What Is Snapping Hip Syndrome?
Snapping Hip Syndrome is a condition that affects roughly 10% of people. It is thought to affect women more than men, although the exact cause is unknown. Usually, a snapping or popping of your hip is not cause for concern. However, if that snapping becomes painful or limits your movements, then it should be evaluated by a medical professional.
There are three types of Snapping Hip Syndrome. The types are based on the location of the snapping and they involve different anatomical structures.
The first type of Snapping Hip Syndrome is external and it is the most common form. It involves the iliotibial band snapping over the greater trochanter of the femur. The picture below shows the involved structures courtesy of manhattansportsdoc.com
A better view of the iliotibial band (IT band) is shown below:
The IT band originates from your tensor fascia latta (TFL), gluteus maximus, and gluteus medius. It runs down the outside of your leg and attaches into your tibia. The IT band is made of fascia, meaning it is not bone or muscle. It arises from the glutes and TFL which are muscles, but it is simply a long, dense stretch of connective tissue that does not contract.
The TFL and IT band run along the greater trochanter, which is the bony mass at the top of your femur. If there is contact between the IT band and the femur, it can cause a snapping sensation as the IT band rubs against the femur. This snapping typically occurs with flexing and extending the hip forward and backwards. Moving forward and backward causes the femur to move on a relatively fixed IT band. Normally, you do not notice anything, but with Snapping Hip Syndrome, there will be symptoms.
The second type of Snapping Hip Syndrome is internal. The image below shows the anatomy of your iliopsoas which is your main hip flexor. During internal Snapping Hip Syndrome, the iliopsoas rubs along your pelvic bone as shown below courtesy of somaticmovementcenter.com
Internal Snapping Hip Syndrome is most often provoked by moving from hip flexion to extension such as when performing abdominal exercises while lying on your back. Symptoms can also occur when externally rotating your hip by turning it outwards. The pain and/or snapping is felt deep in the front of your hip near your groin.
The anatomical cause of the snapping is the iliopsoas tendon moving along the anterior pelvis while the hip is extending. The iliopsoas is your main hip flexor, so hip extension causes it to stretch. Usually, it glides past the pelvis, but in cases of Snapping Hip Syndrome, there is a brief contact with the pelvis before snapping and releasing backwards.
The final type of Snapping Hip Syndrome is intra-articular and it is the rarest. Intra-articular refers to within the joint and the cause of this condition is an injury to the joint itself. The other types of Snapping Hip Syndrome are typically related to chronic stress. However, intra-articular Snapping Hip Syndrome usually involves a traumatic injury that leads to a hip labral tear or other damage to the capsule.
Symptoms are not consistent with this type of injury because the damage could cause snapping through a variety of movements. Typically, you will remember injuring your hip and this condition will not be a surprise. Physical therapy can be beneficial for intra-articular Snapping Hip Syndrome, but it may require surgical correction.
Snapping Hip Syndrome Test
Tests for Snapping Hip Syndrome are varied depending on the type. However, the most practical way to diagnose the condition is through a history and observing the movement that causes the pain and/or snapping. Individuals such as dancers, gymnasts, and some runners are more likely to suffer these injuries due to the repetitive hip movements. Dance and gymnastics often involve extreme hip flexion and extension, which can stress the IT band and iliopsoas muscles.
Asking the individual where they feel the symptoms is often an effective test. External Snapping Hip Syndrome will lead to relatively localized pain on the outside of the hip, while internal Snapping Hip Syndrome is typically located in the front groin region. A healthcare professional should be able to feel your hip and locate the muscle that is snapping and where in the movement it is occurring.
Testing of the affected muscles can also be important. External Snapping Hip Syndrome involves the muscles that extend and abduct your leg out to the side. Weakness or pain with these movements can help indicate the location of the snapping. The iliopsoas is responsible for hip flexion forward so resisting a straight leg raise on your back is often painful. The image below shows the test courtesy of researchgate.net
Ultrasound imaging can determine if the affected tendon is enlarged or damaged from the trauma. Typically, the repeated injury will lead to inflammation and enlargement of the tendon, which worsens symptoms. An MRI may be beneficial to evaluate the surrounding soft tissue as well.
Snapping Hip Syndrome Treatment
It is important to remember that most cases of snapping or popping of the hip do not require treatment. If anything, activities can be slightly modified to avoid aggravating the snapping. However, snapping, clicking, popping, and many other noises in and around your joints is completely normal as long as there is no pain.
Relative rest is normally required to allow the inflamed tendon to heal. Avoiding provocative positions such as extreme hip flexion and extension may be all that is required. In extreme cases, you may need to limit all lower extremity activities depending on the frequency of symptoms.
Surgery can be necessary in some cases of Snapping Hip Syndrome. When there are intra-articular causes, surgery is more likely to clean out the hip joint and repair any tears. In external or internal conditions, surgery can elongate or even release the affected tendon if conservative care is not effective. However, physical therapy should be the first treatment option as it is very effective in most cases.
Manual therapy can be beneficial to decrease stress on the tissues causing the snapping. Trigger point dry needling can be particularly effective for the iliopsoas or TFL and glutes depending on the condition. Foam rolling and soft tissue mobilization can also provide a good starting point for relaxing the muscles and improving mobility. Image below courtesy of integrehab.com
It is also important to consider the surrounding structures that could be causing stress on the tissues. In internal Snapping Hip Syndrome, poor glute strength can lead to stress of the iliopsoas as it becomes overactive. Also, decreased anterior core strength can cause the iliopsoas to become overly stressed and tighten. A physical therapy evaluation should not only determine the source of pain, but any possible causes in surrounding muscles and tissues.
It is important to be assessed by a qualified physical therapist, as many people make similar mistakes when treating these conditions. The first mistake is to foam roll their IT band. As I mentioned before, the IT band is fascia which does not respond to foam rolling in the same way that muscle does. Fascia does not relax and become more mobile from foam rolling. You are probably just irritating surrounding tissues by rolling your IT band.
Similarly, many people try to stretch their hip flexors to alleviate their pain. Unfortunately, many people are stretching their hip flexors incorrectly, but they also probably need to strengthen them as well. Muscles often become tight because they are weak and simply stretching a weak muscle does not fix the root cause problem.
Snapping Hip Syndrome Exercises
Exercises for Snapping Hip Syndrome are relatively simple once you identify the weakness and cause of the symptoms. If you are suffering from external Snapping Hip Syndrome, then you may need glute strengthening exercises. It is important to progress the exercises as tolerated depending on your symptoms.
The simplest glute exercise is a bridge. Bridging involves lying on your back with your knees bent. You will lift your hips off the ground and squeeze your glutes to propel your hips upward. You should keep your pelvis in neutral to prevent arching your back too much. These can be progressed by holding them for a longer period of time or performing them on one leg. Image below courtesy of coachmag.co.uk
Hip thrusts are another great glute exercise that is a more challenging form of a bridge. They require a weight that you can put across your lap and an elevated surface for your back. You will perform a bridge through a wider range of motion with resistance as shown below courtesy of verywellfit.com.
Another great glute exercise is side steps. This targets the glutes through abduction, which is important for the TFL and IT band. Using any resistance band, the goal is to step as far as you can without swinging your hips to compensate. Go slowly and keep your toes pointed forward. Maintain a slight squat the entire time. The least challenging variation is keeping the band above your knees. If you want a more difficult exercise, move the band to your ankles and eventually to your feet, at the location of your shoelaces. Image below courtesy of wynnfitness.com
There are many other glute exercises including squats and deadlifts that you can progress as your symptoms decrease.
Hip flexor strengthening for your iliopsoas is often overlooked. It can be beneficial for internal Snapping Hip Syndrome. The most basic movement is lying on your back and marching. Keeping your lower back on the ground, bend your knees and lift one leg at a time. Bending your knees should take pressure off of your iliopsoas to avoid snapping with the movement. If this is easy, you can add a band around your feet to provide some resistance. Image below courtesy of happyhealthyme.org
Lift offs are another great exercise for hip flexion. They help introduce standing and gravity, but the movement is minimal. However, you are improving end-range hip flexion which is an often neglected motion. To perform this exercise, find a bench or similar structure that you can place your foot on and create an approximately 90 degree angle of your knee and hip. Without moving the rest of your body, lift your foot off of the surface as high as possible and hold for a second. Slowly lower back down. This can also be more difficult by tying a band around your foot and the bench. Image below courtesy of balanceinmotion.com
Finally, standing marches are an excellent way to strengthen your iliopsoas through its entire range of motion in standing. Find a wall to hold onto and perform slow marches, one foot at a time. Adding a band around your feet can make this exercise surprisingly difficult to control slowly. Try this to really target your iliopsoas. Image below courtesy of skimble.com
I have provided some basic strengthening exercises for the front and back of your hip. These exercises can be used to address the tight and weak muscles that may be causing Snapping Hip Syndrome. It is important to be assessed by a healthcare professional to determine if there are other causes for your symptoms.
As always, if you are suffering from pain, nerve symptoms (numbness, tingling, or weakness), or anything else significant, please see a healthcare provider. This blog is meant to be educational and is not a substitute for medical advice.
Hopefully you learned something about femoroacetabular impingement and its symptoms and treatment. If you have interest in other hip injuries, check out our hip page. If you found this blog helpful, please share it with someone. We hope to continue to grow and help people better understand how our bodies move and work. If you want to subscribe so that you don’t miss any other posts, click the sign in button on the top right of this page. Once you have created an account, click the drop-down menu in the top right next to your name and go to your settings page. Click the subscribe button next to “Blog Subscription” and you won’t miss any future posts! If you are in the Sterling, Virginia area and would like to work with me or you have any questions, please email me at danny@eclipsewellnessnova.com or follow me on Instagram or Twitter @drdannydpt.