MSR Runner’s Maintenance, Part 3: Hips
Updated: 4 hours ago
A runner may manage everyday walking yet develop lateral hip pain on longer runs, anterior hip symptoms during hills, or difficulty returning to faster training. Understanding the demands on the hips helps practitioners investigate these limitations without assuming that every movement difference requires correction.
This instalment examines gluteal and hip-flexor contributions to running, connecting anatomy with assessment, MSR manual care, and progressive exercise. Drawing on my experience in distance running and clinical practice, the purpose is to identify relevant treatment targets and determine whether useful changes carry into repeated loading and limb recovery. For the runner, that means building capacity for the routes, distances, and participation they value.
Article Index
Gluteal Muscles: Support, Control, and Force Production
Anatomical involvement: Gluteus maximus contributes to hip extension and control of the thigh and trunk. Gluteus medius and minimus contribute to hip abduction and pelvic control during single-leg support. Their contributions vary with speed, limb position, and task demands.
Clinical interpretation: Buttock or lateral hip pain, painful single-leg loading, or difficulty sustaining running may justify focused assessment. Pelvic drop describes movement; it does not independently establish gluteal weakness or identify the painful structure.
MSR treatment priorities: Consider gluteus maximus, medius, minimus, and relevant hip restrictions when examination supports their involvement. Connect manual care with progressive hip-extension, abductor, and single-leg loading, then reassess the affected task.
Examination Findings That May Influence Care
Palpation can locate tenderness, reproduce familiar symptoms, and establish tolerance to contact. Interpret these findings alongside hip movement and resisted loading. Differences in tissue firmness or sensitivity do not independently establish adhesions, muscle imbalance, or the cause of a running limitation.
Assess relevant hip extension, abduction, rotation, and loading capacity. Single-leg stance, step-downs, or other suitable tasks can help explore symptoms and endurance. Compare these findings with running rather than treating one test as a complete explanation.
Lateral hip tenderness may involve the gluteal tendons as well as adjacent muscles. Adapt contact and loading to irritability rather than applying deeper pressure simply because the region is sensitive.
Hip Flexors: Limb Advancement and Loading Capacity
Anatomical involvement: Iliopsoas contributes to advancing the thigh through hip flexion. Rectus femoris crosses both the hip and knee, contributing to hip flexion and exerting a knee-extension moment. Limb recovery also reflects momentum and interactions between segments.
Clinical interpretation: Anterior hip or thigh pain, painful resisted hip flexion, or difficulty advancing the limb may justify focused examination. Shortened steps, anterior pelvic tilt, or reduced apparent push-off cannot identify hip-flexor dysfunction by themselves.
MSR treatment priorities: Consider iliopsoas, rectus femoris, and relevant hip findings when symptoms or movement limitations support treatment. Connect manual care with progressive hip-flexion loading and suitable marching or running drills. Reassess the movement and demand that prompted care.
Examination Findings That May Influence Care
Assess the location of symptoms, hip movement, and tolerance to resisted flexion. Consider rectus femoris across both joints, including whether knee position changes the response. Restricted hip extension may warrant examination, but pelvic posture alone does not establish hip-flexor shortening.
Palpation can reproduce symptoms and guide contact; it cannot independently distinguish muscle tension, tendon involvement, inflammation, or a tear. Anterior hip and groin symptoms also require consideration of joint, bony, neurological, and non-musculoskeletal sources.
Deep iliopsoas application requires particular anatomical care. Explain the contact, obtain consent, and follow the demonstrated positioning, stabilization, movement, and pressure. Nearby abdominal structures, vessels, and nerves must be considered. Unexplained abdominal or groin pain warrants assessment before local treatment.
Hip and Lumbopelvic Joint Mobility
Hip symptoms and running limitations may involve the hip joints, lumbar spine, sacroiliac region, or several contributing structures. Assess relevant joint movement alongside muscle function and loading capacity.
Hip joints: Examine flexion, extension, and rotation in relation to symptoms and running demands. Distinguish joint restriction from painful muscle loading or reduced strength.
Lumbar spine and facet joints: Assess relevant flexion, extension, rotation, and symptom response when back, buttock, or hip symptoms suggest lumbar involvement. Movement testing helps guide care but does not independently confirm a particular facet joint as the pain source.
Sacroiliac joints: Consider the SI region when the history and examination support its involvement. Use appropriate pain-provocation testing rather than inferring joint displacement from pelvic asymmetry.
Adductors, deep hip rotators, gluteals, and other lumbopelvic muscles may also warrant treatment when findings connect them with the runner’s limitation.
MSR treatment priorities: Selected mobilization or manipulation of the hip, lumbar, or SI joints may complement soft-tissue procedures. Choose the application according to examination findings, contraindications, symptom irritability, patient preferences, and informed consent. Reassess a meaningful movement or loading task, then reinforce useful changes through active mobility, progressive strengthening, and running exposure. The objective is improved function that carries into running.
Hips: Observation and Clinical Interpretation
Observe several strides from the side, front, and behind at comparable speeds. Record symptoms and changes as running continues.
Single-leg support: Does pelvic drop or hip movement coincide with pain or declining tolerance? Examine hip capacity and compare with suitable single-leg tasks.
Hip extension: Does the thigh move behind the pelvis without provoking symptoms? Assess relevant mobility and loading rather than prescribing a fixed trailing-leg position.
Limb advancement: Does bringing the thigh forward reproduce anterior hip symptoms or become difficult at faster speeds? Examine hip-flexor capacity and movement.
Pelvis and trunk: Do changes coincide with symptoms or fatigue? Consider whether they represent an individual strategy or a limitation requiring attention.
Repeated performance: Does the concern emerge with distance, hills, or acceleration? Assess a suitable demand and review training and recovery.
Use observations to form a clinical question, then test it.
MSR Manual Care and Physical Preparation
MSR combines selected soft-tissue and joint procedures with exercise and reassessment. Establish a meaningful baseline, such as painful hip flexion, restricted extension, single-leg loading, or running tolerance. Treat findings that relate to the limitation, then determine whether the response supports the next stage of activity.
Exercise selection should reflect the examination. Options may include bridges or hip-extension exercises, progressive abductor loading, step-ups, split squats, and resisted hip flexion. Adjust resistance, range, and repetition to the runner’s starting capacity and goals. Faster running and hills require their own graded exposure.
Manual care may help address symptoms or movement limitations, but improved range alone does not establish readiness for the previous training load. The research cited here informs anatomy and running demands; it does not directly establish MSR effects on performance or injury prevention.
MSR Demonstration Video
Dr. Abelson demonstrates hip-region MSR procedures. Select the demonstrated applications according to examination findings and patient response, preserving the specified contact, positioning, stabilization, and movement. Connect useful changes with individualized exercise and reassessment.
Supporting the Runner’s Next Step
Hip assessment becomes useful when it explains a runner’s difficulty and informs what to do next. Gluteal and hip-flexor findings may guide MSR procedures, exercise selection, and changes to training, but no single posture or movement pattern provides the whole answer.
Connect manual care with the capacity the runner needs beyond treatment. Reassess relevant symptoms and tasks, build strength and endurance, and progress running demands as tolerance develops. The purpose is sustained participation, whether that means a familiar neighbourhood route or preparation for competition.
Part 4 considers the legs and feet, extending this approach to the structures managing repeated contact and push-off.
References
Dorn, T. W., Schache, A. G., & Pandy, M. G. (2012). Muscular strategy shift in human running: Dependence of running speed on hip and ankle muscle performance. Journal of Experimental Biology, 215(11), 1944–1956.
Lieberman, D. E., Raichlen, D. A., Pontzer, H., Bramble, D. M., & Cutright-Smith, E. (2006). The human gluteus maximus and its role in running. Journal of Experimental Biology, 209(11), 2143–2155.
Neumann, D. A. (2010). Kinesiology of the hip: A focus on muscular actions. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 82–94.
Novacheck, T. F. (1998). The biomechanics of running. Gait & Posture, 7(1), 77–95.
DR. BRIAN ABELSON DC. - The Author
Dr. Brian Abelson is a chiropractor, author, and educator with more than 30 years of clinical experience in musculoskeletal care, rehabilitation, and sports performance. His educational work focuses on musculoskeletal conditions, human movement, sports biomechanics, and evidence-informed approaches to treatment and rehabilitation.
He is the developer of Motion Specific Release (MSR) and Clinical Director of Kinetic Health in Calgary, Alberta, Canada.
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