If you find yourself reading this post, it’s likely that you are experiencing some snapping/popping/crunching/grinding etc. in your hip. If so, you are in the right place!
Snapping hip syndrome is characterized by an audible pop or click with hip movement. Someone can have a noisy hip, but it may or may not be painful. Either way, this is the criteria used to diagnose this condition.
Before we dive into
-The types of snapping hip syndrome
-Causes of snapping hip
-What you should (and shouldn’t) do about your noisy hip
I want to touch on a few things.
First, just because your hip is noisy, doesn’t mean something is wrong with it. The medical term for a noisy joint or soft tissue (muscles, tendons, ligaments, etc) is called crepitus (kre-puh-tis)
Now, there is a chance that doing nothing will increase the likelihood of developing pain or discomfort. However, if you notice a new onset of snapping, the best course of action is to reduce activities that cause the snapping, and it may resolve on its own.
That being said, incorporating an exercise routine to strengthen the muscles of the hip can be a great way to ensure you don’t develop hip snapping in the future.
Types of Snapping Hip Syndrome
There are a few types of snapping hip syndrome, and it can be challenging to self-diagnose without the help of a physical therapist or other medical professional. A physical therapist can conduct a full evaluation to determine what kind of snapping hip you have, and develop a plan to lessen the symptoms. The different types can be characterized as internal, external, or intra-articular snapping hip.
Intra-articular Snapping Hip Syndrome
Intra= inside
Articular= joint
Intra-articular snapping hip syndrome refers to snapping noises from within the joint. This could be from a labral tear, cartilage lesions, or loose debris in the joint. Labral tears are also common in athletes who use their hips at their end ranges of motion.
Important to note, one study of asymptomatic (meaning, athletes that had no complaints of pain or dysfunction) showed that 21/39 hockey players showed a labrum tear on an MRI. The labrum is responsible for keeping the femur (Ball) in the joint (socket).
Now, a torn labrum can cause pain. However, studies like this show us that just because something shows up on an MRI does not mean it is a death sentence. These players had no reason to believe that anything would show up on an MRI. Although, something like this can cause snapping hip, whether symptomatic or not.
Internal Snapping Hip
Internal snapping hip is extra-articular, or outside the hip joint. This is the most common type of snapping hip. In this case, the iliospoas muscle slides over the femoral head, creating an audible clicking noise. Typically, this occurs when the hip moves from a flexed position, such as a squat, to an extended position, which would occur when going from sitting to standing.
External Snapping Hip
This is another form of extra-articular snapping hip. The less common relative of internal snapping hip, this occurs when the IT band or gluteus maximus rolls over a bony prominence on the outside of the hip. This form of snapping hip also occurs when the hip is flexed. Typically, it is associated with activities such as running, climbing stairs, or golfing. This type is usually the loudest sound of the three variations of snapping hip, where people often say that it feels like their hip is dislocating. The good news is, dislocating a hip takes a tremendous amount of force and is usually seen with motor vehicle accidents or traumatic falls from high up.
As you can see in the image, the tensor fascia latae muscle (TFL) connects to the ITB, which extends just below the knee joint. One theory is that the TFL can become taut, which can cause the snapping sensation. More on this later…
Causes of snapping hip
There isn’t one main reason someone has a snapping hip. It is estimated that 5-10% of the general population experiences this “condition.” I put condition in parentheses because it may or may not cause any harm, and labels are sometimes not helpful in things like this.
Snapping hip is associated with athletes that perform at the end ranges of hip mobility. Think hockey players, dancers, and gymnasts. Additionally, people who engage in repetitive movements such as running or cycling can experience snapping hip. This is because the iliopsoas muscle group is a primary hip flexor, meaning when it contracts, it brings the knee towards the chest.
With repeated hip flexion movements, the iliopsoas muscle can become tight or inflamed. This causes the tendon of the muscle to snap over the bony part of the leg bone. In more advanced cases, there can be bursitis associated with snapping hip. Bursae are small, fluid filled cushions found within and around joints to decrease friction and provide cushioning. Bursitis is an inflammation of the bursae, which can exacerbate the symptoms.
Treatments for external and internal snapping hip
Since we know how snapping hip occurs, we can address it. If the snapping hip is caused by a tight muscle, we can stretch it. If you are a runner or cyclist, it is possible that reducing training volume can calm down the muscle and reduce the frequency of snapping hip. Additionally, soft tissue massage on the iliospoas muscle can be a useful tool in reducing this muscle tension. Both strategies work to lengthen the muscle.
As a future physical therapist, I would also recommend a strengthening routine to build up the surrounding muscles of the hip. This shares the load and reduces the amount of work the iliospoas is required to do.
What To Do
If weakness is present, strengthening the muscles on the outside of the hip is a great place to start.
Hip Hike: Stand with the leg you want to strengthen on the step. Let the opposite hip drop, then bring it back up to the starting position. This exercise targets a muscle on the outside of the hip called the gluteus medius. It keeps your pelvis stable when spending time on one leg, such as when walking or running. As a PT student, I have seen countless people help their hip/lower back pain after strengthening their hips (if they are weak to begin with).
Banded Lateral Stepping: This exercise also targets the gluteus medius and other hip muscles. I like this one because it is weight bearing and involves movement.
External snapping hip: We learned before that external snapping hip can be influenced by a tight TFL muscle, which connects to the IT band. Because of this, stretching the TFL muscle can provide relief. A common misconception is that rolling out the ITB can help. However, the ITB is dense connective tissue that is incredibly strong. The force required to change that type of tissue is far greater than anything you could do with a foam roller or tool.
Below is a good stretch for the TFL muscle. In the image below, the person’s right TFL is the one he is stretching.
Stand with a wall on your right side, cross your right leg behind your left, and shift your hips towards the wall while using it as support. This will work to lengthen the TFL muscle. Hold for at ~60 seconds and repeat x 3.
[1]
A great way to relax the TFL is to do some soft tissue mobilization. The QL Claw is a great tool to reach this muscle. See Ben demonstrate how to do this below.
Internal snapping hip: This is where we need to go after the hip flexors, aka the iliospoas. To stretch these muscles, you need to extend your hip behind your body. You can do this laying off the edge of your bed or a table. Something more firm usually works a bit better. See below
[2]
The claw can also help release this muscle group. Below are two videos of Ben demonstrating a iliacus and psoas release:
Iliacus Release
Psoas Release
These are a few tools you can use to figure out if you are suffering from snapping hip syndrome, whether you need to address it, and how to improve it. If you are concerned with your hip pain or dysfunction, see a licensed medical professional for their opinion.
Sources:
[1] https://www.rickysinghmd.com/iliotibial-it-band-syndrome/
[2] https://www.raynersmale.com/blog/2016/5/17/illuminating-iliopsoas