Snapping hip syndrome is a condition that causes a snap or pop sound in the hip area with everyday hip movements. Sometimes, the snap can be accompanied by pain. So what is snapping hip syndrome, how do we diagnose it, and how do we manage clicking hip syndrome?
What is snapping hip syndrome?
Snapping or popping the hip often occurs with everyday activities such as walking, running, getting out of a chair, and swinging your legs around. In most cases, the snapping is due to a tendon and is harmless and annoying. However, in some cases, the snapping may be due to cartilage or labral injury in your hip joint. Generally, we should differentiate between internal and external snapping hip syndrome.
Causes of clicking hip syndrome
Snapping can occur anywhere in the hip where a muscle or tendon rubs against a prominent bone. This rubbing occurs at different sites around the hip joint:
- Front of the hip: this occurs when tendons at the front of the hip slide against the front of the hip bone. The most common tendon causing snapping is the large hip flexor tendon, the iliopsoas. It comprises two large tendons – the psoas and iliacus tendons. When the hip moves from flexed to the extended position, the two large tendons flip over each other, causing a snap or pop. General hip movements such as walking or getting up from a seated position frequently cause a snap. Sometimes, snapping is associated with pain from inflammation or iliopsoas tendonitis.
- Side of the hip: This snapping occurs as the large iliotibial band passes over the prominent bone called the greater trochanter. This is the most common cause of a snapping hip. When the hip is straight, the IT band lies behind the bone. However, when we flex the hip, the IT band lies in front of the bone. If the IT band is very tight, this movement can cause snapping. This sensation is triggered by running or climbing stairs. Also, pain may occur on the outside due to tendonitis. Sometimes, it might be difficult to lie on the hip at night.
- Intra-articular: Also called internal snapping hip syndrome, snapping or clicking in the hip joint can be secondary to a cartilage tear or labral tear of a loose body. The loose body can get stuck in the joint. Sometimes, these injuries are triggered by trauma.
Generally, those people who are tight or perform frequent hip movements (such as dancers, runners, and footballers) are at risk of snapping hip syndrome.
Diagnosis of snapping hip syndrome
You need a full assessment to confirm where your snapping hip is coming from. Then, your doctor will perform a history and clinical examination.
Usually, the snapping or popping occurs with hip flexion. This may or may not be accompanied by pain. Other symptoms include the inability to continue regular exercise or a feeling the hip is not sitting right or may come out.
Often, we examine to confirm the site of the snapping and whether the snapping is coming from inside or outside the joint. In addition, the hip joint is generally carefully examined to rule out cartilage damage or a labral tear.
Snapping hip syndrome test
There are specific snapping syndrome tests to confirm snapping coming from the outside or the front of the hip. It is essential to feel the snap to help determine where it is coming from.
Firstly, the person sits on the side with the affected side up. The hip is then moved backward and forward to bring on a pop.
Secondly, the person is lying on a table. The affected knee is bent upwards and rotated outwards. The hip is moved back to neutral, and a snap is felt at the front of the hip.
Snapping hip syndrome radiology
In most cases of a snapping hip, we use imaging to provide a precise diagnosis.
An X-ray of the hip is helpful to define the shape of the hips.
MRI shows swelling in the tendons associated with snapping or a labral injury of the hip.
However, dynamic ultrasound can be the most useful. Generally, it can show the movement of the tendons and snapping or popping in real-time.
Snapping hip syndrome treatment
In most cases, a snapping hip is not painful. Reassurance is all that is needed.
Generally, simple treatments are started for painful hips, including rest from aggravating activity, ice, and ibuprofen tablets. Sometimes, massage or soft tissue therapy can help reduce hip tightness.
Snapping hip syndrome exercises
Stretching exercises of the hip flexor, quadriceps, hamstring, and iliotibial band will reduce muscle tightness and snapping with hip movement. In general, you should perform stretching on most days. In addition, yoga can help increase the length of the muscle.
In addition to stretching, strengthening exercises for the glutes, hamstrings, and hip flexors are helpful for controlling stability and reducing abnormal hip movement when walking or running.
Are injections an option?
Overall, injections play a minimal role in treating snapping hips. However, in cases of acute pain, and unresponsive to simple treatments such as ibuprofen, a directed cortisone injection can help. Examples include a psoas sheath injection for an internal snapping hip or an IT band injection for an outside snapping hip.
Generally, we should perform injections under ultrasound guidance to improve accuracy and effectiveness.
You should avoid surgery in almost all cases unless you fail conservative management. Surgical options include hip arthroscopy for labral tears, iliopsoas tendon release for internal snapping, and lengthening of the IT band for outside snapping. However, you must know potential complications, including infection, scar tissue formation, and chronic pain.
Final word from Sportdoctorlondon regarding snapping hip syndrome
Snapping hip syndrome is common in young athletes, especially in dancers. In most cases, we give reassurance. However, in cases that involve pain, rehab exercises are effective. Finally, we suggest ultrasound-guided injections in challenging cases.
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