muscle’s spinal attachments.
Symptoms of an irritated psoas are often aggravated when moving from a seated to a standing position or when attempting to flex the hip against resistance. For runners, this pain may become noticeable during the swing phase of the stride or worsen as running speed increases. Chronic tightness, often resulting from prolonged sitting, can also shorten the muscle, contributing to postural issues like an anterior pelvic tilt and increasing the risk of strain when running.
Immediate Action: Should You Run?
The decision to run with psoas pain depends on the severity and nature of your symptoms. Continuing to run through pain that forces you to alter your gait can turn a minor strain into a more significant injury, such as a muscle tear or persistent tendinopathy. The primary guideline is to avoid any activity that causes sharp pain or requires you to limp to compensate for the discomfort.
Any pain that worsens with each subsequent stride indicates that running should stop immediately. If the pain is severe enough to prevent you from maintaining your normal running form, the stress on the injured area is increasing, and you must stop. Light activity, such as walking, may be acceptable only if it is completely pain-free and does not cause a noticeable limp.
For mild soreness or a low-level ache (less than a 5 out of 10 on a pain scale), a very short, slow test run might be considered. However, the pain should not persist the next day or increase week to week. If the pain includes a catching, slipping, or snapping sensation in the groin, or if the discomfort continues even at rest, a period of complete rest is necessary.
Strategies for Recovery and Return to Running
Initial Conservative Treatment
Recovery begins with conservative treatment focused on reducing inflammation and irritation. This phase involves resting from any activity that provokes pain, including high-impact movements like running or deep stretching. Applying ice to the affected area for 10 to 20 minutes helps manage acute symptoms, and over-the-counter pain relievers can assist in reducing pain and inflammation.
Rehabilitation and Strengthening
Once acute pain subsides, the next step is a phased approach combining gentle lengthening and targeted strengthening. Gentle, specific stretches, such as the kneeling hip flexor stretch, help lengthen the shortened psoas muscle, but must be performed without pushing into pain. Overstretching is counterproductive; the goal is a gentle, sustained pull rather than a deep strain.
Focusing on strengthening surrounding muscle groups is paramount to reduce the workload on the psoas. Exercises should target the glutes, hip rotators, and deep core stabilizers, which control pelvic stability during running. Examples include banded marches, clamshells, and alternating front planks, which build resilience and lumbopelvic stability. This combined approach addresses both hip flexor tightness and underlying weakness in supporting musculature.
Gradual Return to Running
The return to running should follow a structured, gradual protocol, starting only when pain has significantly decreased or resolved during daily activities. A walk/run progression is the standard method, beginning with short intervals of running mixed with longer periods of walking. For instance, a runner might start by alternating one minute of running with four minutes of walking, repeating this several times every other day.
Progression to the next phase should only happen if the preceding run was completed without pain, including no residual pain the following day. When running, focus on maintaining a slightly shorter stride or a higher cadence, which reduces the amount of hip extension required and minimizes strain. Once you return to 50–60% of your pre-injury weekly mileage, you can gradually reintroduce hills or speed work.