Blog 4: The Athlete’s Guide to Hip Pain: From Anatomy to Performance
Part 4: Movement Patterns That Break Hips
Welcome back! In Parts 1-3, Dr. Keirstyn covered hip anatomy, anterior hip pain, and lateral hip pain. Now we're getting to the root cause: the movement patterns and training errors that create hip problems in the first place.
Understanding why your hip hurts is just as important as knowing what hurts. Most hip injuries don't come from a single traumatic event — they develop over time from repetitive faulty movement patterns, training errors, and biomechanical compensations.
This blog will show you:
How running, cycling, skating, and dance mechanics contribute to hip pain
Common movement faults that overload the hip
Training errors that accelerate hip breakdown
How to identify and fix your own patterns
The Foundation: What Healthy Hip Mechanics Look Like
During Single-Leg Stance (Running, Walking, Skating):
Pelvis stays level (no dropping on opposite side)
Hip stays centered over the foot (no excessive adduction)
Knee tracks in line with toes (no valgus collapse)
Core stabilizes the trunk (no lateral lean)
During Hip Flexion (Cycling, Skating, Dance):
Hip flexes without anterior pelvic tilt
No pinching or restriction
Smooth, controlled movement
No compensatory lower back arching
When these mechanics break down, hip pain follows.
Running Mechanics That Create Hip Pain
1. Overstriding
What It Is: Landing with your foot too far in front of your body
Why It Hurts the Hip:
Increases braking forces and impact
Hip flexors work overtime to pull leg through
Glutes can't activate properly during stance phase
Creates anterior hip stress
Who's at Risk: Runners focused on "lengthening stride" to run faster
The Fix: Increase cadence (steps per minute), land with foot closer to center of mass
2. Crossover Gait
What It Is: Feet landing on or across the midline instead of hip-width apart
Why It Hurts the Hip:
Hip adductors work excessively to control leg position
IT band and lateral hip structures overloaded
Increases hip internal rotation and adduction stress
Who's at Risk: Runners with weak hip abductors, narrow-hipped athletes
The Fix: Widen stride slightly, strengthen glute medius, focus on "tracking knees over toes"
3. Excessive Hip Drop (Trendelenburg Gait)
What It Is: Pelvis drops on the opposite side during single-leg stance
Why It Hurts the Hip:
Stance-side glute med/min work overtime to prevent collapse
Leads to gluteal tendinopathy and GTPS
Swing-side hip flexors overwork to lift dropping pelvis
Who's at Risk: Runners with weak glutes, high mileage without strength work
The Fix: Single-leg exercises (deadlifts, step-ups), hip abduction strengthening
4. Limited Hip Extension
What It Is: Hip doesn't extend fully behind the body during push-off phase
Why It Hurts the Hip:
Hip flexors stay shortened and overworked
Glutes can't activate fully
Anterior hip capsule remains tight
Compensatory lower back extension
Who's at Risk: Desk workers who run, cyclists, anyone with tight hip flexors
The Fix: Hip extension mobility work, glute activation, address sitting posture
Cycling Mechanics That Create Hip Pain
1. Aggressive/Low Position
What It Is: Handlebar position forces excessive hip flexion and forward trunk lean
Why It Hurts the Hip:
Prolonged hip flexion tightens anterior capsule
Hip flexors work constantly
Anterior impingement if you have FAI anatomy
Limited hip extension during recovery phase
Who's at Risk: Time trialists, triathletes, cyclists with aggressive fit
The Fix: Raise handlebars, improve hip flexion mobility, strengthen hip extensors
2. Saddle Too High or Too Low
What It Is: Saddle height forces improper hip mechanics
Too High:
Excessive hip rocking (side-to-side pelvic motion)
Overworks lateral hip stabilizers and IT band
Can cause lateral hip pain and lower back pain
Too Low:
Excessive hip flexion
Overloads hip flexors and anterior structures
Limits power output
The Fix: Professional bike fit, saddle height adjusted to proper knee angle
3. Cleat Position Issues
What It Is: Cleats positioned incorrectly, forcing hip internal or external rotation
Why It Hurts the Hip:
Rotational stress at hip joint
IT band tension
Compensatory patterns up the kinetic chain
The Fix: Proper cleat alignment, consider foot/ankle assessment
4. Weak Core During Long Rides
What It Is: Core fatigues, pelvis tilts excessively, hip mechanics break down
Why It Hurts the Hip:
Hip flexors compensate for lack of core stability
Anterior hip overload
Lower back and hip pain together
The Fix: Core strengthening off the bike, shorter ride intervals initially
Skating Mechanics (Hockey) That Create Hip Pain
1. Forced External Rotation (Wide Stance)
What It Is: Skating stride requires hip abduction and external rotation beyond natural range
Why It Hurts the Hip:
Adductors work eccentrically to control wide stance
Hip flexors overwork during recovery phase
Can create labral stress if forcing range beyond hip capacity
Groin and anterior hip pain common
Who's at Risk: Hockey players at all levels, especially those increasing ice time
The Fix: Strengthen adductors and hip rotators, improve hip mobility within safe ranges
2. Asymmetrical Skating Patterns
What It Is: Dominant pushing leg creates strength and mobility imbalances
Why It Hurts the Hip:
One hip becomes more mobile but less stable
Opposite hip becomes restricted and compensatory
Often leads to asymmetrical hip pain
The Fix: Single-leg strengthening, address bilateral imbalances, varied skating drills
Dance Mechanics That Create Hip Pain
1. Forced Turnout
What It Is: Forcing external hip rotation beyond natural capacity by compensating with feet, knees, or lower back
Why It Hurts the Hip:
Anterior hip impingement from excessive rotation demand
Labral stress
Compensation creates lower back and knee issues
Who's at Risk: Ballet dancers, contemporary dancers with turnout requirements
The Fix: Work within natural turnout range, strengthen deep hip rotators, improve hip mobility gradually
2. Extreme Leg Extensions (Développé, Arabesque)
What It Is: High leg extensions requiring extreme hip flexion or extension with rotation
Why It Hurts the Hip:
Pinching in anterior hip (impingement)
Capsular stress at end ranges
Hip flexor overload
Who's at Risk: Competitive dancers, especially during intensive training periods
The Fix: Strengthen glutes and hip stabilizers, control through range (not just passive flexibility)
3. Hypermobility Without Stability
What It Is: Dancers often have extreme range of motion but lack strength to control it
Why It Hurts the Hip:
Joint instability
Labral stress from lack of control
Compensatory muscle tightness
The Fix: Strength training at end ranges, eccentric control, proprioception work
Training Errors That Accelerate Hip Breakdown
1. The "Too Much, Too Soon" Problem
Increasing mileage >10% per week (runners)
Jumping from 3 to 6 days/week training
Adding intensity and volume simultaneously
Starting a new sport without building foundational strength
The Result: Tissues don't have time to adapt, overload accumulates, injury follows
2. Single-Sport Specialization
Running only (no cross-training or strength work)
Cycling only (no hip extension or varied movement)
One sport year-round without breaks
The Result: Repetitive stress in the same patterns without recovery or variation
3. Ignoring Early Warning Signs
"It's just tight" → continues training through discomfort
"It warms up after a few miles" → underlying issue worsens
"I'll rest after this race" → small issue becomes chronic
The Result: Acute issues become chronic problems requiring months of rehab
4. Inadequate Strength Training
No off-sport strength work
Not addressing known weaknesses (weak glutes, poor core)
Flexibility without stability
The Result: Sport demands exceed tissue capacity, breakdown follows
Cross-Sport Patterns: Why Multi-Sport Athletes Get Hip Pain
The Triathlete:
Cycling: Prolonged hip flexion
Running: High-volume repetitive loading
Swimming: Limited hip extension
Result: Anterior hip tightness, weak hip extensors, overuse injuries
The Hockey Player Who Runs Off-Season:
Skating: Wide stance, hip abduction/rotation stress
Running: Different loading pattern, high volume
Result: Hip doesn't adapt to new demand, pain develops
The Cyclist Who Does CrossFit:
Cycling: Hip flexion dominance
CrossFit: Deep squats, Olympic lifts requiring full hip range
Result: Impingement symptoms from sudden range demands
How to Identify Your Own Movement Faults
Self-Assessment:
1. Film Yourself
Run on a treadmill, film from front and side
Look for: crossover gait, hip drop, limited hip extension, knee valgus
2. Single-Leg Balance Test
Stand on one leg for 30 seconds
Watch in mirror: Does pelvis drop? Does hip shift out? Does knee collapse inward?
3. Hip Mobility Check
Lie on back, pull one knee to chest (hip flexion)
Any pinching? Restricted range? Asymmetry between sides?
Standing, extend leg behind you (hip extension)
Can you extend without arching lower back?
4. Training Log Analysis
When did pain start? What changed in training?
Mileage increase? New terrain? New sport?
Any other injuries that might create compensation?
Sometimes you can't see your own compensations. A movement assessment identifies patterns you'd miss.
When to Seek Professional Help
See Dr. Keirstyn if:
You can't identify the movement fault on your own
Pain persists despite modifying training
You want to prevent issues before they start (pre-season screening)
You're returning from injury and want to avoid re-injury
At Endurance Therapeutics, we:
Perform comprehensive movement assessments
Identify sport-specific faults contributing to pain
Create individualized correction programs
Guide you through return to sport safely
What's Next
In Part 5, we'll wrap up the series with rehabilitation and long-term hip health — how to fix hip pain, prevent it from returning, and build a hip-healthy training plan for life.
If you suspect faulty movement patterns are contributing to your hip pain, book an assessment with Dr. Keirstyn. We'll identify exactly what's breaking down and give you a clear plan to fix it.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161 | 🔗 https://endurance.janeapp.com/#staff_member/1
Coming up next: Part 5 — Rehabilitation & Long-Term Hip Health