November 13


Running Hip Pain with Iyad Salloum

By Wil Seto

November 13, 2023

hip pain

Mark:  Hi, it's Mark Bossert. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. Today we're talking about hip pain, specifically maybe from running, but hip pain of any kind. What's going on with hip pain, Iyad? 

Iyad: So usually when we see runners come into the office it'll tend to fall into one of four categories. So the problem with the hip is it's such a vague area. So some people will point to the outside, to the front of the hip, the groin to the inside and then sometimes into the buttock region. So I think just calling it hip pain is probably not doing it enough of a justice. So, I guess 1 of the things that we would try to instantly dive into is try to figure out what happened and how it started and all that stuff.

But the main thing that we want to do is try to figure out what kind of thing are we dealing with. So, are we dealing with an irritation of a joint? Because that could happen. Some people are more predisposed to it, and it could happen, for example, with just high running volume. Or maybe people who are new to running, that trying to still learn the skill, because it's a skill after all. It's kind of like juggling. You can't just do 5 bicep curls and become a good juggler. 

So same thing. If you're doing a few squats and you want to pick up running, it's not going to be a simple transition. Or could it be sometimes the tendons? So, for example, we see this a lot with, menopausal women, outer hip pain, and that could be the gluteal tendons. The glute medial tendons specifically can get affected.

And some people call that trochanteric bursitis, but that's one issue. The other issue could be the joint itself. That could be either some form of cartilage injury. Could be arthritis, or it could just be a labrum injury. So those are all things that could fall into that joint pain thing.

And then we have some of the muscular components which I feel like most people think they have, which is tight hip flexors. That's what the diagnosis that they get given, but it's not as simple as just tight hip flexors. It could just be that the hip flexor insertion, which is where the tendon is, is actually affected, or it could be a small injury to that. Those are all possible things. 

And then we would have to kind of figure out, is it any of those or is it just the bone? Because guess what, just because you have a bone injury doesn't hurt differently in the area. It all hurts kind of roughly in the front. 

So, we had a lady come in the clinic with basically what most people told her was just tight muscles in the front, so she wanted some exercise to stretch it out. Well, the clinical exam only showed those symptoms of tightness when they were weight bearing. And when we did other tests to figure out that muscle length, that strength, actually, when it wasn't in the weight bearing position, they were totally fine. Zero symptoms, perfect signs, actually perfect range of movement, good strength.

And so we kind of went down the rabbit hole a bit. We found out that there was a bit of a reaction in the bone. So she was developing a stress fracture actually. And it wasn't a fully complete fracture, but there was something that we were able to pick up on x ray. It was advanced enough.. We worked with an orthopedic surgeon with her on modifying activity.

So we reduced running because we had to because she was at risk of exacerbating that fracture and then we started working on some other things to allow her to heal better.

Mark: So stress fractures do take longer. They don't heal as fast as a complete break. Why is that? 

Iyad: So, it's still relatively under researched, I would say as an injury, but what we do know about it is if I was to suddenly have a traumatic experience and break a bone, we get a massive inflammatory response that happens. Which is important if you want to contain the area of injury and start to send, let's say, send the troops to the right spot so you could start you know, the healing process. Now, in cases where you have a gradual stress fracture, we see it just be a little slower. And it's because probably 1 of the reasons could be that the inflammation response is much more muted. And it's a bit slower of a build. So it also tends to be a bit of a slower recovery.

The other thing is this could be a factor, which is that people just sometimes don't know that it's a stress fracture. And I don't blame, for example, that one client of ours, they just felt some tension in the front of their hip, and that was their only symptom. And I don't blame that person, for example, for thinking it is a tight muscle, because that was their symptom, was some muscle tightness. But maybe that protective muscle tone was just their response of trying to offload or protect or change the way they move to just make it feel better.

So, all of those factors could be into play. And then another thing to think about is basically, is that person dealing with some degree of bone weakness, like osteopenia or osteoporosis? So that's where the bone mineral density is a bit lower. And having that, one of the things we would work on is with our medical colleagues is on like potential adequate supplementation.

We would put them on some different exercise programs that tend to kind of be a bit more, let's call it pro bone building or maintaining the bone mineral density. So those are all things that have to be considered when we're dealing with somebody who has a stress fracture. 

If it's purely from adding a lot of volume, and that's one easy kind of almost, let's say, a very direct cause and effect, but there are other reasons why people can develop stress fractures easier than we need to be aware of. Because we don't want to see that, for example, in other areas. Maybe in the other leg or in some other areas in the pelvis or the foot or whatever, things that could prevent them from moving.

And, you know, as we know, the less we move, the more our bodies get affected in many other ways. So that's the last thing we want to see, like an injury from somebody trying to do something that's good for their health, take away from their actual health. Because now they have to do like a more aggressive, let's say, resting program.

Mark: So basically that client that you mentioned, she started to take charge, be responsible for her own health by getting expert help. First from her trainer, from her doctor and they recommended that she come in to see the physios at Insync Physio, so that she could find out okay is it this muscle issue? And you guys diagnosed because you're the experts on, okay, here's what's actually going on by referring her back to get an x ray?

Iyad: Yeah, I think, like, that was really important. I think we work closely with all our colleagues and from the community setting, where you have the fitness experts all the way to the medical system where we work closely with surgeons and with sports medicine doctors and the family doctors. And I think, yeah, this is not a simple, yes one person can figure this out because they provided us with adequate input for us to suspect something else was going on. And we have the ability to, the time really and like the facility to assess the function of that person adequately.

And then we were made a referral back and then luckily we got that person started on the right track instead of constantly doing this big boom and bust cycle where it recovers for a bit to go for a run, flares up and then they're resting. So that kind of big stop start, we got them off that, we're trying to ramp them up a little more gradually to their tolerance.

Mark: You're having running hip pain or hip pain of any kind from whatever sport or movement you're involved in. Get in to see the physiotherapist at Insync Physio. You can reach them online to book your appointment at There's also hundreds of videos on there, on all types and stories of repairs and issues, body and vendor work on your body, on how to feel better and keep moving at Or you can call the North Burnaby office at (604) 298-4878 or Vancouver (604) 566 -9716. Thanks, Iyad. 

Iyad: Thank you.

Wil Seto

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