Hip Labral Injuries in Female Runners: The Overlooked Role of the Pelvic Floor and Core
Hip labral injuries can cause deep groin pain, pinching in the front of the hip, stiffness, clicking, or discomfort during and after running. Some runners notice symptoms while climbing hills, increasing mileage, sitting for extended periods, or performing deep squats and lunges.
But in female runners, the hip is not always the entire story.
Pelvic floor dysfunction, diastasis recti, and difficulty managing abdominal pressure can affect how the trunk, pelvis, and hip work together. These problems often go undiagnosed—especially when treatment focuses only on the painful hip.
Why Do Hip Labral Injuries Occur in Runners?
The hip labrum is a ring of cartilage that helps support and stabilize the hip joint. Labral changes are relatively common and do not always cause pain. The goal of physical therapy is therefore not simply to treat an MRI finding. It is to determine why the hip has become painful and what is limiting your ability to run.
Potential contributing factors include:
A rapid increase in running mileage or intensity
Limited hip or ankle mobility
Reduced hip and trunk strength
Poor control of the pelvis during single-leg loading
Changes in running mechanics
Inadequate recovery between workouts
Pelvic floor dysfunction or ineffective pressure management (What Is The Pelvic Floor and How Does It Work?)
A successful rehabilitation program should address the runner as a whole—not just strengthen the hip in isolation.
The Connection Between Hip Pain and the Pelvic Floor
The pelvic floor works with the diaphragm, abdominal muscles, and deep spinal muscles to control pressure and stabilize the pelvis. It also has an important anatomical and functional relationship with the muscles surrounding the hip.
Pelvic floor dysfunction may present as:
Urinary leakage while running
Pelvic heaviness or pressure
Pain with intercourse
Difficulty relaxing the pelvic floor
Constipation or straining
Lower abdominal, groin, or pelvic pain
Symptoms that began during pregnancy or after childbirth
Some runners assume these symptoms are normal, particularly after having children. Others may never be asked about them during a traditional orthopedic hip evaluation. As a result, an important part of the problem can remain untreated.
Pelvic floor dysfunction does not automatically cause a labral injury. However, altered pelvic floor function and pressure management may affect trunk control, pelvic positioning, and how force is transferred through the hip while running.
Can Diastasis Recti Contribute to Hip Symptoms?
Diastasis recti is a widening of the connective tissue between the abdominal muscles. It is commonly associated with pregnancy, but the size of the separation alone does not determine how well someone functions.
What matters is whether the abdominal wall can create tension and manage pressure during movement.
A runner with diastasis recti may have difficulty coordinating the abdominal wall with the diaphragm and pelvic floor. This can contribute to:
Reduced trunk and pelvic control
Abdominal doming or bulging
Breath-holding during exercise
Difficulty controlling single-leg movements
Increased demand on the hip muscles
Pelvic floor pressure or urinary leakage
Simply doing more abdominal exercises is not always the answer. Rehabilitation should focus on breathing, pressure management, abdominal wall tension, and gradually integrating these skills into running and strength training.
Physical Therapy for a Hip Labral Injury
1. Reduce Hip Pain and Irritation
The first step is identifying what aggravates the hip. This may include running volume, hills, speed work, prolonged sitting, deep hip flexion, or certain strength exercises.
Complete rest is not always necessary. We help runners modify their training so the hip can calm down without losing more fitness than necessary. Hands-on treatment may also be used when appropriate.
2. Restore Mobility
We assess mobility at the hip, pelvis, lumbar spine, and ankle. The goal is not to force the hip into painful positions, but to restore the motion needed for comfortable running and strength training.
3. Improve Pelvic Floor, Core, and Hip Coordination
This is where female runners are often underserved.
We assess breathing, abdominal pressure management, pelvic floor function, and control of the trunk and pelvis. Treatment may include pelvic floor relaxation or strengthening, depending on the individual. A pelvic floor that is overly tense can be just as problematic as one that is weak.
We then integrate this coordination into movements such as step-downs, single-leg squats, lunges, and running drills.
4. Build Hip and Lower-Body Strength
Strengthening should progress beyond basic band exercises. Runners need sufficient capacity in the glutes, quadriceps, hamstrings, calves, trunk, and hip muscles to tolerate repeated impact.
At Summit Physical Therapy, we can use VALD strength-testing technology to objectively compare strength between sides and benchmark progress. This helps us determine whether you are truly rebuilding the capacity needed to run—not merely feeling better during basic exercises.
5. Restore Power and Running-Specific Capacity
Running is a series of repeated single-leg landings. Before returning to full training, runners need to absorb force, produce power, and maintain control as fatigue develops.
Rehabilitation may progress to:
Hopping and landing exercises
Running drills
Plyometric training
Changes of speed and direction
Hill preparation
Running-specific strength circuits
VALD force plates can help measure force production, landing ability, and differences between legs when appropriate.
6. Rebuild Running Endurance
Feeling good during a few exercises does not necessarily mean the hip is ready for normal mileage. Running is repetitive, and symptoms may emerge only after fatigue accumulates.
A gradual return-to-running program helps rebuild durability by controlling running duration, intensity, terrain, and recovery. Mileage, hills, and speed work should be progressed separately rather than reintroduced all at once.
When Should a Female Runner Consider a Pelvic Floor Assessment?
A pelvic floor assessment may be especially valuable if hip pain occurs alongside:
Urinary leakage
Pelvic heaviness or pressure
Pain with intercourse
Abdominal doming
A history of pregnancy or childbirth
Known or suspected diastasis recti
Persistent groin or pelvic pain
Hip symptoms that have not improved with traditional strengthening
These symptoms can be easy to overlook when the primary complaint is hip pain. Identifying them may explain why an otherwise reasonable rehabilitation program has not produced lasting results.
You May Not Need to Stop Running Forever
A hip labral injury does not automatically mean you need surgery or must give up running. Many runners can improve by managing irritation, restoring mobility, addressing pelvic floor and abdominal function, building measurable strength, and following a progressive return-to-running plan.
The key is determining which factors are relevant to you.
Summit Physical Therapy provides orthopedic, running, and pelvic floor rehabilitation for patients from Summit, Short Hills, Millburn, Maplewood, Chatham, Florham Park, New Providence, Springfield, and South Orange, New Jersey.
If hip or groin pain is limiting your running—or traditional hip exercises have not solved the problem—contact Summit Physical Therapy to schedule an evaluation.