Many people experience a snapping sensation when they get up from sitting, twisting on a leg or doing rotational moves with the leg. This snapping sound is usually painless and harmless in the beginning stage, but it is annoying. This condition is usually found in the older population but it can also occur in young athletes and dancers.
Causes of snapping hip syndrome
The snapping sensation results from the movement of a muscle or tendon over a bony structure. In the hip, one most common site is over the outer portion of the upper leg where a band of tissue, the iliotibial band, passes over the thighbone. Additionally, the gluteus medius tendon can also rub over the outside of the thighbone.
Other common areas are on the inner leg where the adductors or psoas become shortened. Here the snapping sound occurs when the leg is rotated outwards as in sitting cross-legged on the floor or in a yoga pose.
If the iliotibial band is involved, it is too tight and rubs against the leg bone. This occurs because when the hip is straight; the band is behind the trochanter of the femur or thigh bone. When the hip bends, the band moves over the upper leg bone so that it is in front of it. Because the leg bone is shaped with a bend in it, it juts out and the movement of the band across it creates the snap you hear.
If the adductors are too short and tight it can cause dysfunction in the hip joint itself, resulting in a snapping of the hip.
If the psoas is too short and tight it can rub or snap over one of several bony prominence known as the anterior inferior iliac spine (on the pelvic bone), lesser trochanter (on the inside of the femur), or the iliopectineal eminence.
A tear in the cartilage or some bone debris in the hip joint can also cause a snapping or clicking sensation. This type of snapping hip usually causes pain and may be disabling. A loose piece of cartilage can cause the hip to catch or lock up
Complication of a snapping hip
The complications of this, if the underlying conditions are not corrected, are tendonitis, bursitis and hip joint degeneration. Tendonitis is an inflammation of the tendons of the muscles, those that attach to the iliotibial band
as well as the muscles that hold the leg in the hip socket and those that control the motion of the hip and leg. Bursitis is a thickening and inflammation of the bursa, a fluid-filled sac that allows the muscle to move smoothly over the bone.
Any chronic contraction of a muscle or misalignment of the normal forces that pass through a joint will eventually lead to arthritic changes.
Diagnosis
The most important information is exactly what motion causes the snapping. This helps to isolate the muscles and tendons that have shortened. This is only part of the answer. For every short muscle, there is usually at least one weak muscle that is not doing its job. The weak muscles cause changes in muscle function that adversely affect the function of the joint.
Other common causes are a dropping of the arch (or overpronation) in the foot that causes twisting or torque of the lower leg that again distorts the forces coming up the leg. Pelvic imbalances will cause changes in weight distribution down the leg.
Range of motion of the leg should be tested and all the related muscles should be tested for proper functioning.
Treatment
Treatment involves correcting the structural changes that have changed the way the weight is transferred up and down the leg. This might include the use of orthotics, exercises for the muscle of the lower leg, pelvic corrections and changes in the way you walk. Locally, the muscles that have shortened will need to be elongated using appropriate therapy. The muscles that have weakened and caused the shortening need to be identified and the reasons for the weakness corrected.
Many times, you will have to do home stretching or massage to aid in the elongation of the shortened muscles and strengthening exercises if the opposing muscles have weakened and/or atrophied.
As most people with this problem have lower leg/foot problems that are a part of the underlying cause, you may have to change your footwear, use orthotics or exercise the muscles of the foot and ankle to provide proper support.
Finally, there are usually changes in the small muscles that control hip rotation. These are similar to the rotator cuff muscles in the shoulder. Imbalances in these muscles need to be identified and corrected.
While a snapping hip seems like a minor problem, it can lead to severe problems like hip joint degeneration and possibly hip replacement later in life.
Source: Education Materials of the International College of Applied Kinesiology
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology
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