Pilates Technique Thursday: Supporting a Return to Running with FAI and Menopausal Hip Pain

Post-menopausal hip discomfort can affect daily mobility and return to activities like running.

As Pilates teachers, we often find ourselves working with clients navigating life transitions and injuries at the same time. One common example is women returning to running after menopause who are also dealing with Femoroacetabular Impingement, or FAI. Understanding this link can make a big difference in how we support our clients back to movement with confidence and control.

What is FAI?

Femoroacetabular Impingement is when extra bone growth at the hip joint causes abnormal contact between the femur and the socket. This limits mobility and causes pain, especially with flexion and rotation of the hip. For runners, this means discomfort during lifting the knee or pushing off the ground. If untreated or unmanaged, it can wear down cartilage and lead to more serious joint damage.

How Menopause Affects the Hips

Menopause brings hormonal changes that impact connective tissue, bone density and muscle recovery. Lower levels of oestrogen reduce collagen, affecting the stability and resilience of joints. Many women also experience changes in posture, gait and even fat distribution, which can all affect how pressure is absorbed through the hips when running.

This combination means that even if a client has been a runner all her life, the same activity post menopause may feel very different and may even trigger pain, particularly if there is a pre-existing issue like FAI.

Movement Strategy for Pilates Teachers

We are in a unique position to bridge the gap between rehabilitation and performance. Pilates offers a controlled environment to rebuild strength, mobility and alignment before returning to higher impact activities.

Here are five focus points to bring into your teaching:

1. Gluteal strength and hip stabilityUse side-lying leg series, standing leg work and bridge variations to target the glutes and improve control around the pelvis.

2. Pelvic alignment and movement awarenessIncorporate imagery and hands-on cueing to help clients understand their natural posture and how it may be affecting their gait.

3. Hip mobility without compressionFavour open chain movements and supportive equipment like the Reformer or Cadillac to explore safe ranges without aggravating impingement.

4. Breath and pelvic floor connectionReinforce breath-led movement and help clients connect to their deep core, especially important after menopause when changes in pressure management can affect posture and joint health.

5. Progressive loading strategiesEncourage a slow and smart return to impact. Pilates sessions can gradually introduce dynamic movement to mimic the running stride without the immediate stress of running itself.

Final Thoughts

Returning to running is possible for many clients with FAI or menopausal-related hip pain, but it requires a plan. As Pilates teachers, our skill lies in teaching precision and control, helping clients feel supported in their bodies, and ultimately, giving them the tools to move with freedom.

By understanding the mechanics and layering in mindful movement, we become an essential part of their return to doing what they love.