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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/groin region, or back of the hip (ie, the “sit bone”) 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. Although the condition most often affects dancers and athletes, a snapping hip can occur in anyone performing forceful leg movements. It is mostly seen in people 15 to 40 years of age. Although snapping hip syndrome is estimated to occur in 5% to 10% of the population, the incidence may be higher in dancers, and athletes such as soccer players, weight lifters, and runners.


     

    What is Snapping Hip Syndrome?

    Snapping hip syndrome occurs when a muscle, tendon, or ligament rolls over a bony prominence in the hip, with or without causing pain. It can occur in different areas of the hip, including:

    • 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 iliotibial band (ITB) 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 1 of the hamstring muscles rolling over the bottom of the hip bone.

    Snapping hip syndrome can occur when the hip muscles are excessively used and become fatigued, tight, and/or swollen. Athletic activities like track and field, soccer, weight lifting, horseback riding, cycling, gymnastics, and dance can trigger the condition. It also can occur during everyday activities that require repeated lifting or rotating of the leg outward.

     

    How Does it Feel?

    Snapping hip syndrome 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. The sensation is often experienced when an individual is required to use their hip to change positions. 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 syndrome, you may experience:

    • Snapping or popping in the front, side, or back of the hip when lifting, lowering, rotating, or swinging the leg
    • Weakness in the leg when trying to lift it forward or sideways
    • Tightness in the front, back, or side of the hip
    • Swelling in the front, back, 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 physical therapist may 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, popping, or pain
    • If you experienced a direct hit to the leg
    • If you saw swelling in the first 2 to 3 hours following an injury
    • If you experience pain when lifting your leg forward or backward, walking, changing directions while walking or running, or when lifting the leg
    • If you participate in any repetitive, forceful, or plyometric (quick explosive jumping) sport activities
    • Is this a preexisting sensation that is now becoming painful

    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 or rotate your hip outward
    • Asking you to push against the physical therapist’s hand when the therapist 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)
    • Assessing your muscle flexibility

    Your physical 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 physical 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 to diagnose snapping hip syndrome.

     

    How Can a Physical Therapist Help?

    Your physical therapist will design an individualized treatment program based on your specific condition, health history, and goals, to help you recover from snapping hip syndrome in the safest way possible. It may include exercises you can perform at home. The program will also focus on reconditioning and prevention of future injury.

    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 to reduce swelling.
    • Consult with another health care provider for further services, such as medication or diagnostic tests.

    Your physical therapist will design your treatment program to ensure your safe recovery. It may include treatments and exercises to:

    Reduce pain. Your physical therapist can use different types of treatments to control and reduce your pain including ice, heat, ultrasound, electrical stimulation, taping, exercises, or manual (hands-on) therapy techniques for your muscles and joints. Your physical therapist will determine the best treatments for your specific condition.

    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 physical therapist gently performs for you, and progress to active exercises and stretches you perform yourself. Treatment for snapping hip syndrome often involves manual therapy techniques called trigger point release and soft tissue mobilization, as well as specific stretches for muscles that might be abnormally tight, and to correct any muscle imbalances.

    Improve strength. Certain exercises will benefit you at each stage of recovery. 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, resistance bands, weight-lifting equipment, and cardio-exercise machines, such as treadmills and stationary bicycles. Muscles of the hip and core may be targeted.

    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 could 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, and design your plan of care to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist may use hands-on therapy and teach you exercises and work-retraining activities. Athletes may be taught sport-specific techniques and drills to help them return to their particular sports.

    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 and safest manner possible after surgery.

     

    Can this Injury or Condition be Prevented?

    Snapping hip syndrome can be prevented:

    • Warm 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 increase the intensity of an activity or sport. Avoid pushing too hard, too fast, too soon.
    • Follow a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport’s off-season.
    • Wear shoes that are in good condition and fit well.
    • Modify activity when symptomatic snapping occurs. Call a physical therapist.
     

    Real Life Experiences

    Samantha is a 26-year-old sales manager who lives an active, athletic lifestyle. She hikes, swims, or bikes regularly, and plays pick-up sports with her friends. Two weeks ago, she added an intense “spinning” bicycle workout and a high-energy dance class to her regimen. She bicycles an hour in each spinning session; in the dance class, she’s 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 from the curled position required for spinning and when riding her bike. At first there was no pain, just the weird sensation of the snapping. A day or two later, she noticed some pain with the snapping, which eased when she didn’t lift or extend her leg. She decided to see her physical therapist.

    Samantha’s physical therapist reviews her health history and asks her to describe her symptoms. She asks Samantha to carefully perform a high kick; the snapping is audible. She then conducts a full examination that reveals abnormal tightness and lack of flexibility in the back and front of Samantha’s hip and her hamstring muscle, some loss of hip-joint motion, and weakness in the surrounding muscles. She tells Samantha she is experiencing snapping hip syndrome.

    She explains that the syndrome developed because Samantha had increased her activity level too quickly, and hadn’t allowed time for her muscles to adapt successfully to the new demands placed on them. She assures Samantha that she will be able to participate in her workout activities quite well after her muscles are properly stretched and strengthened. She advises her to avoid movements that cause the snapping, and to take a break from her dance class.

    During that first session, Samantha’s physical therapist begins treatment to reduce her muscle tightness using manual (hands-on) therapy, applying firm pressure on specific points in the muscles of the hip, leg, buttocks, and back. She teaches Samantha some gentle stretching techniques, and applies electrical stimulation (TENS) to the affected areas. She shows Samantha how to apply ice at home on the snapping area to help reduce any swelling, and teaches her special stretches and strengthening exercises that she can do at home to help restore normal flexibility and strength to her muscles.

    Over the next few weeks, Samantha’s physical therapist evaluates her condition each time she visits the clinic, and adjusts her exercise and treatment program as needed to help her recover as quickly as possible.

    At this week’s session, Samantha reports the snapping has subsided and she is pain free. Her physical therapist encourages her to continue her home-exercise program, and allows her to return to her dance class.

    Today in class, with her newly-developed strength and flexibility, Samantha safely kicks higher than ever before!

    This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

     

    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 orthopedic or sports physical therapy. This physical 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.

    Henning PT. The running athlete: stress fractures, osteitis pubis, and snapping hips. Sports Health. 2014;6(2):122–127. Free Article.

    Shur N, Dandachli W, Findlay I, Beech Z, Bankes MJ. A pain in the backside: a case report of coxa saltans occurring at the proximal hamstring origin. Hip Int. 2014;24(3):302–305. Free Article.

    Deleget A. Overview of thigh injuries in dance. J Dance Med Sci. 2010;14(3):97–102. Article Summary in PubMed.

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

    Lewis CL. Extra-articular snapping hip: a literature review. Sports Health. 2010;2(3):186–190. Free Article.

    Strauss EJ, Nho SJ, Kelly BT. Greater trochanteric pain syndrome. Sports Med Arthrosc Rev. 2010;18(2):113–119. Article Summary in 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 in 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 in PubMed.

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

    Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3(5):303–308. Article Summary in 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. Updated by Keelan Enseki, PT. Reviewed by the MoveForwardPT.com editorial board.

     

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