The Niggle Playbook - name it, then train around it!
Trail Notes | Female Athlete Health
name it, then train around it
The Niggle
Playbook.
Most of the joint complaints that interrupt a trail runner are not the start of something catastrophic. They are recognisable, nameable conditions, and each one has a known way through. Knowing which is which is half the battle.
This is a quick-reference guide to the four joint niggles we see most often in female trail and ultra runners, plus a clear-eyed note on true arthritis. It is here to help you recognise what you are feeling and know the first sensible steps, not to replace assessment by a physio or doctor.
One thread runs through every entry below: load management settles the flare, and strength keeps it from coming back.
Rest calms a niggle down. Strength is what actually fixes it.
For almost every condition here, the long-term answer is a stronger hip, not a longer break.
Niggle · 01
Patellofemoral pain (runner's knee)
The most common overuse complaint in female runners. Pain behind or around the kneecap that gets worse with downhill running, stair descent and long periods of sitting. It is driven by a larger Q-angle, the inward drift of the knee, and hip abductors that are not yet strong enough to control it.
First steps
Reduce running volume for a short block while symptoms settle.
Strengthen the hip abductors with clamshells, lateral band walks and single-leg squats.
Lift your cadence slightly to cut ground contact time.
Pause downhill volume until the knee is comfortable again.
Most athletes who commit to the hip strength work see meaningful improvement within six to twelve weeks.
Niggle · 02
IT band syndrome
Sharp or burning pain on the outside of the knee, classically arriving deep into a longer run, often somewhere between 20 and 40 kilometres. Here is the part most people get wrong: the IT band is not a muscle and cannot be stretched loose. The pain comes from compression of the sensitive tissue beneath the band, which worsens with hip adduction and the inward drift of the knee.
First steps
Reduce load and cross-train through the acute phase rather than running through pain.
Strengthen glutes and hip abductors to control the inward knee drift.
Address pelvic drop in your gait, the moment one hip dips as you land.
Foam rolling may ease symptoms briefly, but it is the hip strength and gait change that resolve the cause.
Niggle · 03
Gluteal tendinopathy
Pain at the bony point on the outside of the hip, especially common in perimenopausal and postmenopausal women because declining oestrogen reduces tendon resilience. It is aggravated by sitting with knees together, crossing your legs, prolonged sitting, and hill and stair work. It is often misdiagnosed as hip bursitis, and that distinction matters, because the real fix is loading the tendon, not resting it or reaching for anti-inflammatories.
First steps
Avoid the compressive positions: legs crossed, knees together, long sitting.
Work with a physio on isometric then isotonic tendon loading.
Correct the hip adduction pattern so the tendon is not pinched as you run.
Tendons respond to graded load, not to time off. A guided loading plan beats rest almost every time.
Niggle · 04
Hip and knee osteoarthritis
True structural arthritis, confirmed on imaging, is a different category from the soft-tissue niggles above, and it deserves its own conversation with an orthopaedic team. But the headline often surprises people: for early to moderate hip OA, the evidence supports continued moderate-load running. Cyclical loading helps nourish cartilage, supporting muscle protects the joint, and a healthy body weight reduces the load it carries.
Trail running can actually be kinder here than the road. Variable surfaces, natural walking breaks on the climbs, and lower peak joint forces than continuous road running at the same volume can all make the trail better tolerated.
For knee OA, remember the perimenopause picture. New knee symptoms in your mid-to-late forties are a genuine period of cartilage vulnerability, so address the whole story: strength, load, hormonal context, and a GP conversation if it is appropriate. Athletes with significant cartilage loss or bone-on-bone change should plan an individual approach with their orthopaedic team and physio.
Soft-tissue niggle, or true OA?
Soft-tissue pain tends to be localised, load-related, and responsive to targeted strength.
OA tends to bring deeper joint stiffness, morning ache, and reduced range of movement.
If you are unsure, get it assessed. The label changes the plan.
The through-line · 05
The three levers, every time
Look back across all four niggles and the same framework appears. These are the levers we reach for with every joint complaint in the Her Trails community.
Load
Adjust volume and intensity to settle the flare. Soft trails, more walk:run, fewer back-to-back impact days.
Strength
Hip abductor, glute and single-leg work is the therapy. It is medicine for joint pain, not a reason to rest.
Cross-train
Cycling, swimming and aqua running hold your fitness without compressive joint load. Not a consolation prize.
Her Trails coaching cue
Name the niggle, settle the load, build the strength. If pain is sharp, persistent or unexplained, get it assessed rather than guessing.
The goal is never to run less. It is to run sustainably, for decades.
Recognise it. Manage the load. Strengthen the hip. Cross-train through the worst of it. The next good decision.
a niggle is a message, not a sentence
Written by the Her Trails coaching team
Trail Notes are evidence-informed coaching journals written for women who train, race and run on trails. Made to be absorbed in ten minutes and remembered for a season.
Evidence: Alentorn-Geli E, et al. Recreational and competitive running and hip and knee osteoarthritis. JOSPT, 2017 (PMID 28504066). Mohr M, et al. Sex-specific hip movement during running. Front Bioeng Biotechnol, 2021 (PMID 34235137). Gilmer G, et al. Menopause and cartilage degeneration. Nature Aging, 2025 (PMID 39820791). This note is general coaching education, not individual medical advice. Sharp, persistent or unexplained joint pain should be assessed by a physiotherapist or doctor.
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