What is snapping hip?
Snapping hip is a condition often seen in dancers which results in a snapping noise and feeling around the hip joint. This can either be lateral or internal. Lateral snapping hip is caused by the muscle fibres of Tensor Fascia Lata (TFL) flicking across the greater trochanter (bony protrusion on the upper part of the femur (thigh bone). Internal snapping hip is caused by the Iliopsoas muscle as it flips across the Iliopectineal eminence (front part of the pelvis).
Symptoms of Snapping Hip include:
- A feeling of snapping or clicking on the outside of the hip (lateral snapping hip)
- A feeling of snapping or clicking at the front of the hip (internal snapping hip)
- Sometimes a snapping noise can be heard
- This is not usually painful
The snapping sensation results from the movement of a muscle or tendon (the tough, fibrous tissue that connects muscle to bone) over a bony structure. In the hip, the most common site is at the outer side where a band of connective tissue (the iliotibial band) passes over the broad, flat portion of the thighbone known as the greater trochanter.
When the hip is straight, the band is behind the trochanter. When the hip bends, the band moves over the trochanter so that it is in front of it. The band is always tight, like a stretched rubber band. Because the trochanter juts out slightly, the movement of the band across it creates the snap you hear. Eventually, this could lead to hip bursitis. Bursitis is thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over bone.
Another tendon that could cause a snapping hip runs from the inside of the thighbone up through the pelvis (rectus femoris tendon). As you bend the hip, the tendon shifts across the head of the thighbone; when you straighten the hip, the tendon moves back to the side of the thighbone. This back-and-forth motion across the head of the thighbone causes the snapping.
A tear in the cartilage or debris in the hip joint can also cause a snapping or clicking sensation. This type of snapping hip usually causes pain and may be disabling. A loose piece of cartilage can cause the hip to catch or "lock up."
Most people do not bother seeing a doctor for snapping hip unless they experience some pain. Your doctor will first determine the exact cause of the snapping. You may be asked where it hurts, what kinds of activities bring on the snapping, whether you can demonstrate the snapping, or whether you have experienced any trauma to the hip area.
You may also be asked to stand and move your hip in various directions to reproduce the snapping. The doctor may even be able to feel the tendon moving as you bend or extend your hip.
X-rays of people with snapping hip are typically normal, but they may be requested along with other tests so that the doctor can rule out any problems with the bones or joint.
Is any treatment needed for snapping hip syndrome?
This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern.
Correcting any contributing biomechanical abnormalities and stretching tightened muscles, such as the iliopsoas muscle or iliotibial band, is the goal of treatment to prevent recurrence.
Referral to an appropriate professional for an accurate diagnosis is necessary if self treatment is not successful or the injury is interfering with normal activities. Medical treatment of the condition requires determination of the underlying pathology and tailoring therapy to the cause. The examiner may check muscle-tendon length and strength, perform joint mobility testing, and palpate the affected hip over the greater trochanter for lateral symptoms during an activity such as walking.
If the patient does not respond well to medicine or physical therapy, or abnormal structures are found, surgery may be recommended.
Surgical treatment is rarely necessary unless intra-articular pathology is present. In patients with persistently painful iliopsoas symptoms surgical release of the contracted iliopsoas tendon has been used since 1984.
Both active and passive stretching exercises that include hip and knee extension should be the focus of the program. Stretching the hip into extension and limiting excessive knee flexion avoids placing the rectus femoris in a position of passive insufficiency, thereby maximizing the stretch to the iliopsoas tendon. Strengthening exercises for the hip flexors may also be an appropriate component of the program.
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