A common complaint we get from a wide variety of patients, whether they are high-level athletes or people getting back into an exercise routine, is that they experience a snapping or popping sensation in the front of their hip with activity. It can range from a small “click” to a deep “thud” kind of sound and for the most part they have no idea why it happens.
Well, there is actually a name for the condition, aptly called Snapping Hip Syndrome and if affects about 10% of the general population. Snapping Hip Syndrome seems to happen more often in people who participate in activities involving repetitive hip flexion and extension, such as running, dancing, and soccer to name a few activities.
There are several sources of the snapping sensation whether it comes from the outside of the hip, inside of the hip (groin area), or from within the joint itself.
Snapping from the outer portion of the hip is the most common cause of Snapping Hip Syndrome. Typically the snapping happens when the iliotibial (IT) band is under tension and moves over the greater trochanter of the femur. Usually, this is something that develops over time but there could be a minor trauma to the hip (i.e a fall) that could cause it.
Someone who develops these symptoms may have a prominent greater trochanter of the femur, scar tissue formation, or a history of knee instability from previous injuries or surgeries. When the hip snaps through the groin area, typically the iliopsoas muscle (or hip flexor) moves over a bony piece of the pelvis as the hip moves forwards and backwards, such as in running or squatting.
Typically this type of snapping hip also develops over time and can be quite uncomfortable, while the clunk can usually be heard. Finally, if the clicking comes from within the joint itself (the least common) we would suspect a potential labral tear or recurrent near dislocations (subluxations) among other things. Usually, these types of injuries require trauma or some other mechanism of injury.
Treatment for Snapping Hip Syndrome
Typically if the snapping hip is painful, which isn’t always, conservative treatments such as physiotherapy are the best options. Really we would treat it like we would tendonitis, which would include rest, ice, and anti-inflammatories.
In terms of physical therapy, the first thing we would do is assess the hip and see where the snapping is coming from. Since the main causes are related to tension in the hip flexor or IT band, usually we’ll begin by trying to loosen up the front of the hip.
This could include several types of treatment such as stretching, active release therapy, dry needling, or other myofascial release techniques. From there the next step is to develop an exercise program to improve the muscle balance around the hip to reduce the impact of the repetitive strain on the hip flexors and IT band.
The exercise program would include strengthening exercise for glutes (i.e clamshells, bridges), hamstrings, and core muscles. Usually, we begin with very basic exercises to make sure the proper muscles or doing the work and then progress to more dynamic and functional exercises from there. In severe cases injections (i.e. cortisone or lidocaine) or surgery (usually if the symptoms or coming from within the joint).