Top 4 Reasons for Thigh Pain when Running – What Could Yours Be?

Reasons for Thigh Pain when Running

If you have been running for more than six months, you’ve more than likely felt the sensation of a thigh pain when running.

You know the feeling…when you’re done with the run and your hammy feels as tight as a rope.

Or when your quad feels like it is going to explode after a hill workout.

This is not always normal. If you feel it is normal, ask yourself why it only feels that way in one thigh and not the other?

Tightness and soreness from normal use is bilateral (on both sides) and equal.

In this article, I will go into the most common reasons for thigh pain when running you can experience and some corrective therapy exercises/treatments you can do if you have one of them.

If so, you are not alone. These are symptoms of a possible “overuse” injuries of the ankle/ foot, which are often correctable through some of the methods I will go over in this article.

Hi, I’m Dr. Sebastian Gonzales. I own a rehab clinic in Huntington Beach, CA where we specialize in reduction of running overuse injuries.

I’ve run many races from 5k’s to 1/2 Irons. I’ve experienced joint issues as a runner, just as you have, yet I’ve been fortunate to have a sports medicine educational background to trouble-shoot “what works and what doesn’t work” to heal many conditions like thigh pain.

How long does it take to recover? Everyone is a little different but if I had to estimate:

• 1/2 of the people I see feel 75% better within a matter of minutes and are able to keep milage up, with slight suggestions.
• 1/4 take roughly a month to get back into their desired milage, with a focal warm-up/ cool down.
• The last bit are more complex cases and can take months.

Don’t get me wrong, the complicated ones aren’t broken. I still have them train in some way, shape or form within the first week. Typically, I start them with resistance training and tempo work first.

If you want these same results, I’m here to guide you. Take a look through the article below to get a feel of what I can offer.

Some of you may get benefit from the tips within, but if you’re not don’t fret. You probably just need a little one on one direction is all.

There’s no substitution for one on one help.

I could write an article telling you how to build a house, or I could just come over and show you!

On that note, if you’re in the Southern CA area, book a time with me. The proof is in the pudding and it’s faster to make pudding when you can use your hands.

People recover from thigh pain/ tightness everyday. All you need to do is duplicate what works.

Just book an appointment with me HERE.

I’ll be providing you some very valuable free information in this article. However, if at any point you just think, “Screw it, just tell me what works… I’m tired of reading,” just click on one of the links below.

You’ll be sent to some very effective video mini guides I’ve created on how to recovery from running overuse injuries.

Unfortunately, these additional video mini guides cost a few dollars. I gotta eat some how guys!

The free information in this article works for 50% of the people I see.

The paid guide methods work for closer to 90% of the people I work with. They’re effective, simple and tend to work for most people, if performed correctly.

Don’t worry, the guides are 100% refundable if you think they’re useless.

How long till you are able to run again if rehab goes well?

Great question.

With any well performed program you should feel an immediate reduction of an overuse injury within a few minutes.

If you’re not, then you could be getting the wrong care for your condition.

The body is like an Internet connection that’s temporarily not working. The right solution can turn it back on quickly.

You can do this.

You can get better.

Your body is resilient.

IT Band pain can be reduced within under 5 minutes with a MOVEMENT-BASED CORRECTION.

Quad strains (without a bruise) can be reduced within 10 minutes. You should even be able to quickly run on it and test the efficiency of the treatment.

Hamstrings that feel like ropes can feel 75% better within 5 minutes as well.

You’re going to have to trust that I’m not blowing smoke.

When corrective exercise is performed correctly, results will follow… getting them to stick for the whole duration of a run in another story.

Just click on them if you’re interested in getting better faster. If not, no biggie.

Here we go into the free information.

Here are the top four reasons for thigh pain when running.

• Hamstring strain
• Quad Strain (I’m aware it says hip but it will work for most)
• IT Band Syndrome
• Nerve Pain (coming soon)

HAMSTRING STRAIN

• Tightness in the back of your thigh?
• Does it start on the sit bone?
• Does it increase in track workouts?
• Is it painful to sit down?

Hamstring injuries are the downside of being fast. Sprinters actually get hamstring injuries more than distance runners, but high-level distance athletes get it more than joggers.

Let me start out by telling you, I have a PASSION for hamstrings.

I have had two hamstring tears from baseball and have gone through everything you are going through myself.

Pain with taking off my shoes and taking my foot off of the gas pedal.

I didn’t have any idea these would ever hurt with a hamstring injury until I had mine.

So I understand.

What is a Hamstring Strain?

A Hamstring Strain is an injury to where the muscle and tendon parts of one of the hamstring muscles normally come together. It can happen anywhere along this musculotendinous junction, but common places are the belly region and where the hamstring attaches to the pelvis.

Pain at the sit bone is normally called High Hamstring Tendinitis, a High Hamstring Strain or Upper Hamstring Pain.

If the lower portion is damaged, most people call it Lower Hamstring Tendonitis or a Distal Hamstring Strain.

Regardless of where it is, a strain is a Grade I hamstring tear. It is not just an upset muscle. It is a real injury so you need to treat it as such or it will only get worse.

What causes a Hamstring Strain?

Hamstring Strains are caused by overuse or over demand of the muscle/tendon complex.

I have found it is more common for over demand to be the issue.

Over demand from gait changes or over striding can be major reasons why one hamstring is being forced to work overtime.

Muscular imbalance is another major reason for thigh pain when running.

In this category, we can also throw in a few regions of possible weakness or lack of endurance. Here are a few of the first spots I look at:

• Core/Trunk
• Low Back
• Glutes

The reason these regions of the body are so important is because the hamstrings attach to the pelvis, which is held in proper position by all of these muscle groups.

Therefore, these muscle groups directly affect proper running form or gait.

If they are weak or lack endurance, your form WILL degrade and your hamstring will tear.

To get specific, tears occur because the hamstring’s length-tension relationship changes.

Hamstring Strain Rehab

I’m not going to lie…hamstring rehab is a long process.

It is frustrating, and you will experience a flare-up, so just expect it from the start.

Rehab includes:

• Treatments/exercises to decrease pain
• Exercises for local rebuilding of the hamstring muscle fibers
• Core/Hip rehab and gait retraining so it doesn’t happen again

Here’s the same style lacrosse ball work for High Hamstring Tendonitis. Once we are to the loading phase, I like to prep the motion with a dynamic activity such as Good Mornings. After, we like to load with an isometric exercise like Heel Digs.

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

We have more information on a full program in one of our online classes on how to rehab thigh pain when running, if it’s not up already.

Hamstring Strain Treatment Options

Some great treatment options to decrease excessive scar tissue formation are listed below. It is extremely important to keep the scar mobile.

Scar tissue is not the enemy, but the lack of isolated pliability is.

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Corrective exercise and progressive loading as healing occcurs (best option)
• PRICE therapy

QUAD STRAIN

• Upper quad pain?
• Quad pain above knee?
• Thigh strain?

If you have been running higher volumes and hills, you could have a Quad Strain.

A Quad Strain can take up to four months to heal completely, but there are things you can do to accelerate the healing process.

Read on, and I’ll go over how we rehab and treat this condition to decrease thigh pain when running.

UPDATE 2019: On another note, if you are dealing with INNER quad/ adductor cramps or aches then you probably don’t have an issue with the muscles of the thigh at all. If this is the case, I would search hip impingement on my site or just fast forward to my mini guide on hip health for runners for the video instructional. If you don’t like it just ask for a refund.

Before you read on, if this is your symptom pattern please look into hip femoroacetabular impingement. I’ve compiled everything to start you off in the right direction in the guide.

What is a Quad Strain?

The quads are a group of muscles in the front of the thigh that connect the hip and the knee. Three of the muscles only connect to the knee and are less susceptible to tearing: the vastus lateralis, vastus medialis, and vastus intermedius.

One muscle assists in flexion of the hip and for this reason, it is at the highest risk for strain during running. It is called the rectus femoris.

You may be wondering, “What does a strained quad feel like?”…

If you get a Grade I tear while running, it will feel like a band of the muscle is tight, like a guitar string.

If you get a Grade II tear while sprinting, it feels like someone shot you.

The quads run the whole length of the thigh, so it can feel like upper thigh muscle pain.

What causes a Quad Strain?

As I said before, most of the time, we are looking at a rectus femoris strain because it is the two-joint quad muscle.

A rectus femoris strain, just like two-joint hamstring tears, happens when you do not have proper function of the core/hips and improper running gait.

The rectus femoris attaches to the pelvis, which is supported by these muscle groups.

Proper gait allows the quads to do their job effectively and not become torn up, even with minimal workloads.

Quad Strain Rehab

I like to start with some self-myofascial release. We use a lacrosse ball for this at the office and spend a few minutes on upper quad pain. This is better for Grade I Quad Strains… basically thighs that don’t have apparent bruises or discoloration. Myofascial release is great at decreasing pain and tightness but if it tend to come back then we need to do more. See the video to come as an example.

If we are looking at a Grade II Quad Strain, then there is a 5-10 day resting period that’s needed before we can get too aggressive with deep tissue work. One clue that you’ve got a Grade II tear is if there is bruising.

Be aware that the blood goes the way of gravity; the bruising can even be found in the bottom of the foot!

The more advanced tissue work for upper thigh muscle pain can be found at a sports medicine office. Active Release and tool-assisted treatments are great. I’ve provided in a video to follow about what you can expect from Graston Technique, one variation of tool assisted myofascial release.

After we have decreased some of the local stiffness/ spasm in the quad applying a load to the muscles is a great way to allow the muscle to repair with resiliency. Isometric (non-movement) exercise for the quad muscles is our next step to make sure the area is safe to load further. See the videos to follow…

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

Quad Strain Treatment Options

Just as in Hamstring Strains, we need to keep the healing tissue pliable. If it is not, then it will re-tear again.

Here are some treatment options that I have found helpful for this:
• Active Release Technique
• Progressive loading of hips and pelvis under supervision (best option)
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Dry needling
• Chiropractic adjustments or mobilizations
• PRICE therapy

IT BAND SYNDROME

• Pain on the outside of the knee when bending?
• Worse when you start and stop at a light?
• Outer thigh “tightness”?

IT Band Syndrome (ITBS) is one of the top five injuries you can develop as a runner and it can present on the knee, thigh and hip.

I did a whole write up on IT Band Syndrome in our knee section, but many runners experience pain and tightness from ITBS on the outer part of the hip and thigh.

You may have tried an IT Band Strap?

They can help a lot, but remember passive devices are only doing what your body’s muscles should be doing on their own. The use of straps and tape should be used sparingly since the condition seems to progress when people use them too long with a progressive mechanism of injury.

I won’t spend a lot of time on ITBS in this section since all of the information is in the knee write up. For those of you who are on their 5th article on ITBS, I’d suggest you stop reading and just do something about it. It’s really not a hard condition to address if you catch it early. To start you off, I created a video mini-guide. It’s cheap and contains a lot of rehab/ strength videos that you’ve been missing in your treatment hunt. 

Here it is.

What causes IT Band Syndrome?

• Improper gait
• Decreased core endurance/ reactive posture
• Decreased hip strength
• Decreased glute strength
• Compensation from an old injury to the other limb
• Poor roads
• Old shoes
• New shoes

But overall…internal femoral rotation in the direct cause.

This is where the femur turns inward and changes the contact points of the knee bones, leading to a change of the path of the IT Band as well.

IT Band Syndrome Rehab

We like to start with some self-myofascial release of the hips.

After, we like to work on some torso stabilization. IT Band exercises are really just core and hip ones.

Here is one we use for the hip rotators to control internal rotation of the thighbone (femur) when landing, which is what creates the rubbing.

There are so many more IT Band Syndrome exercises targeted at the hip than these I’ve listed here, so don’t think these are it.

When you have a well put-together program, there are progressions and variations of exercises. A circuit could take around 30 minutes.

Later on, we need to load the hip in various motions:

• Deadlifts
• Squats
• Lunges
• Rotational Squats
• RDLs
• Lateral Lunges

I don’t recommend doing these unless you really know what you’re doing. They are complex, and you would need to add weight to them, which increases the chance of further injury.

IT Band Syndrome Treatment Options

IT Band Syndrome does not have excessive scar tissue formation unless it is a really old condition. In newer cases, we can still use some of the pain relief methods to give comfort, however it is important to know pain reduction doesn’t mean it’s time to throw down a long run.

It just means you are on your way to healing and we still need to improve your movements.

• Active Release Technique
• Corrective Exercise followed by strategic loading (most effective option)
• Deep tissue massage
• Anti-inflammatory injections
• Acupuncture
• Prolotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy

NERVE PAIN

• Burning sensation in the thigh above the knee?
• Numbness in the front of the thigh?
• Outer thigh muscle pain?
• Thigh pain when running?

All off these can be signs of nerve pain. I should have listed this first because a strong majority of leg discomfort runners experience can be reduced with 1 week of simple nerve correction. Much of it can be done at home, like foam rolling, but many clinicians tend to focus the bulk of treatment on the local muscles that hurt.

This is a shame that most treatment recommendations have become more “muscle-based.” I made the same mistake my first 5 years of practice. I understand it “feels like it is in the muscle.” I really do understand what you’re feeling, yet it is still more effectively reduced with a nerve treatment than a muscle one. Trust me.

Since using nerve-based suggestions, I have been able to reduce IT band ache, quad pain and hamstring tension with 3 minutes of nerve treatment. It doesn’t hurt and actually feels like you’re not doing a thing until you get up and test the results. 

I’ve seen runners experience 30-75% reduction of their thigh pain within just a few minutes of applying a nerve solution over a muscle one. 

It’s always very interesting to me when I examine a runner with nerve pain. Most of the time, they have tried thigh stretching, foam rolling, massage and more.

Why haven’t these helped? I explain to them that the issue is not with the thigh. There is nothing wrong with the muscles or flexibility of the hip and thigh, typically. It is all nerve pain.

This is hard to understand for most runners because they correlate the burning and numbness to use of the legs or their workouts.

And yes, this does make sense, but again, the presentation is more of a nerve pattern, which means if you are spending time stretching and foam rolling your thigh, you are wasting your time.

I have seen this many times in my clinic, and once we stabilize the trunk, it often improves very quickly.

In this article, I will go over educational information you need to know about burning thigh pain as a runner and what we do for rehab.

What is Nerve Pain?

A good analogy for nerve impingement is the act of stepping on a hose. The place where you clamp your foot down is a pinch point.

Just like the hose, the effect of a pinch point on a nerve can be evident along the whole distance of its course.

Still hard to understand?

Think of a heart attack. When someone has a heart attack, they normally have face and left arm pain, right?

Do we ever foam roll in a heart attack?

No, of course not.

Nerve pain is the same. The pain refers and travels. It is best not to chase it and miss the site of impingement.

What causes Nerve Pain?

Nerve pain is a direct result of a nerve that’s being compressed.

Compressed by what? This is up for debate.

It could be from within or outside of the spine. Some possible things that can cause compression are:

• A disc herniation
• Central Stenosis
• Foraminal Stenosis
• Spinal tumor
• A thigh piriformis
• A tight hip flexor (iliopsoas muscle)
• Tight hamstrings
• Scar tissue

You may be thinking Sciatica?

Sure, Sciatica is a reason for numbness of the buttocks, thigh, calf and foot, but it is not the only reason for nerve pain.

One video I put on YouTube years back was about femoral nerve entrapment, which yielded “Sciatica-like” numbness and pain, but on the front side of the thigh.

Here’s the video.

You may be wondering if running could aggravate Sciatica and Femoral Nerve Entrapment?

Sure it can.

Remember, the nerve is being compressed… somewhere… and if that area tightens further via bones moving or muscles becoming tight, then the burning will increase.

Does this mean Sciatica, or any nerve pain for that matter, should stop you from running?

Depends…my answer is always it depends.

• Can you keep your core stable?
• Can you control an increase in the nerve pain when running?
• Will you stop if the group is getting ahead of you?

If you cannot do these things, then the firm answer is no.

Nerve Pain Rehab

The first thing we start with for nerve pain from running is to establish if it gets worse with isolated spinal motion, isolated hip motion or both.

If it is isolated spinal motion, we then need to find if it is more TOLERANT to spinal flexion or extension.

Don’t understand this? Here is a our podcast on the topic. “Do not pass Go” and “Do not collect $200” if you do not understand this concept.

If we find it is extension tolerant, we start with something like a Birddog exercise because it gets into low back extension. If we are correct, this therapy exercise will feel very comfortable but challenging.

If the injury likes flexion, we would start with a Dead Bug.

If we have found motion of the low back does not increase or decrease pain, but the hip does, we would go towards deep tissue mobilization of the soft tissues of the hip followed by strengthening of the core and hip.

I hope that makes sense, but it is not as clear-cut as other injuries. There is a lot of trouble shooting.

To be clear: therapy of nerve pain from running is very specific to the cause of compression. If we do not know the compression point, your rehab will be a waste of time.

Find the cause first.

Nerve Pain Treatment Options

Treatments for releasing the pinch point vary based upon their origin whether it’s spinal entrapment or something outside of the spine.

Extra-spinal (outside the spine) entrapment will respond to nerve flossing techniques and deep tissue work.

For this I would use:

• Active Release Techniques
• Instrument-assisted tissue work
• Nerve flossing stretches
• Mobility activities for the hip

Spinal entrapments will not respond in the same way.

I would work more towards trunk stabilization exercise and add mobility around the lumbar spine.

To do this, I would use:

• Lewit
• Dead Bugs
• Birddogs
• McKenzie Extension Series
• Rope Stretching of the hip
• Thoracic spine mobility exercises

The pain relief therapies are all still in play as well.

• Anti-inflammatory injections
• Acupuncture
• Prolotherapy
• Electrotherapy
• Chiropractic adjustments or mobilizations
• PRICE therapy

Thigh pain when running does not have to be your reality. It can be treated and rehabbed to get you running again in 9 out 10 cases.