When there is a snapping sound that occurs with flexion or extension of the hip, it is called internal snapping hip syndrome, or Coxa Saltans internal type. The snapping sound comes from the tendon of the iliopsoas (hip flexor) muscle as it moves through its normal motion across the bony structures of the hip joint (iliopectineal eminence, femoral head, or lesser trochanter). Internal snapping hip syndrome is usually painless, but for some people, it can become painful.
This condition typically affects athletes in their mid-adolescence or adulthood. Females seem to be affected more frequently. It is most commonly seen activities that involve repetitive hip flexion, such as dance, soccer, gymnastics and running.
What Causes Internal Snapping Hip Syndrome?
Internal snapping hip syndrome is an overuse injury that is caused by repetitive flexion and external rotation of the hip. Athletes with tight hip flexors and unbalanced strength in their pelvic, hip, and abdominal muscles are more prone to this condition.
What Are the Symptoms of Internal Snapping Hip Syndrome?
A snapping or clicking sound is heard with flexion or extension of the hip. Athletes are usually able to voluntarily reproduce the snapping sound by extending and rotating their hip. The snapping is usually painless, but can sometimes generate pain in the groin area. Symptoms tend to worsen with activity.
How Is Internal Snapping Hip Syndrome Diagnosed?
Your doctor will ask about your symptoms and examine your hip and pelvis. Findings that suggest internal snapping hip syndrome include tenderness over the iliopsoas tendon, tightness in the iliopsoas muscle, and a snapping sound with hip extension and rotation. An x-ray may be performed to rule out more serious causes of hip pain. An ultrasound can sometimes demonstrate the movement of the iliopsoas tendon over the iliopectineal eminence but it is not required for making the diagnosis.
How Is Internal Snapping Hip Syndrome Treated?
Internal snapping hip syndrome that is painless does not require any treatment. Painful cases are treated with temporary rest from irritating activities until the pain resolves. A short course of anti-inflammatory medicines might also be prescribed. Physical therapy that includes stretching and soft tissue massage for the iliopsoas muscle and strengthening of all the hip muscles can help to reduce pain and speed return to activity. Once pain has resolved and flexibility and strength have improved, gradual return to sports and activities is allowed.
When Can I Return to My Sport or Activity?
The goal is to return you to your sport or activity as quickly and safely as possible. If you return to activities too soon or play with pain, the injury may worsen. This could lead to chronic pain and difficulty with sports. Everyone recovers from injury at a different rate. Return to your sport or activity will be determined by how soon your injured area recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer you have symptoms before starting treatment the longer it will take to get better.
You may return safely to your sport or activity when each of the following is true (Begin at the top of the list and progress to the bottom):
- You have a full range of motion in the injured leg compared to the uninjured leg.
- You have regained normal strength in the injured leg compared to the uninjured leg.
- You are able to jog straight ahead without pain or limping.
- You are able to sprint straight ahead without pain or limping.
- You are able to do 45-degree cuts, first at half-speed, then at full-speed.
- You can do 20-yard figure-of-eight runs.
- You can do 90-degree cuts.
- You can do 10-yard figure-of-eight runs.
- You are able to jump on both legs without pain and can hop on the injured leg without pain
How Can Internal Snapping Hip Syndrome be Prevented?
- Perform a proper warm-up before starting any activity. Ten minutes of light jogging, cycling, or calisthenics before exercise will increase circulation to cold muscles, making them more pliable and less prone to injury.
- Stretch your iliopsoas muscle regularly (1–2 times per day). The ideal time to stretch is after your muscles are warmed-up. Hold each stretch for 30 seconds. Don’t bounce.
- Maintain balanced strength in the hip muscles.
- Do not play through pain. Pain is a sign of injury, stress, or overuse. Rest is required to allow time for the injured area to heal. If pain does not resolve after a couple days of rest, consult your physician. The sooner an injury is identified, the sooner proper treatment can begin. The result is shorter healing time and faster return to sport.