Snapping Hip Syndrome

Overview of snapping hip syndrome

A vast majority of the professional athletes, swimmers and dancers complain of injuries of the bones, muscles, and joints. The rigorous stress and strain on a regular basis subject their musculoskeletal system to immense pressure. Hence after some point in time, different parts of the joints and muscles show signs of injury. “Snapping hip syndrome” is a very common injury in professional athletes.  Nearly 5-10% of the athletes suffer from snapping hip syndrome. Accurate diagnosis and treatment are necessary for the early stages of the disease. Failure to do so may result in hospitalization or permanent immobility.

What is snapping hip syndrome?

Snapping hip syndrome or “coxa saltans” is a disorder of the musculoskeletal system wherein a sensation of snapping or breaking of the hips occurs during hip movements. A cracking or popping sound occurs even during normal hip movements. This is more prominent during rigorous flexion and extension of the hip muscles. The two primary conditions that lead to snapping hip syndrome are the presence of minor bony outgrowths in the pelvic region or inflammation of the tendons. Presence of cartilage fragments in the pelvic joint or imbalance of the fluid present in the joint can also cause a snapping sensation during normal locomotion. Normally this condition is not painful. But the repeated occurrence of the symptoms can cause pain and discomfort.

What causes snapping hip syndrome?

Multiple etiological factors such as structural or functional problems in the muscles and joints can cause snapping hip syndrome. The major contributing factors are as follows-

• The tightness of two sets of muscles namely- iliopsoas muscle and the tensor fascia lata
• Friction between the tendons and the bony protrusions
• Irritation of the trochanteric bursa (it normally acts as a buffer between the iliotibial band and the pelvis)
• Friction between the pelvis (greater trochanter) and the iliotibial band
• Inflammation of the iliopsoas tendon at the point of junction with the hip
• Presence of an unwanted bony outgrowth known as the iliopectineal eminence
• An occurrence of loose fragments of cartilage or bone in the pelvic joint
• The accidental snapping of the biceps femoris (hamstring tendon) over the bony structures of the buttock (ischial tuberosity)
• Friction between the greater trochanter and the anterior gluteus maximus during pelvic extension
• A weakened gluteus medius (a muscle present in the pelvic region)
• Wear and tear of the labral muscle due to overuse
• Existing medical conditions like synovial chondromatosis (irritation resulting from a cartilage present in the synovial membrane)
• Instability of the synovial capsules
• Thickening and stiffening of the fibers of the gluteus maximus
• Thickening of the posterior Iliotibial band

How can you detect snapping hip syndrome?

Snapping hip syndrome has a few typical and easily identifiable symptoms. These are as follows-

• A distinct cracking or popping noise during movement of the pelvic region
• Snapping on the external part of the hip due to problems in the iliotibial band
• A sensation of snapping in the groin due to problems in the iliopsoas muscle
• Trembling of the overlying skin at the moment of snapping
• Occasional pain and discomfort during locomotion
• Worsening pain during rigorous physical activities (running or jumping) or lifting of heavy loads
• Feeling that the hip will spring out of the socket
• Tenderness in the external hip region (if the iliotibial band is severely damaged)
• Temporary immobility of the pelvic region after sitting or standing for a long time

What are the different types of snapping hip syndrome?

According to the region of occurrence, snapping hip syndrome has the following subtypes-

• External Snapping Hip Syndrome: This type of snapping takes place when a tendon or a muscle moves over a bulging bone (greater trochanter) on the top of the thigh bone (femur). This exerts pressure, which in turn causes an apparent snapping on the external part of the hip. External snapping may occur in two conditions. The iliotibial band may move over a bulge on the thighbone. In the other case, a particular muscle known as gluteus maximus slides over the greater trochanter. Friction results in both cases, that leads to snapping. Patients with very tight or stiff iliotibial band or gluteus maximus usually experience external snapping. External snapping causes pain, inflammation, and tenderness of the external portion of the hip. This is known as trochanteric bursitis.
• Internal Snapping Hip Syndrome: This type of snapping takes place in the frontal portion of the hip joint. When a particular tendon slides over a bony mass present in this region, snapping occurs. Two cases of internal snapping are common. One is when the iliopsoas tendon (connects the inner hip muscles to the femur) slides over a bony bulge on the pelvic bone called iliopectineal eminence. Another instance is when the quadriceps muscle (rectus femoris) slides over the head of the ball-and-socket joint present in the hip. Internal snapping gets worse with running or other physical activities. The patients may experience a sharp pain arising from the groin. Internal snapping often leads to pain and inflammation of the bursa (cavity) present at the front of the hip joint. This is called iliopsoas bursitis.
• Intra-articular Snapping Hip Syndrome: This type of snapping results from a major problem in the hip joint. Three cases of this category are common. Firstly, an injury to the flexible cartilage that surrounds the hip socket may occur. This is commonly known as an acetabular labral tear. Secondly, damage to the articular cartilage may occur. Thirdly, loose fragments of bones or soft tissues may be present in the ball and socket region of the hip. All these conditions can contribute to intra-articular snapping hip syndrome.

Diagnosis

The following diagnostic tests are recommendable-

• X-rays
• MRI scan
• CT scan
• Digital radiography
• Synovial fluid analysis

Treatment and precautions

Having an adequate amount of rest is important to reduce the stiffness that is present in the muscles or tendons. Following the instructions that have been provided by the doctor to reduce the pain and treat the problem. Try doing basic exercises at home like – light stretches, massages, retraining (for athletes by increasing their physical awareness, posture and modifying form etc.) These treatments can help change the hips biomechanics and improve the symptoms.

Make sure that your posture is right at almost any given point in time. Following through the steps taught during physiotherapy are done properly is important.

If you are facing problems like popping and clicking of your hip bone with each movement you make, don’t panic. There are a host of natural remedies to treat and manage this condition. This is a condition that can affect any age group.  There are numerous factors that contribute to this problem whereas inflammation and minor bone growth are the two main conditions that stand out.  This condition generally is not painful, but a persistent problem can lead to pain and inflammation as well as erosion of the femoral head.  This may worsen over time and can lead to femoral head dislocation.  Correcting postures and natural anti-inflammatory herbs such as fenugreek can help relieve these symptoms. Fenugreek paste can work wonders in reducing the pain associated with snapping hip syndrome and also strengthens the bones from within.

References