Snapping Hip

snapping-hip-intro

What is the snapping hip syndrome?

The snapping hip syndrome is a condition characterized by a snapping sensation or a popping sound in the hip with certain movements. As it is particularly common in dancers, it has become known as “dancer’s hip”.
The condition is generally regarded as harmless as long as it doesn’t cause pain. It is, however, almost always related to dysfunction of the pelvis (twists and blocks) and to relevant muscle dysfunction. It should therefore be taken seriously, as these conditions can lead to a whole range of other problems over time.

How can it occur?

The snapping hip syndrome is a common complaint in dancers and has many possible sources. Different types are described:

  • lateral snapping hip
  • medial snapping hip and
  • internal snapping hip

The most common of these is the lateral snapping hip. This occurs when a tight iliotibial band (ITB), the tensor fascia lata muscle, or the gluteus medius tendon snap over the greater trochanter – a bony bump on the thighbone to which many hip muscles are attached. Muscle dysfunction is the trigger for the elevated tension in these areas. It is commonly related to dysfunction of the pelvis, with the pelvis being twisted and blocked and the pelvic bone (ilium) being falsely rotated. The muscles that are usually affected by this condition are the quadriceps, the psoas and the piriformis muscle, among others. A lateral snapping hip can be quite painful and may feel similar to a dislocation.
The medial snapping hip is less common. This occurs when the iliopsoas tendon catches on the anterior inferior iliac spine (AIIS) or the iliopectineal ridge, both of which are bony protrusions of the pelvis. Muscle dysfunction of the iliopsoas is also related to dysfunction of the pelvis.
An internal snapping hip is most often caused by a forward subluxation of the femoral head (the top of the thighbone). The hip may produce a popping sound when relocating to its normal position. This so-called anterior displacement of the femoral head occurs due to looseness of the hip joint tendons (iliofemoral and/or pubofemoral ligament). It is usually the result of repeatedly forcing an extreme turnout position. Other causes of an internal snapping hip can be problems inside the joint, such as tears of the labrum, loose cartilage pieces or synovitis.

Beginner dancers are more likely to have snapping hip problems because their dysfunctions are not yet compensated to the same level as a trained dancer.

What are the typical symptoms of snapping hip syndrome?

A snapping or popping sound inside the hip related to certain movements characterizes the snapping hip syndrome. It is usually not painful, but can cause dyscomfort after extensive exercise. A snapping hip is a chronic condition that can persist over months or years if left untreated.

How can a snapping hip syndrome be diagnosed?

Your doctor will examine your hip and will try to provoke the snapping or popping noise that bothers you. If you know how to demonstrate it, it will be extremely helpful if you do so. Correct diagnosis of this issue demands a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the exact causes of snapping hip syndrome is often challenging and your doctor may ask a specialist in manual medicine for his opinion.
X-rays or MRI scans usually do not help with the diagnosis of the snapping hip syndrome except for cases of an internal snapping hip that are caused by structural problems inside the joint. These, however, often show typical symptoms in clinical examination and can therefore be identified in advance.

snapping-hip

This MRI scan of the hip shows the close relation of the psoas muscle to the hip joint. However, a snapping hip is a functional problem that occurs with movement of the hip and cannot be visualized with a static MRI scan.

What treatment options are there?

Correction of present hip and pelvis dysfunction is in the focus of treating the snapping hip syndrome. In order to handle the situation successfully, muscle dysfunction and muscle dysbalance have to be specifically addressed in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.

Next steps

Do you have a snapping hip and want to have it sorted out? These are the next steps:

  • See a doctor

Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.

  • Find a specialist in manual medicine

Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.

  • Start working on your problem

There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:

Flexibility training: Complete stretching routine, Lumbar spine release, Psoas stretch, Rectus femoris release, Psoas release, Piriformis release,

Strength training: Core training – resistance band workout, Core training – Abs crunches, “The clamshell” – Piriformis training, “The monster walk” – Piriformis training

Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.

  • Talk to your ballet master or dance teacher

Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.


 

 


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