Finding an effective treatment for Snapping Hip Syndrome

Ross Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C

Snapping hip syndrome is a frustrating problem for the people who have it. If you are reading this article you are most likely one of those people. It is also likely that you are a runner or a dancer. Your story may go something like this:

About two years ago my hip gave way. I am a long-distance runner, I run in competitions. One day during a run I heard a loud snap in my hip, it started to swell so I thought I tore something. I went straight off to an orthopedic surgeon and I was diagnosed with something I never heard of, snapping hip syndrome.

Treatments 

At the initial visit with the surgeon, I was given my treatment guidelines.

After a few weeks and no improvement, I was reassessed and given a cortisone injection. This did not help either. I was told that this may be a permanent problem and I need to give up the long-distance runs unless I wanted to consider surgery. This was unacceptable. Now I am looking for different treatment options because surgery is my last choice.

What do we do?

Below we will explain that we treat snapping hip syndrome by addressing ligament damage in the pelvic and hip area. Many people that reach out to us for treatment did not have this approach explained to them. We will document why that may have happened in the research below.

Snapping Hip Syndrome is not a problem in isolation

When people contact us with a diagnosis of snapping hip syndrome, many times it is a problem among many problems. In many cases, people will begin with a discussion of their hip labral tear, a paralabral cyst that may be causing sciatica-like symptoms, iliopsoas tendonitis, greater trochanteric pain syndrome, and snapping hip syndrome. The thinking many have, and they are mostly correct, is that the snapping is a symptom of many hip problems. Again, we will explain that we treat snapping hip syndrome by addressing ligament damage in the pelvic and hip area and restoring hip instability. In many cases restoring hip, instability will not only resolve the snapping but the concurrent conditions.

What are we seeing in this image?

The snapping sensation in the front and/or the outer side of the hip occurs from tightness or tensing of the iliopsoas muscle or the tensor fascia latae muscle. The muscles are compensating for ligament weakness or labral tear causing hip instability. This is explained at length below.

The snapping sensation in the front or the outer side of the hip occurs from a tightness or tensing of the iliopsoas muscle or the tensor fascia latae muscle. The muscles are compensating for ligament weakness or labral tear causing hip instability.

The snapping sensation in the front or the outer side of the hip occurs from tightness or tensing of the iliopsoas muscle or the tensor fascia latae muscle. The muscles are compensating for ligament weakness or labral tear causing hip instability.

Finding an effective treatment for Snapping Hip Syndrome

Snapping hip syndrome is a frustrating problem for the people who have it. If you are reading this article you are most likely one of those people. It is also likely that you are a runner or a dancer.

You finally went to the doctor because it was becoming too painful to run or dance or jump and nothing you were doing on a self-help basis were helping. An equally alarming concern was that you noticed that your hip had become “noisy.” It was making a “snapping,” popping,” noise. You may have heard this noise before on occasion, but now it is getting much louder and more frequent. You were probably told, “stay away from running for a couple of days,” and were given anti-inflammatory medication. Probably a prescription strength dosage far in excess of the over-the-counter pain and anti-inflammatory medications you were taking when you went to the doctor.

You were then told that if the pain does not go away after rest and medication, come back, and “we will get an MRI done.” Your pain did not go away, when you tried to resume running after a few days,  your hip “snapped,” “popped,” and remained painful. You went for an MRI, the result? “Negative.” How can that be? How can the MRI show nothing? Because in “Snapping Hip Syndrome,” the MRI may show “nothing.” That is in part the diagnosis criteria for Snapping Hip Syndrome – MRI shows nothing.

So now what? Physical Therapy, massage, stretching, more medications, more rest, stop running? Get on an exercise bike? Ice, Ice, and more ice?

If you are reading this article this problem has now gone on for months maybe a year or two. What was once a minor inconvenience, then an annoying problem has now become a big problem. You may have groin pain, low back pain, it hurts now when you walk.  Surgery is now being discussed. What are the options?

So now what? Physical Therapy, massage, stretching, more medications, more rest, stop running? Get on an exercise bike? Ice, Ice, and more ice?

Guidelines for doctors treating snapping hip syndrome were offered in a paper published in the Sports medicine and arthroscopy review.(1) Here are the summary learning points:

Conservative care treatment guidelines

When your muscles are rolled up into a ball or they have become “short”

Snapping Hip Syndrome is a degenerative joint condition

Snapping is a form of crepitus, the medical term for any audible noise or internal sensation of popping, grinding, clicking, or “snapping” in a joint.

Crepitus is not a normal condition and signs of it point to an injury or degenerative joint condition.

In the 2018 publication, Stat Pearls(2) doctors describe Snapping Hip Syndrome in this way:

Soccer players, weight lifters, runners, ballet dancers

In research from doctors in Poland, a detailed analysis of the diagnosis and determination of Snapping Hip Syndrome is given in the Journal of Ultrasound (3). Here is the summary of that research:

There are two main forms of snapping hip: extra or intraarticular.

Many snapping hip syndrome incidences are underreported or misdiagnosed

In December 2018, doctors at George Mason University reported in the journal Medical Problems of Performing Artists (4) of the confusion surrounding hip pain in dancers.

They write that:

“Because snapping hip syndrome is poorly identified and can present similarly to other hip pathologies, many snapping hip syndrome incidences are underreported or misdiagnosed. Though snapping hip syndrome can begin as a harmless popping sensation, pain can become severe enough to limit dancers’ activities and potentially result in the development of concomitant issues.” Our note: concomitant issues are the degenerative hip problems related to hip instability.


In this video Ross Hauser, MD covers some of the problems we see in our clinic surrounding Snapping Hip Syndrome, and, our treatment options.


Finding an effective treatment for Snapping Hip Syndrome

Since snapping hip syndrome is commonly seen among athletes, the typical approach is to blame it on overtraining and tight muscles and tendons. As such, it involves at least part of the RICE protocol, which includes rest, ice, compression, and elevation.

Although some of these treatment components do indeed help with muscle injuries, they do not heal the soft tissue involved such as the ligaments, tendons, and hip labrum.

In addition, athletes must also stop training immediately, advice that is rarely popular, and when ligament laxity is involved, not even necessary for very long.

Another standard practice involves the use of steroids and anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Long-term side effects of these drugs can lead to other systemic health concerns.

When all else fails, patients who experience chronic snapping hip syndrome may be referred to a surgeon in order to lengthen the “tight” tendons thought to be involved. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source.

Treating the Iliotibial Band (IT Band) and iliopsoas tendon

Snapping hip syndrome involving the iliotibial band, or IT band.

Snapping hip syndrome involving the iliopsoas tendon,

Snapping hip syndrome involving involves a tear in the hip cartilage or bone debris in the hip joint (loose bodies). This type of snapping hip usually causes pain and may be disabling. In addition, a loose piece of cartilage can cause the hip to catch or lock up.

 Surgery for snapping hip syndrome

At the beginning of this article, we suggested that snapping hip syndrome is not a problem that sits in isolation. There are many problems happening in the hip, snapping hip syndrome may only be one of many.

An October 2020 study published in the journal Arthroscopy Techniques (5), offers this same assessment. In this paper, surgeons offer a technique that allows them to see and repair the various problems that may be discovered in the hip while treating the snapping hip problem. Here are the summary points:

Psoas Tendon Snapping

Similarly, a group of orthopedic surgeons combined their results in the journal Frontiers in Bioengineering and Biotechnology (6) and found that psoas snapping and ischiofemoral impingement are possibly two presentations of a similar underlying rotational dysplasia of the femur.

More pain after surgery

I wanted to run. Now I have more pain after the surgery. My pre-surgery pain centered on my hip, groin, and pelvis. I had limited rotation and my hip made a snapping sound. When it happened it felt like a “snapping my fingers” sensation. I was diagnosed with enthesopathy at various points in my hip. I had a small hip labrum tear and my orthopedist thought that if we fixed that up I could run again. It got worse after the surgery. Pain is severe. I am now on painkillers and “heavy-duty,” anti-inflammatories. My doctors do not know how to help me at this point because I no longer have any inflammation.

First, many people have very successful surgeries for problems related to snapping hip and/or hip labral tears. This person’s story is just one story where the surgery did not work. It is more typical of the patients we see as we usually do not see successful surgery people, we see the not so successful surgery people at our center.

Prolotherapy for Snapping Hip Syndrome

In this section, we will discuss and describe the use of Prolotherapy for snapping hip syndrome. Prolotherapy is a series of simple dextrose injections.

In more than 28 years of helping patients with various disorders, we have found Prolotherapy injections to be a safe, reliable treatment in helping to alleviate various problems of the hip, spine, and joints. Dozens of research studies have documented Prolotherapy’s effectiveness in treating chronic joint pain.

Snapping Hip due to Gluteus Medius Tendinopathy

Doctors  (7) presented a case of snapping hip syndrome in regards to gluteus medius and minimus tendon problems and dextrose prolotherapy in its treatment.

The doctors also reported that they did not use corticosteroids due to their weak benefit in treating chronic tendinopathy and its detrimental effect on tendon healing.

Prolotherapy for snapping hip syndrome gets at the root cause of the problem, damaged connective tissues like tendons and ligaments. The abnormal movement of these connective tissues rubbing over bony parts of the pelvis is due to these structures becoming lax or loose from repetitive use like in dance or sports or from a traumatic incident like a fall. The dextrose in the Prolotherapy solution, when injected around the injury, causes a mild inflammatory response, mimicking what the body does naturally in response to soft-tissue injuries. The immune system is drawn to the area of injury and immune cells and platelets release growth factors to build new healthy tissue.  The ligaments and tendons become thicker and stronger from this inflammatory response, proven decades ago in rabbit studies. When they do, the laxity or looseness of these structures is resolved and the snapping and pain go away.

The intra-articular causes of snapping hip are usually more serious. But a Prolotherapy doctor, a specialist in this regenerative injection therapy like our team, can determine if Prolotherapy or surgery is called for. Loose bodies, usually bone or cartilage fragments, sometimes do have to be surgically removed if they are rubbing on other structures causing pain. If one has a tear of the labrum, a specialized structure/tissue that covers the joint capsules of hips and shoulders, it can cause pain and snapping. Then the doctor may have to use slightly more advanced techniques to resolve the problem. Platelet-rich plasma (PRP) is a type of Prolotherapy that uses a patient’s own blood, from which the platelets and their large concentrations of growth factors are used as part of the Prolotherapy solution. Labral tears usually respond well to PRP.

In this video, Ross Hauser, MD demonstrates and describes the Prolotherapy treatment. A summary transcription is below the video.

Degenerative Joint Disease and Snapping Hip Syndrome

Degenerative joint disease, or osteoarthritis, is the long-term result/worst-case scenario of what initially begins as a minor injury like snapping hip syndrome. If your IT band or iliopsoas tendon becomes chronically weakened, it can lead to osteoarthritis. If these extra-articular problems are addressed in a timely manner, then the arthritic intra-articular problem is arrested. When caught early, normal dextrose Prolotherapy can help repair this cartilage damage. In more severe cases, where x-rays and MRIs show bone-on-bone, or basically, no cartilage, then more sophisticated Prolotherapy may be needed.


Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your Snapping Hip Syndrome.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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References

1 Yen YM, Lewis CL, Kim YJ. Understanding and treating the snapping hip. Sports medicine and arthroscopy review. 2015 Dec;23(4):194. [Google Scholar]
2 Musick SR. Snapping Hip Syndrome. StatPearls Publishing, Treasure Island (FL) [29 Aug 2017] [Google Scholar]
3 Piechota M, Maczuch J, Skupiński J, Kukawska-Sysio K, Wawrzynek W. Internal snapping hip syndrome in dynamic ultrasonography. Journal of Ultrasonography. 2016;16(66):296-303. doi:10.15557/JoU.2016.0030. [Google Scholar]
4 Nolton EC, Ambegaonkar JP. Recognizing and managing snapping hip syndrome in dancers. Medical problems of performing artists. 2018 Dec 1;33(4):286-91. [Google Scholar]
5 Malinowski K, Kalinowski Ł, Góralczyk A, Ribas M, Lund B, Hermanowicz K. External Snapping Hip Syndrome Endoscopic Treatment:“Fan-like” Technique as a Stepwise, Tailor-made Solution. Arthroscopy techniques. 2020 Oct 1;9(10):e1553-7. [Google Scholar]
6 Audenaert EA, Khanduja V, Claes P, Malviya A, Steenackers G. Mechanics of Psoas Tendon Snapping. A Virtual Population Study. Frontiers in Bioengineering and Biotechnology. 2020;8. [Google Scholar]
7 Hung CY, Chang KV, Özçakar L. Snapping hip due to gluteus medius tendinopathy: ultrasound imaging in the diagnosis and guidance for prolotherapy. Pain Medicine. 2015 Oct 1;16(10):2040-1. [Google Scholar]

This article was updated January 9, 2021

 

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