Updated: May 5, 2022
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