The marathon is at the top of many runners’ “must do” activities list. An increasingly large number of people embracing running for recreational and competitive reasons. Although running is a great stress buster and has many cardiovascular benefits, it is presumed to cause injuries in the lower extremities. Most running injuries related studies have focused on the knee health of the runners, but very less is known about the effect of long-distance running on the hip health of the runners. Advances in hip injury management and diagnostics have been limited due to the absence of sophisticated diagnostic tools that are sensitive and specific enough for the early identification of pathogenesis in the hip joints.

Researchers led by Dr. Laura Maria Horga and Professor Alister Hart from the University College London, along with Mr. Johann Henckel, Dr. Anastasia Fotiadou and Dr. Anna Di Laura from the Royal National Orthopaedic Hospital, London, UK, and Dr. Anna Hirschmann from the University Hospital Basel, Basel, Switzerland, used advanced 3.0 Tesla MRI technique to evaluate the health status of the hip joints of inactive non-runners, moderately active runners, and highly active runners. To this effect, bilateral hip 3.0 Tesla MRIs were done for fifty-two asymptomatic individuals. The MRI findings were scored by two independent musculoskeletal radiologists using a validated scoring system. In addition, the individuals also rated their perceived hip function in a self-assessed Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire. This research was published in the journal BMJ Open Sport & Exercise Medicine.

This prospective cohort study found no major hip injuries in moderately active and highly active runners compared to non-runners. Particularly, according to MRI findings, researchers have concluded that there were no major differences among inactive non-runners, moderately active runners, and highly active runners in the number of labral abnormalities, articular cartilage lesions, tendon abnormalities (Figure 1), ligament abnormalities.

Figure 1: Tendon MRI signal (arrow) of identical size in a moderately active runner (A) and a highly active runner (B);

Only a few small bone marrow findings were more common in some runners than in non-runners, but these were pain-free and were not of clinical concern.

Also, in contrast with the popular belief that highly active runners may be most predisposed to cartilage and subchondral bone marrow injuries, it was, in fact, reported that highly active runners did not have any articular cartilage lesions or bone marrow oedema.

Moreover, HOOS questionnaire scores suggested that there were no self-reported hip symptoms or functional problems among the three groups of participants.

Dr. Laura Maria Horga, who is a corresponding author of the paper, said: “This study is the first to assess hip health in asymptomatic runners using large sample size and high-resolution MRI technology. Only bone marrow oedema was significantly more common in moderately active runners than in inactive non-runners and highly active runners, while subchondral cysts were significantly more common in runners than non-runners —however, these were minor/small in size and all asymptomatic, non-specific, thus not indicating specific exercise-related strain. The findings help correct popular misconceptions that long-distance running damages the hip joints, and therefore should be taken into account when making health recommendations.”

Journal Reference and image credit

Horga, Laura Maria, Johann Henckel, Anastasia Fotiadou, Anna Di Laura, Anna Hirschmann, and Alister Hart. “3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners.” BMJ open sport & exercise medicine 7, no. 2 (2021): e000997. DOI: 10.1136/bmjsem-2020-000997

Main image credit: Pexel

About the Authors

Social media


instagram: exerciseforscience

twitter: @Running4Science (Exercise For Science)

linkedin: Exercise for Science; Laura Maria Horga

Prof. Alister Hart
UCL chair of orthopaedics and RNOH consultant hip surgeon. Leads research projects on Exercise Science, Implant Science and Surgical Imaging Technology
Mr Johann Henckel
RNOH Orthopaedic surgeon with research interests in Exercise, Implant Science and Surgical Imaging Technology, expertise in robotics & computer assisted surgery
Dr Laura-Maria Horga
UCL Research Fellow in Sports and Exercise Science, biotechnologist with expertise in Running science and Imaging Technology and clinical study organisation
Dr Anna Di Laura
RNOH Surgical Imaging Fellow and BRC Fellow for Healthcare Engineering and Imaging, orthopaedic engineer with experience in Running science
Dr Anastasia Fotiadou
RNOH Consultant Musculoskeletal Radiologist and Clinical Director for imaging services; Honorary Associate Professor at UCL
Dr Anna Hirschmann
Leads the Musculoskeletal Radiology division at University Hospital of Basel in Switzerland