Do you have a noisy hip? Part 2: "Dancer's Hip"

In our previous post we went over external snapping hip syndrome. This time, we’re going through internal Snapping Hip Syndrome aka. “Dancer’s Hip”.

Internal snapping hip syndrome (SHS), also known as internal coxa saltans, is a condition characterised by a snapping or popping sensation felt on the inside of the hip during certain movements. It occurs when the iliopsoas tendon snaps over bony structures in the front of the hip joint.

The iliopsoas muscle is a hip flexor muscle that runs from the lower spine, through the pelvis, and attaches to the upper part of the thigh bone (femur). The iliopsoas tendon, which is an extension of the muscle, passes over the iliopectineal eminence or the femoral head in the hip joint. During certain movements, such as hip flexion or extension, the iliopsoas tendon can snap over these bony structures, resulting in the characteristic snapping sensation.

Internal SHS is commonly seen in athletes or individuals who engage in activities that involve repetitive hip movements, such as runners, dancers, or soccer players. It can be caused by several factors, including:

1. Iliopsoas muscle or tendon tightness: When the iliopsoas muscle or tendon is tight, it has less flexibility and is more likely to snap or pop over the bony structures during movement.

2. Muscle imbalances: Weakness or tightness in the muscles surrounding the hip joint, including the hip flexors or other hip stabilisers, can alter the movement patterns and increase the risk of internal SHS.

3. Overuse or repetitive activities: Repeatedly performing activities that require hip flexion or extension, such as high-impact jumping or kicking movements, can strain the iliopsoas tendon and contribute to SHS.

The main symptom of internal SHS is a snapping or popping sensation felt deep within the hip joint. It may be accompanied by pain or discomfort, although not all individuals experience pain. The snapping sensation is often more noticeable during specific movements, such as bringing the knee toward the chest (hip flexion) or extending the hip backward.

Physiotherapy treatment for internal SHS may include the following:

1. Rest and activity modification: Avoiding activities that exacerbate the snapping hip can help reduce symptoms and allow for healing. Modifying movements or using proper form during activities can also be beneficial.

2. Stretching exercises: Stretching the iliopsoas muscle and other hip muscles can help improve flexibility and reduce tension in the tendon. Hip flexor stretches and other targeted stretches are commonly recommended.

3. Strengthening exercises: Strengthening the muscles around the hip, including the hip extensors and hip stabilisers, can help improve muscle balance and stability, reducing strain on the iliopsoas tendon. Exercises such as bridges, lunges, and core stabilisation exercises are often prescribed.

4. Manual therapy: soft-tissue massage or mobilisations can address muscle imbalances and reduce pain.

5. Injections: In some cases, corticosteroid injections or local anaesthetics may be used to relieve pain and inflammation associated with internal snapping hip syndrome.

If conservative measures are ineffective, surgical options may be considered for severe or refractory cases. Surgical procedures can involve releasing or lengthening the iliopsoas tendon to alleviate the snapping or popping sensation.

If you’re experiencing these symptoms it's important to consult with a physiotherapist, for an accurate diagnosis and personalised treatment plan for internal SHS. We can assess your specific condition, provide appropriate recommendations, and guide you through the recovery process.

Stay tuned for the final instalment in our noisy hips series!

References

• Cheatham, Scott W. PT, DPT, OCS, CSCS, NSCA-CPT; Cain, Matt MS, CSCS; Ernst, Michael P. PhD. Snapping Hip Syndrome: A Review for the Strength and Conditioning Professional. Strength and Conditioning Journal 37(5):p 97-104, October 2015. | DOI: 10.1519/SSC.0000000000000161

• Laible, C., Swanson, D., Garofolo, G., & Rose, D. J. (2013). Iliopsoas Syndrome in Dancers. Orthopaedic journal of sports medicine, 1(3), 2325967113500638. https://doi.org/10.1177/2325967113500638