Snapping Hip Syndrome

What is snapping hip syndrome?
Snapping hip syndrome is a condition in which the muscles or tendons at the hip “snap” across the upper thigh bone during hip movement. This can occur with either flexion or extension of the hip. It’s often called “dancer’s hip,” but it is known to occur in runners as well. Two variations of snapping hip syndrome have been described and are classified by location of the snapping, either inside the hip joint or outside the hip joint. A snapping sensation can be felt with hip movement and in some cases an audible snapping or popping can be heard. Pain and inflammation can be present after extended exercise. Pain often decreases with rest and diminished activity. Symptoms can last months or years without treatment and can be very painful. With either variety of snapping hip syndrome, inflammation, bursitis, or potential muscle or tendon damage can occur.

The first variation of snapping hip syndrome occurs outside the hip joint, or extra-articular. This is the more common variety and occurs on the outside of the hip. It occurs when the iliotibial band (ITB), the tensor fascia latae (TFL), or the gluteus medius slides across an portion of the upper thigh bone called the greater trochanter. This type of snapping hip syndrome is commonly associated with a tight iliotibial band (ITB) on the involved side, weakness in hip abductors and external rotators, poor lower back/pelvic stability, leg length discrepancy (usually the long side is symptomatic), and abnormal foot mechanics such as excessive pronation.

The second variation of snapping hip syndrome occurs inside the hip joint, or intra-articular. This is less common than extra-articular. It occurs when the hip flexor tendon rubs across the front of the pelvis or a portion of the inside upper thigh bone called the lesser trochanter. The causes are similar to extra-articular snapping hip syndrome but often with an underlying mechanical problem in the lower extremity. In addition, this type of snapping hip syndrome suggests a problem with the hip joint such as arthritis, a labral tear, or ligament tear. The pain associated with internal variety tends to be more intense and therefore more debilitating than the external variety.

How is snapping hip syndrome diagnosed?
Clinical examination and patient history will reveal pain on the front or outside of the hip. An x-ray may be used to rule out other problems such as bone spurs, stress fractures of the femur, and arthritis in the hip joint. An ultrasound can be used to examine the muscles and tendons in the area of pain while the hip is flexed and extended or rotated. On occasion, an MRI is needed to more fully evaluate the hip and upper thigh region.

How is snapping hip syndrome treated?
Treatment for snapping hip syndrome focuses on two main problems: inflammation and faulty biomechanics. Inflammation is best treated with ice, non-steroidal anti-inflammatory drugs (NSAIDs) and rest from activities that aggravate the pain. Addressing faulty biomechanics focuses on improving flexibility and strength in muscles around the hip and in the leg. Alternative training activities can give the hip region a chance to rest and inflammation to resolve. Physical therapy can help reduce local inflammation and improve the strength and flexibility in the hip and leg region. This condition is usually curable with appropriate treatment, or sometimes it heals spontaneously. If it is painless, there is little cause for concern.

When can I return to running?
The goal of rehabilitation is return you to running as soon as is safely possible. If you return to a full training load too soon, the injury may return or worsen. Everyone recovers from injury at a different rate, so don’t compare your rehabilitation to other runners. Returning to running is determined by how well your hip responds to treatment rather than a set number of days or weeks. In general, the longer you have had the symptoms, the longer it will take you to recover. Here are some general guidelines for a full return to running. Keep in mind, not all runners need to stop running, but they may need to merely reduce their training load (distance, intensity, frequency) during the rehabilitation process.

• You should be able to bend and straighten your hip without pain.
• Your hip should not be swollen.
• You should be able to jog in a straight line without limping.
• You should be able to sprint without limping.
• You should be able to perform 45-degree and 90-degree cuts without difficulty.
• You should be able to jump on both legs without pain.
• You should able to jump on the injured leg without pain.

What can be done to reduce the chances of developing snapping hip syndrome?
The most important factor in preventing snapping hip syndrome is addressing biomechanical deficiencies. With optimal strength and flexibility, the chances of developing snapping hip syndrome are reduced. Addressing strength and flexibility can improve anatomical alignment in some cases.

Exercises and stretches

1. Quadriceps stretch: Stand an arm’s length away from the wall, facing straight ahead. Brace yourself against the wall with the hand on the uninjured side. Using the hand on the injured side, grasp the ankle on the injured leg and pull your heel toward your buttock. Keep an upright posture with the hips straight forward and the knees close together. Hold the stretch for 30 seconds. Repeat 3-5 times.
2. Hamstring stretch (lying down): There are two versions of this stretch. Version one is performed by lying down with buttock against the wall close to a doorway. Extend the injured leg straight up the wall. The opposite leg should extend through the doorway flat on the ground. Hold the stretch for 30 seconds. Repeat 3-5 times. Version two is also performed while lying on the ground. Lie with your back on the ground and both legs extended straight. Bend the knee of the injured leg and grasp behind the knee or the front of the shin. Bring it toward your chest. Hold the stretch for 30 seconds. Repeat 3-5 times.
3. Hamstring stretch (standing): Place the heel of the injured leg on a stool or chair anywhere from 12-24 inches high. Keep your hips straight forward. Bend at the hips and lean forward. Hold the stretch for 30 seconds. Repeat 3-5 times.
4. Piriformis stretch: Lie on your back with both knees bent and the foot of your uninjured leg flat on the floor. Cross the leg of the injured leg over the opposite leg. Grasp behind the thigh of the uninjured leg and pull it toward your chest. You should feel a stretch in the buttocks and sometimes on the outside of the hip of the injured leg (the one you crossed over). Hold the stretch for 30 seconds. Repeat 3-5 times.
5. Iliotibial band stretch (Standing forward-lean): Cross your legs with the uninjured leg in front of the injured leg. Bend down and touch your toes, or go as far as you can reach. Move your hands toward the hip of the uninjured side. You should feel a stretch on the outside of the injured hip and thigh. Hold the stretch for 30 seconds and return to the starting position. Repeat 3-5 times.
6. Iliotibial band stretch (standing side-lean): Cross the foot of the injured leg behind the uninjured leg. Lift the arm on the injured side up over your head and lean toward the uninjured side. If you are are unstable, modify the stretch by holding onto a wall without lifting an arm over your head. Hold the stretch for 30 seconds. Repeat 3-5 times.
7. Gluteus maximus strengthening: Lie on your stomach with your legs straight. Tighten your buttock and lift the injured leg off the floor 6-8 inches. Keep the knee straight. Hold this position for 5 seconds. Relax and return to the starting position. Repeat 10 times. Perform 3 sets.
8. Gluteus medius strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. While keeping the leg straight, lift the heel upward and back at a 45-degree angle. Slowly lower the leg to the starting point. Each direction should take to a count of two. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.
9. Hip abductor strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. While keeping the leg straight, lift the heel upward and to the side of your body. Slowly lower the leg to the starting point. Each direction should take to a count of two. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.
10. Hip external rotator strengthening: Select a resistance band appropriate for your strength. Secure one end of the band to a chair or other heavy object and loop the other end around the ankle of the injured leg. Stand in front of a chair and place the knee of the injured leg on the chair. Your hips should be straight while your knee is bent at 90 degrees and the foot is lifted from the floor behind you. While keeping the knee bent at 90 degrees and resting on the chair, pull the heel of that foot toward the other leg. This will externally rotate your hip. Slowly rotate the hip to the starting point. Each direction should take to a count of three. You should feel the outside, back corner of your buttock tighten. Repeat 10 times. Perform 3 sets.

This information is not intended to diagnose, treat, or prevent any injury or disease. It is intended to serve as an overview of running-related injuries and should not be used as a substitute for sound medical advice from a doctor or therapist.