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    Move Forward Guide

    Physical Therapist's Guide to Snapping Hip Syndrome

    Snapping hip syndrome refers to a snapping or popping sensation that occurs in the side, front, or back of your hip when you forcefully lift, lower, or swing your leg. Snapping hip makes it more difficult to perform activities such as lifting, kicking, or twisting your leg, getting up from a chair, walking, running or cycling. While the condition most often affects dancers and athletes, a snapping hip can occur in anyone performing forceful leg movements. Snapping hip is mostly seen in people 15 to 40 years of age.


     

    What is Snapping Hip Syndrome?

    Snapping hip occurs when a muscle, tendon, or ligament rolls over a bony prominence in the hip. Snapping hip can occur in different areas of the hip:

    • Front. Snapping at the front of the hip can involve the hip flexor muscle rolling over the front of the hip bone, or the hip ligaments rolling over the thigh bone or tissues of the hip joint.
    • Side. This condition involves the ITB (iliotibial band) rolling over the outer thigh bone or the big muscle on the back of the hip (gluteus maximus) sliding over the outer thigh bone.
    • Back. This condition involves one of the hamstring muscles rolling over the bottom of the hip bone.

    Snapping hip can occur when the hip muscles are excessively used and become fatigued, tight, and/or swollen.

    Athletic activities like track and field, soccer, horseback riding, cycling, gymnastics, and dance can trigger the condition. It can also occur during everyday activities that require repeated forceful movement of the legs.

     

    How Does it Feel?

    Snapping hip causes a snapping sensation and sound that can be felt in the front, the side, or the back of the hip. Often, the snapping can be pain-free. If it causes pain, the pain usually ceases when the leg movement causing the snapping is stopped. In athletes and dancers, the snapping can be accompanied by weakness and may diminish performance.

    The snapping is most commonly felt when kicking the leg forward or to the side, when bringing the leg behind the body, when rising from a chair, or when rotating the body or the leg.

    Often, walking and running in a straight line are snap-free and pain-free, although in some people these activities are limited by the pain of the structure that is snapping.

     

    Signs and Symptoms

    With snapping hip, you may have:

    • Snapping or popping in the front, side, or back of hip when lifting, lowering, or swinging the leg
    • Weakness in the leg when trying to lift it forward or sideways
    • Tightness in the front or back of the hip
    • Swelling in the front or side of the hip
    • Difficulty performing daily activities such as rising from a chair and walking
     

    How Is It Diagnosed?

    If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will ask you:

    • How you injured your hip and if you heard a pop when you suffered the injury
    • If you feel snapping, popping, or pain
    • Where you feel the snapping or pain
    • If you experienced a direct hit to the leg
    • If you saw swelling in the first 2 to 3 hours following the injury
    • If you experience pain when lifting your leg forward or backward, walking, changing directions while walking or running, or when lifting the knee
    • If you participate in any repetitive, forceful, or plyometric (quick explosive jumping) sport activities.

    Your physical therapist also will perform special tests to help determine whether you have a snapping hip, such as:

    • Asking you to lift your leg quickly
    • Asking you to push against the physical therapist’s hand when he or she tries to push your leg outward, backward, and forward (muscle strength test)
    • Gently feeling the muscle to determine the specific location of the injury (palpation)

    Your therapist may use additional tests to assess possible damage to other parts of your body, such as your hip joint or lower back.

    To provide a definitive diagnosis, your therapist may collaborate with a physician or other health care provider. The physician may order further tests—such as an x-ray or magnetic resonance imaging (MRI)—to confirm the diagnosis and also to rule out other potential damage. However, these tests are not commonly needed for snapping hip syndrome.

     

    How Can a Physical Therapist Help?

    Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should perform at home. This program will help you return to your normal life and activities and reach your recovery goals.

    The First 24-48 Hours

    Your physical therapist may advise you to:

    • Rest the injured hip by avoiding walking or any activity that causes pain. In rare cases, crutches may be recommended to reduce further strain on the muscles when walking.
    • Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
    • Consult with another health care provider for further services such as medication or diagnostic tests.

    Reduce Pain

    Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electricity, taping, exercises, and special hands-on techniques that move muscles and joints (manual therapy).

    Improve Motion

    Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with movements of the leg and hip joint that the therapist gently performs, and progress to active exercises and stretches. Treatment for snapping hip often involves manual therapy techniques called trigger point release and soft tissue mobilization, as well as specific stretches to muscles that might be abnormally tight.

    Improve Strength

    Certain exercises will benefit your injury at each stage of recovery, and your physical therapist will choose and teach you the appropriate exercises that will restore your strength, power, and agility. These may be performed using free weights, stretchy bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For snapping hip syndrome, muscles of the hip and core are often targeted by the strength exercises.

    Speed Recovery Time

    Your physical therapist is trained and experienced in choosing the treatments and exercises to help you heal, get back to your normal life, and reach your goals faster than you might be able to on your own.

    Return to Activities

    Your physical therapist will collaborate with you to decide on your recovery goals, including return to work and sport, as well as design your plan of care to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work retraining activities. Athletes will be taught sport-specific techniques and drills to help achieve sport-specific goals.

    Prevent Future Re-injury

    Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core (abdomen) to help prevent future injury. These may include strength and flexibility exercises for the hip, thigh, and core muscles.

    If Surgery Is Necessary

    Surgery is rarely necessary in the case of snapping hip syndrome. If it is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.

     

    Can this Injury or Condition be Prevented?

    Snapping hip syndrome can be prevented by:

    • Warming up before starting a sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including those for the muscles on the front, side, and back of the hip.
    • Gradually increasing the intensity of an activity or sport. Avoid pushing too hard, too fast, too soon.
    • Following a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport’s off-season.
    • Wearing shoes that are in good condition and fit well.
     

    Real Life Experiences

    Samantha has suddenly increased her physical activity level, including daily workouts and outdoor sports. Two weeks ago, she added an intense bicycle workout and a high-energy dance class to her regimen. She bicycles a few hours in each session, and in the dance class she is learning to do high kicks while keeping her knee straight, which the students practice for 10 minutes in each class. She also practices on her own at home.

    A few days ago, Samantha began to feel a snapping in the front of her hip when she performed her high kicks, and when she straightened her leg out from the curled position required while riding her bike. At first there was no pain, just the weird sensation of the snapping. A day or two later, she noticed that there was some pain with the snapping. However, the pain did not occur when she was not lifting or extending her leg.

    Samantha decides to see her physical therapist three days after the snapping starts. The therapist observes her while she performs a high kick, and the snapping is audible. The therapist performs some tests that reveal abnormal tightness and lack of flexibility in the back and front of the hip and the hamstring, some loss of hip-joint motion, and weakness in other muscles. The therapist begins treatment to reduce the muscle tightness using hands-on therapy, applying firm pressure on specific points in the muscles; stretching techniques; and machines that provide heat, ultrasound, and electrical stimulation. The therapist teaches Samantha to use ice at home on the snapping area to help reduce any swelling. She teaches Samantha special stretches and strengthening exercises that she can do at home to help restore normal flexibility and strength to her muscles.

    The therapist tells Samantha that her activity level increased too quickly, not allowing her muscles to adapt successfully to the new demands placed on them. Samantha is informed that she will be able to participate in her workout activities quite well after her muscles are stretched and strengthened. The therapist reassures Samantha that she will reevaluate her every time she comes to the clinic, and will adjust treatment as needed to help her recover as quickly as possible.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat snapping hip syndrome. However, you may want to consider:

    • A physical therapist who is experienced in treating people with snapping hip syndrome. Some physical therapists have a practice with an orthopedic, sports rehabilitation, or performing arts/dance focus.
    • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people experiencing snapping hip syndrome.
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what motions and/or activities make your symptoms worse.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence related to physical therapy treatment of snapping hip syndrome. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Deleget A. Overview of thigh injuries in dance. J Dance Med Sci. 2010;14:97–102. Article Summary on PubMed.

    Bancroft LW, Blankenbaker DG. Imaging of the tendons about the pelvis. Am J Roentgenol. 2010;195:605–617. Free Article.

    Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc. 2010;18:113–119. Article Summary on PubMed.

    Little TL, Mansoor J. Low back pain associated with internal snapping hip syndrome in a competitive cyclist. Br J Sports Med. 2008;42:308–309. Article Summary on PubMed.

    Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;35:118–126. Article Summary on PubMed.

    Paluska SA. An overview of hip injuries in running. Sports Med. 2005;35:991–1014. Article Summary on PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.

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