Before we can appreciate how to alleviate hip pain while walking, we need to discuss what causes hip pain.
–
Common reasons for hip issues
Here are some common things people will say are causing their hip pain:
Structurally people will go:
-
- Labral tear
- Femoractebular impingement (FAI)
- Bursitis
More generally people will go:
-
- “I get this aching in the front and or the side of my hip.”
- “I feel this catching / clicking / pinching when I bring my leg up too high or back too much.”
- “My hip snaps during certain movements.”
Let’s make this easier: When it comes to the hip, pain is nearly always centralized to the front of the hip / groin area. There may be pain on the outside too, but hip issues disproportionately manifest in the front of the hip.
–
What causes the causes of hip pain?
Bursitis, tendinitis, clicking, pinching, etc. are not causes of pain; they are symptoms. What causes the labral tear? What causes the snapping? That’s what we need to address. In other words, why do we get pain in the front of our hips?
–
Simple anatomy talk
When it comes to anterior hip pain, a common issue going on starts at the top of the leg, the femoral head.
The muscles acting on the femoral head are not working optimally. Therefore, the femoral head acquires a tendency to travel too far forward, too often.
It travels too far in the direction of where we typically get pain. Where are most labral tears? Where do people feel clicking, pinching, snapping? The front of the hip. Right where the femoral head is moving too much.
So, when trying to alleviate hip pain, we want to implement things which limit the amount of force in the anterior direction. We want to eliminate the amount of stress on the front of the hip as it’s already stressed too much, hence the pain.
–
“What do I need to make stronger?”
The first question people inevitably ask is what muscles do I need to make stronger? I’ve extensively gone over which muscles need to be trained when hip pain is present here and here. That’s not the point of this post though. We’re dealing with hip pain while walking. Therefore, we need to talk about walking.
One of the muscles I’ve gone over training wise is the glutes. The glutes help pull the femur backwards, helping to avoid the excessive forward travel in hip issues.
Because of this, and the plethora of information out there about the glutes not being activated enough, it’s often advocated to squeeze the glutes during walking. Something like, “Each time your heel hits the ground you should squeeze your butt.” Over the years I’ve played around with this. In my experience, it just doesn’t work well. People have enough trouble squeezing their glutes during something like a prone straight leg raise.
–
Asking them to do it while walking is simply too hard.
Also, while getting the glutes to fire better during walking may help the excessive anterior glide, it’s not diminishing the overall work (stress) at the hip. Because of these factors I’ve gone to a different method.
–
The relationship between the ankle and the hip during walking
To simplify things we’re going to say while walking we have the hip, knee and ankle joints. (I say simplify because aspects such as arm swing can contribute, but we’ll ignore that here.) These three joints, and the muscles acting on them, help us do the work to get from point A to point B.
Let’s say it takes 100 units of work for us to get somewhere. Therefore, the ankle, knee and hip joint have to combine to give us 100 units. To get there, it doesn’t matter if the ankle does 10%, knee 40%, and hip 50%. Pretty much as long as all 100 units are attained, we’ll get there. In terms of being in pain though, how we get there matters very much.
Back to our cause of hip pain: Too much stress primarily on the front hip structures. This gives us a plausible way of lessening hip pain while walking: Diminish the amount of stress on the anterior hip. How do we do that? Get the other joints to do more work.
Now, the knee doesn’t contribute to walking the way the hip and ankle do. While the hip and ankle primarily help us propel into each stride, the knee primarily helps us slow down from each step. The hip and ankle have a propensity to produce force, the knee a propensity to receive it. Because the ankle and hip serve similar functions, by getting the ankle to do more work we can diminish the amount the hip does. Diminish the amount of work on the hip = diminish the amount of stress on the hip = diminish the amount of pain in the hip.
–
How do we get the ankle more involved?
Pretty simple. Each time you take a step think, “Push off from my ankle more.” Other ways to think of this are, “Lift my heel off the ground higher,” “Lift my heel off the ground quicker,” “Walk with a little bounce in your step,” etc. Whatever works. The principle is to use the ankle / foot / calves more than you normally would. Essentially we’re trying to do more of a calf raise with each stride.
–
Visualizing why this works
Let’s diagram this out a bit more. Here’s a person whose right foot just hit the ground during gait:
From this point the leg is going to travel backwards a bit, then need to swing forward.
What needs to happen to swing the leg forward? Plantar (foot) and hip flexion. The ankle and hip both need to lift.
By having a greater focus on the ankle the achilles can serve as a nice spring all the way up to the hip.
The hip can “come along for the ride” due to the momentum from the achilles.
–
The achilles tendon
Some people may think, “Ok, we’re helping attenuate stress at the hip, but aren’t we adding a bunch of stress to the foot? Could this cause foot pain?” This is unlikely because the main component of the ankle helping our push-off here is the achilles tendon. Tendons are made for this type of work (elastic / springlike movements).
–
More anatomy
(Again, more extensively covered elsewhere on the site.)
A big component of hip pain is an imbalance in the hip flexors. Pretty much all the hip flexors become too active except for the psoas.
The psoas is one of the muscles helping to keep the femoral head nice and snug so it doesn’t travel too far forward.

Credit to research paper “Effect of position and alteration in synergist muscle force contribution on hip forces when performing hip strengthening exercises”
If you take someone who is lacking push off while walking they’re more likely to use excessive hip flexion (that reciprocal relationship we’ve been talking about). The issue here is while walking all this work happens below 90 degrees of hip flexion. The psoas gets the most amount of work above 90 degrees…Excessive hip flexion work during walking therefore either 1) Feeds into or 2) Causes our hip dysfunction and imbalance.
–
How to spot someone with poor ankle push-off
Analyzing push-off in the midst of walking is not easy. There are some other non-walking ways which can be indicative of what happens during gait.
Position of the feet / ankles
Are the feet pointed out (everted)?
Are the ankles rolled in (overpronated)?
These are two very good signs the person has trouble with push-off.
Calf size
Another easy method is to assess calf size. Do they look atrophied? Is one significantly smaller than the other?
Here’s a a guy who had surgery on his right foot a few years ago. Watch closely as he does some heel raises. Notice 1) The size of his right calf (smaller than left) and 2) How the foot wants to turn out / roll in.
–
Now let’s watch someone from the side. When the plantarflexors -such as the calves- aren’t working optimally the person may also compensate with knee and hip extension in order to “get up.” Notice the trouble this woman has despite my continued cueing.
–
Contrary to the internet world, dorsiflexion is not the only issue at the ankle; proper plantarflexion is just as important.
–
Bringing footwear into play
Back to our achilles tendon. Look at someone standing barefoot.
Let’s raise their heels up. Much like heels or sneakers with a high heel lift would do.
Notice how the achilles tendon gets shortened?
If we think of the achilles tendon as a rubber band, how does a rubber band get launched? By getting pulled back.
Higher heeled shoes can limit how much the achilles tendon can be stretched, thereby eliminating how much the tendon can help us propel (launch) ourselves during walking. And what happens if we limit how much work the achilles / ankle can do during walking? We increase the amount of work the hip has to do.
We saw how heels affect the position of the achilles, but look at what they do to the knees and hips as well.
Lifting the heels also makes it more likely the person will stand (and walk) with the hips and knees in excessive extension. This is important because hip extension puts the anterior hip structures under more stress. When the leg moves backwards into extension is when the femoral head is more susceptible to moving too far forward.
(Of course the degree of lift matters here. A little heel lift is rarely worth worrying about.)
Thus, it’s probably a good idea to get rid of the heels and bulky shoes.
–
Treadmill considerations
I bring up treadmills because I know a lot of people get their walking done on one. Something I don’t think gets enough attention is the differences between being on a treadmill and being on regular ground.
Once you get to the point where you’re over 4mph on a treadmill is when problems seem to begin. 4mph is typically where people go from a brisk walk to a very fast walk / running. Because we’re talking about walking with hip pain, this is for being on a treadmill below 4mph. (And that’s probably as fast as most people should go anyways.)
One of the main concerns with a treadmill is the tread helps a person move their leg backwards, but the person still has to do the normal amont of work to bring their leg forwards. Because of this discrepancy it’s conceivable an imbalance between the hip extensors (bring leg back) and flexors (bring leg forward) could arise.
When comparing treadmill walking to regular, here’s what you seem to find:
- In terms of timing, not much is different. Stride length, cadence, etc. stay very similar.
- Same goes for range of motion. However much you flex your hip on ground is about how much you do on a treadmill.
- Slightly greater moments at the hip. (Basically a bit more work is being done at the hip.) This isn’t ideal when dealing with hip pain, as we’ve gone over we want to diminish things like this.
- There are quite a few differences in muscle activation patterns. Perhaps most interestingly, if you look closely at the numbers many of the muscles we want to activate more, like gluteus maximus, become more active, and muscles we want to calm down, like the hamstrings, become less active…both while on a treadmill.
- However, the rectus femoris (hip flexor) becomes quite a bit more active on the treadmill.
So when getting on a treadmill we have a few things in our favor and a few things that aren’t.
My thoughts at this point are: When getting a person on a treadmill, if we get the person to focus on the ankle push off we’ve been talking about, that should help diminish 1) The extra hip moment present and 2) The extra rectus femoris action. How much? I’m not sure. But we should get a good effect. Then we still have the added benefits of better glute activation, less hamstring activation, and the ancillary aspect of it’s easier to focus on your walking form while on a treadmill.
–
Summing up
- Hip pain is primarily caused by excessive stress on the front of the hip.
- We can relieve hip pain by walking with a greater focus on using the ankle / foot / calf complex.
- High heeled shoes are not ideal for making this transition.
- Walking on treadmills is ok, but be sure to focus on the extra ankle push-off.
–
References (with poignant quotes and charts)
Acetabular Labral Tears (originally found in APTA PT Journal)
Biomechanics of overground vs. treadmill walking in healthy individuals
Effect of Hip Angle on Anterior Hip Joint Force during Gait
“The maximum anterior hip joint force occurs just before the hip reaches its maximum hip extension angle, further implicating an interaction between anterior hip force and hip angle. “
It pays to have a spring in your step
Walking with Increased Ankle Pushoff Decreases Hip Muscle Moments
Wholistic Running
June 13, 2013
People need to relearn how to walk. Chi Walking and Chi Running does just that. You’ve gotta look into it!
reddyb
June 13, 2013
Dear Chi / Wholistic running people,
If any of you would put a worthwhile comment on my site, something more than “Chi Running is the shit, trust me, check it out,” I may do so. Until then, stop spamming. I’m not going to let you put a link on my site just so you can increase your google ranking or whatever it is you’re trying to do.
Barbara Carter
June 16, 2013
Well, the squeezing the glutes has helped me so much. I don’t know how I would be doing without this lesson. I practice it all the time. If I am not using the glutes or the cane, I am limping. I do work a lot with the ankles like you say here, but even this does not work without the glutes. I had never learned about these muscles before. I was thinking about asking you for some more exercises for these butt muscles. That is why I was on your site today. Anyway, I don’t think you should give up teaching this. These are some lazy stretched out muscles that aren’t doing their fair share. I learned that from you. Thanks. I am pretty sure I would have a permanent limp without this practice.
reddyb
June 17, 2013
Hey Barbara,
It’s not so much I’ve abandoned focusing on the glutes, it’s more I approach it in a different manner now.
Typically what I’ll do is have the glute focus be during the Prone Straight Leg Raises (video above). Because of how similar this movement is to hip extension during walking, I find there can be a nice transference. Then, during actual walking, I’ll shift the focus to the foot / ankle due to much of what I discussed above.
Of course, some approaches work better for others. If someone feels they benefit as much as you say from a certain approach, it can be hard to advocate something different.
Either way, glad to hear you’ve made so much progress with that limp!
Nick
January 6, 2014
Hi reddyb,
I’ve practised the gait technique you mention to try and resolve hip pain on my right side (fai/torn labrum/I suspect glide) however when trying to double bang for buck like Barbara, I aggravated my right hip by squeezing the right glute, have you heard other reports about this? It seems squeezing my glute fires up my hip flexors on my right side also…which I though was impossible given antagonist nature!
Thanks,
Nicm
reddyb
January 6, 2014
Hey Nick,
In hip pain, squeezing the glute can definitely flare things. I wouldn’t recommend it with your hip history. At least not in this fashion. Just squeezing the glute in stance can push the femoral head forward.
My focus would likely be more on the ankle push off. Remember, don’t go crazy squeezing the shit out of your muscles. You merely want to gently change how some things are done. If you’re straining, you’re probably trying too hard.
Ignore the antagonist nature. Anatomy is more complicated than that. I’ll use an upper body example.
The biceps and triceps, opposing muscles, right? When one contracts the other has to relax, right?
So, if I flex my elbow, I’m using my biceps and my triceps is relaxed. Well, what if I flex my elbow and pull my arm backwards at the same time (humeral extension)? Then my biceps is flexing my elbows and my humeral extensors are working. What’s one of the humeral extensors? The long head of the triceps. Thus, (part of) the triceps is working and the biceps is working.
I have a whole thing about anatomy being trickier than people make it out to be, using the glutes as a primary example, here if interested: http://b-reddy.org/2013/11/20/rethinking-how-and-why-youre-training-your-glutes/
Worry much more about how you move than working one particular muscle. This is why I’ve gravitated much more to the push off cue than the glute squeeze cue. The former is more concerned with movement; the latter with working a particular muscle.
Wholistic Running
June 17, 2013
I’m not spamming. There’s zero chance my comments on this site will get me a student in Montana. I say it because I want YOU to check out Chi Running. I think you’d really like it and agree with it. Sorry if you aren’t into learning about something with great benefits. The science and research shows it works. Thanks!
Blaine Pullin
December 31, 2013
Thank you for the in depth info. I’ve started hitting the treadmill daily (doctor’s orders) and have developed pain in my right hip. I do raise the incline and keep the speed up to around 3.3 mph. I look forward to fixing my stride as you’ve stated. I am also going to try to hit the nearby walking track when weather allows which will help with normal walking motion.
reddyb
January 1, 2014
You got it. Best of luck Blaine.
Donna
October 11, 2014
I’m a 65 year-old active (or at least I used to be) female and have had a limp for almost 3 years due to a tennis injury followed by a tight and painful IT and/or TFL, and have been told I have tight hip flexors. No knee pain, just extreme pain down the side of my leg, especially if I try to lift the leg to the side in a bent position, such as in a hydrant exercise. I’m also aware of glute tenderness from time to time. Can’t climb steps without support or walk normally for a few steps after rising from a seated position. MRI arthrogram showed a glute medius partial thickness tear, but I have a feeling that was there somewhat before the tennis injury (a sudden forward lunge that went too deep), and was made worse by the lunge injury. I’m trying to avoid surgery to repair the glute medius, but am wondering, can the glute medius be strengthened while it has the tear? I’m doing ART and PT 3 times combined a week, but I’m losing muscle mass due to not being able to exercise the way I used to. I’m afraid of getting to the point of no return. Since I have some minor pain with every step I take, I recently started using a cane with the idea to take away weight-bearing on my injured side for a few weeks so it can rest and perhaps have a chance to heal. My doctor disagrees. Do you have any thoughts or suggestions on the direction I’m taking to recover my active life?
reddyb
October 14, 2014
Hey Donna,
If you have pain during every step, and can’t mitigate that through how you walk, then a walker may be what’s best until things calm down. Same thing would go for any exercises you’re doing. If they hurt, they need to either be modified, or cut out until things calm down. You do want to be moving, but not through pain.
Donna
October 14, 2014
Ok, thanks, and I forgot to mention how much I enjoy reading your articles. You obviously enjoy what you do, and take a lot of time doing it to help a lot of people!
reddyb
October 15, 2014
Thank you, I appreciate it.
Sam
February 25, 2015
Thank you for your detailed posts about hip pain.
I am bit confused, though..You say that excessive hip flexion (below 90 degrees of hip flexion, which is what normally happens to the leg that steps forward during walking) and hip extension (which is what happens to the back leg during walking) both contribute to anterior hip pain. I don’t understand..what movement is not flaring things up? The same is true for standing.
To sum up, what is the correct cue for butt while standing, walking and sitting?
reddyb
February 26, 2015
Hey Sam,
You may want to reread things. I go over cueing the butt, why you probably don’t want to do that, and why you probably want to be cueing for the ankle instead. Because the ankle can influence how much work the hip is doing into flexion below 90 degrees.
Better ankle push-off -> Less hip flexion work below 90 degrees.
Riley
October 2, 2020
Thank you for this post. You might have helped me figure out my Constant severe ankle/foot pain of 2 years with intermittent hip/groin pain and rare Anterior/medial knee pain.
So far 2 orthos, 3 PTS and a GP have not. Excruciating. Especially while weight bearing.
Everyone has focused on “strengthen your glute medius, do these ab exercises, do these hip flexor exercises, do these right Side open book thoracic rotations). After 6 months of PT, 3x per week I am no better off.
And yes, I have lateral hip shift and hip rotation but its weird. Normally, I appear that my hips are rotated right, with right lateral hip shift, Neck bent over to left, shoulders to left and bent over to right. If, I release my right QL it all becomes opposite, but not for long.
Also, have external tibial torsion and left foot’s heel whips in when walking and I walk on the lateral edge of right foot with right arch kept much higher than left. Walking on toes seems to help the ankle/foot pain some. Barefoot or flatter shoes is painful.
Right calf has now lost muscle mass over 2 years due to the extreme right side foot, ankle, hip, groin pain in weight bearing. I do have right side neck, face, ear and back pain too.
Supposedly, hip, back mris are good with finding of mild left scoliosis at L3, right disc bulge and tear at L3/4 and 4/5 and Tarlov Cysts at right S1.
Ankle xray was negative at Urgent Care. Foot pain seems to be in the navicular area with radiation.
b-reddy
October 5, 2020
Hey Riley,
Glad to hear the post may have been of help, though sorry to hear you have so much going on.
As a brief FYI, sometimes people, whether the person having issues and or those they’re working with, can get wrapped up in “strengthen this; stretch that” but forget to focus on moving differently. For instance, if you have a lateral hip shift while walking, just because you go strengthen your glute medius doesn’t mean that’ll go away. You likely also need to practice walking in different ways, without letting that hip shift occur.
Good luck.