How can I manage pelvic pain as a runner?

Pelvic pain and running are not a great match, and they shouldn’t have to be. So it’s great that you’re looking for ways to manage this and stay out running on the trails comfortably.

We all know how hard it is to run with any sort of pain or niggle, and pelvic pain is no different. In fact, I would argue it can be even more challenging. Depending on the type and cause, pelvic pain can be persistent, complex, and at times incredibly debilitating - which can take both a physical and emotional toll.

When I get a question like this, my first thought is always: what type of pelvic pain are we talking about? There are many different types, all with different drivers and management approaches. For example:

• Is it related to a musculoskeletal injury, such as a groin strain, gluteal strain, or tailbone irritation?
• Is it pelvic girdle pain during pregnancy, often felt at the front or back of the pelvis?
• Or is it chronic pelvic pain associated with conditions such as endometriosis?

For the purpose of this blog, I’m going to focus on chronic pelvic pain, but I’d be more than happy to expand on pregnancy related pelvic girdle pain or acute pelvic injuries in another post.

Chronic pelvic pain is often linked with conditions such as endometriosis. Endometriosis affects around 1 in 9 women and can take many years to diagnose. One of the hallmark symptoms is pain in the pelvis, lower abdomen, and lower back. While this pain is often cyclical, many people experience symptoms for a large portion of the month - especially after years of ongoing inflammation and sensitisation of the nervous system.

This is often where things can become tricky with running.

You might see advice about training around your menstrual cycle or pushing performance at certain times of the month. But when you’re living with pelvic pain, your body doesn’t always follow a predictable pattern, and trying to force it into one can be frustrating and disheartening.

So how can you manage pelvic pain and continue running?

1. Let symptoms guide your training - not just your cycle

Cycle tracking can be helpful, but it shouldn’t override how you’re actually feeling. If your pain tends to flare during menstruation or ovulation, it may not be the best time for high intensity sessions or long runs. Adjusting your training is not losing progress, it’s working with your body.

2. Track patterns over time

Keeping a simple log of your pain, cycle, training load, stress, and sleep can be incredibly helpful. Over time, this can reveal patterns and triggers, allowing you to plan more effectively and feel more in control.

3. Have a ‘flare up’ plan

Put systems in place for when pain increases. This might include:

• Gentle mobility or stretching for the hips and lower back
• Heat packs for symptom relief
• Adjusting gym exercises that aggravate symptoms
• Booking in for hands on treatment or support when needed

4. Address the whole picture

Chronic pelvic pain isn’t often just isolated to one tissue such as muscles, and it often involves the nervous system becoming more sensitive over time. Stress, fatigue, and emotional load can all influence pain levels. Supporting your overall wellbeing is just as important as the physical side.

5. See a women’s health physiotherapist

I can’t stress enough how helpful this can be. A thorough assessment can identify contributing factors such as muscle overactivity, weakness, load intolerance, or movement patterns - and guide a personalised plan to keep you running.

6. Involve a wider health care team

If your pain is worsening or not improving, it’s important to speak with your GP or a gynaecologist. A multidisciplinary approach is often key, particularly for conditions like endometriosis.

Conclusion

Running with pelvic pain can feel frustrating, unpredictable, and at times isolating - but it doesn’t mean you have to give it up altogether.

With the right support, a flexible approach to training, and a better understanding of your body’s patterns, many people can continue to run in a way that feels manageable and enjoyable.

Remember - your training should adapt to your body, not the other way around.