Why Your Hamstring or Groin Hurts When You Run (and What to Do About It)
These injuries start as a small annoyance. A deep ache near your sit bone during the last few miles of a weekend long run, or perhaps your inner thigh feels tight every time you pick up the pace, climb a hill, or cruise downhill. At first, you run through it because it’s not interrupting your stride, and it just simply feels “tight.” You stretch a little more, foam roll after your run, and convince yourself it'll work itself out. However, over the next few weeks, the pain starts showing up earlier during your runs, sitting at your desk becomes uncomfortable, and adding speed or hills feels nearly impossible, let alone good. If this sounds familiar, you may be dealing with proximal hamstring tendinopathy or an adductor injury - two of the most common yet frequently misunderstood overuse injuries in runners.
Luckily, these types of injuries are rarely a sign that you need to stop running altogether. In fact, ignoring it or relying only on stretching may not be the best strategy to fix it, as that often keeps runners stuck in a cycle of recurring pain. What actually works is the right rehabilitation plan that is customized to you and your running goals, likely involving a combination of manual therapy and corrective exercises to reload the tissue properly. In this article, you'll learn how to tell the difference between proximal hamstring and adductor pain, why these injuries develop, and what the latest research says about treatment. Most importantly, you’ll find out how physical therapy can help you return to pain-free running and reduce the risk of the problem coming back. Whether you're training for your first 10K, chasing a marathon PR, or enjoying hikes on the Boulder trails, understanding and addressing these injuries early can help keep you doing what you love.
What Are Proximal Hamstring and Adductor Injuries?
Although these injuries affect different muscles, they often feel very similar and sometimes even occur together. Proximal hamstring tendinopathy develops where the hamstring tendon attaches to the sit bone (a.k.a the ischial tuberosity). Runners often describe hamstring tendinopathy as:
Deep buttock pain near the sit bone
Pain that worsens during speed work or hill running
Discomfort while sitting for long periods
Morning stiffness or soreness after longer runs
Adductor tendinopathy affects the muscles along the inner thigh. Those with this injury commonly report:
Pain in the groin or inner thigh
Pain when pushing off while running
Discomfort during lateral movements
Tenderness where the adductor attaches to the pelvis (often near the pubic bone)
These injuries are considered overuse injuries, meaning the tissue has been asked to tolerate more stress than it can handle, often leading to damaged tissue and swelling. (1)
Why Do These Injuries Happen?
Training volume alone usually isn't the problem. Instead, these injuries often develop when the demands placed on the tendons - such as training volume, intensity, heavy resistance, or other stress (i.e. undereating, poor sleep, etc.) - exceed their capacity.
Some common contributing factors include:
Rapid increases in weekly mileage
Adding speed workouts too soon
Increased hill training
Reduced hip and core strength
Poor muscle control of the spine and pelvis
Returning to running too aggressively after time off
Previous injury
Pelvic floor dysfunction
Many runners make the mistake of only stretching the painful area. While stretching may provide temporary pain relief and improve flexibility of the tendon fibers and muscle tissue, it is crucial that the area regains its capacity for high loads again. Typically, this requires strategic, progressive loading. (2-4)
What Does the Research Show?
If you've searched for the "best" treatment for proximal hamstring or adductor pain, you've probably encountered everything from rest and stretching to massage, dry needling, injections, and strengthening. So what does the research actually support? While the evidence is constantly evolving, the strongest evidence for successful tendon rehabilitation is progressive exercise training, strengthening, strategic load management, and shockwave therapy when necessary (5). For proximal hamstring tendon injuries, research and current clinical guidance emphasize gradually increasing the tendon’s capacity to tolerate load while addressing contributing factors such as hamstring strength, hip and core strength, and single leg control. Because the proximal hamstring tendon can become irritated by compression, rehabilitation may initially involve modifying activities such as aggressive hamstring stretching, deep hip flexion, or prolonged sitting before gradually reintroducing them as tolerance improves.
Research on adductor-related injuries similarly supports an active rehabilitation approach. Studies have found that exercise programs focused on progressively strengthening the adductors, abdominal muscles, and surrounding hip musculature can improve pain and increase the likelihood of returning to sport (6). For runners, this means rehabilitation shouldn't simply focus on stretching a "tight" inner thigh. The goal is to progressively rebuild the tissue's ability to produce and absorb force and then prepare it for the specific demands of running. In many cases, runners don't need to stop running completely; instead, training can be temporarily modified while strength and tissue capacity are rebuilt. Ultimately, successful rehabilitation is less about finding a quick fix and more about gradually closing the gap between what your body can tolerate today and what you want it to handle tomorrow.
How Physical Therapy Treats Hamstring and Adductor Injuries
The good news: most proximal hamstring and adductor injuries improve without surgery. At Boulder Sports Physiotherapy, treatment begins by identifying how and why your tendon became overloaded rather than simply “treating where it hurts.” Your physical therapy plan to address your hamstring or adductor injury may include:
Running gait analysis
Progressive tendon loading exercises
Single-leg stability training
Mobility work when appropriate
Manual therapy and dry needling as needed
Focused Shockwave Therapy for chronic, stubborn injuries
Gradual return-to-running programming
Rather than stopping all activity, many runners can continue training with temporary modifications while their tendon becomes stronger. This could mean continued running at modified mileage and intensity, or cross training on a bike or elliptical. Most runners begin noticing meaningful improvement within 6–12 weeks, although recovery timelines depend on symptom duration, the individual, and the severity of symptoms.
Don't Let a Small Ache Become a Season-Ending Injury
Fall race season should be exciting, not frustrating or scary. If you're dealing with deep butt pain, sit bone discomfort, or inner thigh pain during your runs, then addressing it now can help prevent week or months of lingering symptoms.
At Boulder Sports Physiotherapy, we help runners identify the root cause of pain, build stronger, more resilient tendons, and return to training with confidence. Whether it’s performing a gait analysis, using shockwave therapy to speed up the healing process, or programming an individualized loading program - we can help keep you doing what you love for as long as possible. Schedule an appointment to start your healing journey today!
Frequently Asked Questions
Can I keep running with proximal hamstring pain?
Often, yes. If pain remains relatively mild (generally ≤3/10 during running) and does not significantly worsen over the following 24 hours, many runners can continue training with temporary modifications. A physical therapist can help determine safe training loads.
Should I stretch my hamstring?
Not necessarily. Aggressive stretching of an irritated proximal hamstring tendon may increase symptoms. Early rehabilitation typically emphasizes improving tendon capacity through strengthening rather than prolonged stretching.
How long does recovery take?
Most runners improve within 6–12 weeks with a structured rehabilitation program, although symptoms that have been present for several months often require longer recovery.
Will I need imaging?
Usually not. A thorough clinical examination is often enough to diagnose proximal hamstring or adductor tendinopathy. Imaging is generally reserved for cases where another diagnosis is suspected or symptoms fail to improve.
References
Aicale, R., Tarantino, D., & Maffulli, N. (2018). Overuse injuries in sport: a comprehensive overview. Journal of orthopaedic surgery and research, 13(1), 309.
Witvrouw, E., Mahieu, N., Roosen, P., & McNair, P. (2007). The role of stretching in tendon injuries. British journal of sports medicine, 41(4), 224–226. https://doi.org/10.1136/bjsm.2006.034165
Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J., & Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283.
Williams, B., & Gyer, G. (2025). Tendons under load: Understanding pathology and progression. Journal of Musculoskeletal Surgery and Research, 9(3), 393-402.
Rich, A., Cook, J., Hahne, A., & Ford, J. (2025). Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary. International journal of sports physical therapy, 20(6), 892–910. https://doi.org/10.26603/001c.138308
Hölmich, P., Nyvold, P., & Larsen, K. (2011). Manual therapy or exercise therapy for long-standing adductor-related groin pain: A randomised controlled clinical trial. Manual Therapy, 16(2), 148–154. https://doi.org/10.1016/j.math.2010.09.001