Snapping Hip Syndrome

Snapping hip syndrome is characterised by an audible or visible snap or click in or around the hip joint when walking, getting up from a chair, or swinging the leg around. Athletes appear to have an increased risk of snapping hip syndrome due to repetitive and physically demanding movements of the hips and lower limbs.

1. ​The symptoms of snapping hip syndrome include snapping in and around the hip joint with moving the leg forward (flexion) or backward (extension) at the hip.
   
2. The sensation of hip popping may sometimes be felt (palpable) at the front or side of the hip and may be accompanied by pain.
   
3. These symptoms are usually present for several months or years rather than days or weeks before treatment is sought.

Snapping hip syndrome can be prevented by stretching the tight lower limb and hip muscles regularly, as well as strengthening the weak core muscles that help to stabilise your hip and maintain your posture.

1. Strengthen the hip and lower limb muscles

An ideal exercise programme should also include exercises that strengthen the lower back muscles, the gluteal muscles and the hip flexor muscles. These muscles are important as they help to stabilise your hips and maintain your posture during activities.

These exercises may include stepdowns, clamshells, front and side planks, bridges, lunges as well as squats.

2. Stretch your muscles and ITB

Stretch after your workout to keep the ITB, hip flexor muscles (anterior hip and thigh muscles), the gluteal muscles (backside muscles) and the hamstrings (posterior thigh muscles) flexible and prevent them from tightening.

You may also use a foam roller to stretch them after exercise, especially when the muscles are still warm and supple.

3. Warm up adequately

It is recommended to perform 5 to 10 minutes of a low-to-moderate intensity activity, such as brisk walking, before engaging in the more strenuous phase of your exercise routine to ensure that these muscles are warmed up prior to the activity.

Causes of Snapping Hip Syndrome

Snapping hip syndrome has multiple causes and is classified based on the anatomic structure that is the cause or the source of the snapping sensation.

Three main snapping hip categories have been recognised:

1. The most common cause involves the snapping of the iliotibial band (ITB) that runs over the outside of the hip joint (extra-articular). This is commonly associated with differences in lower limb length (usually the longer side is symptomatic) and predisposed by:
• Tight or thickened ITB on the involved side
• Weakness in the hip abductor and external rotator muscles
• Poor stability in the lower back and pelvic region
• Abnormal foot mechanics such as excessive rolling in of the foot (overpronation)
  
2. The second cause for snapping hip is due to the iliopsoas tendon catching on the prominence of the pelvis when the hip is flexed.
   
3. The third and least likely cause involves snapping within the joint (intra-articular), and can be due to loose bodies, wear and tear of the joint cartilage, or tears of the soft tissue covering the hip socket (labrum).

Risk Factors of Snapping Hip Syndrome

There is no data available on the prevalence or incidence of snapping hip syndrome in our local population.

In the United States, the syndrome is most often found in individuals aged 15-40 years and affects females slightly more than males. The most common athletes to be affected are ballet dancers, runners and soccer players.

The diagnosis is often obtained clinically through a history and physical examination.

Imaging tests may also be ordered to confirm the clinical diagnosis. Although x-rays of people with snapping hip do not typically show anything abnormal, x-rays or other tests may be ordered to exclude any other problems with the bones or joints.

Ultrasound examination examines the soft tissues, and when performed dynamically during hip motion, may visualise the tendon snapping and any accompanying inflammation of fluid-filled pockets (bursitis).

Magnetic resonance imaging (MRI) can sometimes identify intra-articular causes of snapping hip syndrome.

Seek medical attention if there is pain or if the injury interferes with normal activities.

1. Rest
   Start by avoiding repetitive movement of the hip and lower limbs. Apply ice to the affected area to reduce pain or inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used.
   
2. Corticosteroid
   Injection of a corticosteroid into an inflamed fluid-filled pocket (bursitis) may be useful to reduce painful inflammation.
   
3. Physiotherapy
   Physiotherapy for stretching and strengthening of the musculature surrounding the hip, as well as manual release of certain tight structures, may be part of the treatment.
   
4. Surgery
   In the rare instance that snapping hip does not respond to conservative treatment or when an intra-articular pathology is present, surgery may be recommended.
   The type of surgery (keyhole arthroscopy or an open procedure) will depend on the cause of the snapping hip, and should be decided in consultation with an orthopaedic surgeon.