Hip alignment issues are one of the major causes of hip pain during and after running, and, if left untreated, injury. Given the role of the pelvis as a fulcrum in each of the three planes of motion of the body (frontal, sagittal, transverse), there are numerous potential drivers of alignment issues, as problems tend to propagate to the hips.
The symptoms of pelvic misalignment can take quite some time to show up (and can be quite broad in nature), and the condition is often first recognized as a leg-length discrepancy. Such discrepancies can be mistakenly attributed to permanent biomechanical issues when in fact they are often a temporary condition brought on by poor pelvic alignment. Thus the tendency is to leap quickly to orthotics in such a situation, when in fact appropriate corrective and preventative exercises may address the true issue.
Hip alignment is a concern because it—or rather the functional leg-length discrepancy it tends to introduce—is a source of many potential injuries. If you can visualize the impact of running with one leg slightly longer than the other, you may be able to imagine some of the injuries listed below.
On the "longer leg" (raised side of the hip), which experiences greater impact and torsional forces:
- Hip injuries or soreness: This seems the most obvious, as the increased force of impact is transmitted all the way up to the hip.
- Hamstring strains and piriformis syndrome: The longer leg can end up bearing slightly more of the work in propelling you forward, thus making the hamstring more vulnerable to strains.
- IT Band Syndrome: ITBS is seen increasingly as an issue originating from weak hips and glutes, but the increased loads from a seemingly longer leg can have the same effect.
- Patellofemoral Pain Syndrome (Runner's Knee): The knee is another joint that bears excessive forces on the longer leg, and can therefore be subject to injury.
On the "shorter leg" (lowered side of the hip), which typically ends up experiencing more of a midfoot landing, the most common issue is Achilles tendinitis (or plantar fasciitis). The situation is similar to the runner who transitions too quickly to minimalist running; without the proper strength and mobility in the lower leg, injuries become more likely.
There are several potential causes of pelvic alignment issues, and there are often several involved in each specific case. Running-related drivers include:
- Strength imbalances (or asymmetries): This can cause a runner to favor one side over the other, which ultimately pulls the hip out of alignment.
- Injury history: This can be a source of the asymmetries driving form hitches that cause misalignment to develop.
- Cambered roads: Since we have all been taught to run (or walk) against traffic, we tend to go to the left (in the U.S.) side of the street. This causes our left leg to have to reach down a little farther than our right, since roads have a slight camber to help water drain off.