Snapping Hip Syndrome (SHS) is the medical term for an audible or palpable clicking sensation in the hip joint during movement. This mechanical clicking is a common phenomenon and is generally considered benign. SHS does not require intervention unless the snapping is accompanied by pain or begins to interfere with daily activities. Understanding the underlying structures involved helps determine when professional evaluation is necessary.
What Snapping Hip Syndrome Is
Snapping Hip Syndrome, also known as coxa saltans, is categorized into three distinct types based on the anatomical structures that produce the snapping sensation. The vast majority of cases fall into the extra-articular category, which occurs outside the hip joint itself. Differentiating between these types is important for accurate diagnosis and treatment.
External SHS
This is the most frequent type, occurring on the outside of the hip. The snapping is caused by the iliotibial (IT) band or the gluteus maximus tendon sliding over the greater trochanter, the bony prominence on the upper thigh bone. This movement of the taut tissue across the bone creates a snap as the hip flexes and extends. Repetitive friction can sometimes lead to inflammation of the underlying bursa.
Internal SHS
Internal snapping is felt toward the front of the hip or groin area. This sensation occurs when the iliopsoas tendon, a major hip flexor, abruptly catches and releases as it moves over bony structures. These structures include the iliopectineal eminence on the pelvis or the anterior aspect of the femoral head. This snap is often felt when moving the hip from a flexed position into extension, such as when rising from a chair.
Intra-articular SHS
Intra-articular snapping originates from issues inside the hip joint capsule. This type is caused by mechanical problems within the ball-and-socket joint, not by a tendon or muscle sliding over bone. Common causes include a torn acetabular labrum, the rim of cartilage around the socket, or loose bodies floating within the joint fluid. This internal disruption often causes a sensation of catching or locking, rather than a simple snap.
Severity and Functional Impact
The question of whether Snapping Hip Syndrome is problematic hinges entirely on the presence of pain and its effect on function. If the clicking is painless and does not limit physical activity, it is typically a simple mechanical annoyance that requires no immediate intervention. This asymptomatic snapping is a common physical finding, especially in athletes and dancers with high flexibility.
The condition becomes concerning when repetitive friction causes irritation and inflammation. Constant snapping can lead to secondary conditions like trochanteric bursitis or iliopsoas tendonitis, characterized by pain and tenderness. When the snapping is painful or persistent, it can impair walking, running, and participation in sports.
Intra-articular snapping is inherently more serious than the extra-articular types because it signals underlying structural damage within the joint. A labral tear or loose body can cause instability and progressive pain, making this form a more urgent concern. Any snapping sensation accompanied by sharp pain, a feeling of the joint locking, or progressive weakness warrants a prompt medical assessment.
Causes and Risk Factors
The primary cause of extra-articular Snapping Hip Syndrome is the imbalance between muscle length and strength around the hip joint. Repetitive motions, such as those found in running, ballet, gymnastics, and swimming, are a major contributing factor. These activities often involve repeated hip flexion and extension, which increases the likelihood of tendons thickening or becoming tighter.
Muscle tightness is a significant underlying issue, particularly in the hip flexors and the iliotibial band. When these tissues are tight, they are forced to rub against bony prominences with increased tension, which creates the snap. Conversely, weakness in the core muscles and the gluteal muscles (gluteus medius and maximus) can also contribute by compromising hip stability and alignment.
Anatomical variations can also predispose an individual to the condition. The shape of the greater trochanter or the prominence of the pelvic bone can influence how the overlying tendons track. In the internal variant, a slightly thicker iliopsoas tendon may be more likely to snap over the bone. These anatomical factors, combined with repetitive activity, lead to the mechanical friction that defines the syndrome.
Treatment and Management Options
Management of Snapping Hip Syndrome emphasizes conservative methods, especially for the external and internal types. The first step involves activity modification, meaning temporarily reducing or avoiding movements that trigger the snapping and pain. Applying ice and taking over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce associated pain and inflammation.
Physical therapy is a major component of the recovery plan, focusing on exercises designed to address the underlying muscle imbalances. Therapists prescribe specific stretching routines to lengthen tight structures like the iliotibial band and hip flexors. Strengthening exercises target the glutes and core muscles to improve dynamic stability and proper hip mechanics.
If pain persists despite several weeks of physical therapy and activity modification, a physician may suggest a corticosteroid injection. This delivers a potent anti-inflammatory medication directly to the irritated area, such as a bursa or tendon sheath, to provide pain relief. Surgery is considered a last resort, typically reserved for severe cases that do not respond to six to twelve months of conservative treatment. Surgical options, such as lengthening the iliopsoas or iliotibial band tendon, are performed to release the tension causing the snap.