The psoas muscle, which forms part of the iliopsoas complex, functions as the primary hip flexor, connecting the lower spine and pelvis to the femur. This deep muscle is responsible for swinging the leg forward during movement. For runners, the repetitive motion of the legs combined with hours of prolonged sitting, which keeps the muscle in a shortened state, often leads to irritation, strain, or tendinopathy in this area. Managing this injury properly is important for a safe and prompt return to running.
Identifying Psoas Pain in Runners
Psoas pain often presents as a deep ache located in the front of the hip or groin area, which can make it difficult to distinguish from other common running-related hip injuries. The pain typically worsens when the muscle is actively engaged, such as when lifting the knee during a run, climbing stairs, or attempting to stand up straight from a seated position. In some cases, the discomfort may radiate down the front of the thigh toward the knee or be felt in the lower back.
Unlike a groin pull (adductor strain) or a labral tear, psoas discomfort is often aggravated by resisted hip flexion. A tell-tale sign can also be a sharp, catching, or slipping sensation deep in the hip, sometimes referred to as internal snapping hip syndrome. The location of pain deep in the anterior hip and its reaction to hip flexion movements are strong indicators of an iliopsoas issue.
Immediate Action: Should You Stop Running?
The direct answer to whether you can run with psoas pain depends entirely on the severity of the symptoms, but continuing to run through sharp pain is generally discouraged. Running with significant discomfort risks turning a mild muscle strain or tendinopathy into a more severe, chronic issue or even a tear. The repetitive, high-force nature of running places considerable stress on the injured muscle, hindering the natural healing process.
If you experience sharp, sudden pain, if the pain increases as you continue running, or if the discomfort causes you to noticeably alter your running gait, you must stop immediately. For very mild soreness (less than a 3/10 on a pain scale) that does not worsen during the run and resolves completely within 24 hours, you might consider significantly reducing your mileage and avoiding speed work or hills. If any symptoms persist beyond a few days or involve moderate-to-severe pain, seeking a medical evaluation is important to confirm the diagnosis.
Initial Management and Conservative Treatment
When running is paused, the initial focus shifts to conservative treatment. This phase involves relative rest, which means avoiding activities that provoke pain. Applying heat to the area can help relax the muscle, while ice may be used to reduce acute inflammation and pain.
Mobility work, such as a passive psoas stretch or the Thomas test position, can help maintain tissue length without causing further irritation. Cross-training is a productive way to maintain cardiovascular fitness without stressing the psoas, with cycling (using a raised seat to minimize hip flexion) and swimming often being well-tolerated options. Avoid activities that strongly activate the hip flexors, such as aquajogging.
Strategies for Safe Return to Running
The safe return to running is heavily dependent on a rehabilitation program that addresses underlying weaknesses. This phase focuses on two main components: strengthening the surrounding support muscles and a gradual progression of running volume. Strengthening the gluteal muscles and the core is essential, as these stability muscles help to offload the strain on the psoas during the running stride.
Exercises like clamshells, glute bridges, and planks help to build the strength needed to maintain proper pelvic alignment and reduce excessive anterior pelvic tilt. Eccentric strengthening of the psoas itself, such as slow, controlled leg lowering exercises, is also important to build tendon resilience and prepare the muscle for the demands of running.
Once pain-free walking is achieved, a structured return-to-running plan using walk/run intervals should be implemented. Start by alternating one minute of running with one minute of walking, gradually increasing the running time while keeping the total duration short. The total weekly mileage should not increase by more than 10% to allow the tendon and muscle to adapt to the new load. Incorporate a dynamic warm-up focused on hip mobility before each run.