Snapping Hip – ITB/Iliopsoas
Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Snapping hip occurs when muscles or tendons are pulled tightly over bones and then released, with an audible “pop” or “snap.” While snapping hip is not considered a serious orthopedic or sports condition, research suggests that it can lead to joint pain or damage in the hip.
To better understand, snapping hip manifests in three ways: internal, external and intra-articular, with the latter being less common. When the muscle tendon moves over bone in the front of the hip joint and produces a snapping sound as tension is released, it is called internal snapping hip. This involves the sliding of the hip flexor tendons (iliopsoas tendon and rectus femoris tendon) across bony structures in the hip.
Internal snapping hip is a common running injury, and symptoms include hip popping when the hip is rotated away from the body. This also occurs when the hip is in a flexed position greater than 90 degrees. In some cases, hip popping is followed by severe pain in the groin or pain that increases with activity. In other cases, symptoms begin with mild discomfort and worsen with time. Either way, internal snapping hip is marked by inflammation and may result in iliopsoas bursitis.
Eliciting a popping sound on the outside of the hip, external snapping hip is the result of muscle tendons (the iliotibial band or the gluteus maximus) moving or sliding over the bone at the top of the femur. While some report hip popping when running or playing golf, others report popping and snapping when walking upstairs or carrying heavy groceries. Other symptoms of external snapping hip include pain on the outside of the hip that can be severe, and the feeling that the hip is going to dislocate or pop out of socket. Like internal snapping hip, inflammation is a factor and can result in bursitis.
Tightness and rigidity of gluteal muscles are believed to be one cause of external snapping hip, as these muscles move and release tension across bony structures. Yet, this condition is also linked to a tight IT band, or iliotibial band syndrome (ITB). The IT band, which is referred to as a tendon, ligament or fascia tissue, runs along the outside of the leg and knee from the top of the pelvis to an area just below the knee joint. This band is a common source of pain, particularly for athletes involved in physical conditioning and training, runners, cyclists and military recruits.
Causes of Snapping Hip and Iliotibial Band Syndrome (ITB)
Classifying snapping hip and iliotibial band syndrome (ITB) can be difficult, given the many nerves, bones, joints, ligaments, muscles and tendons involved in complex hip and knee flexion movements. Yet, because the hip and knee rely heavily on surrounding muscle tendons for stability and controlled movements, careful examination of an individual’s biomechanics and muscle balance is necessary. In effect, it is believed that hip dysfunction, as well as ITB syndrome, may be caused by improper form and altered running mechanics due to weak or tight muscles, muscle fatigue or impact issues (foot positioning when hitting the ground).
Other causes may include:
- Weak hip or gluteal muscles
- Weak hip rotators
- Weak inner quadriceps
- Weak abdominal core
- Weakened foot arch
- Sudden increase in training frequency and endurance (overload)
- Training or conditioning downhill
Treatment and Rehabilitation for Snapping Hip and Iliotibial Band Syndrome (ITB)
With knowledge and expertise across multiple disciplines, physiatrists are best positioned to identify and classify snapping hip and iliotibial band syndrome. Carefully studying the complex network of nerves, bones, joints, ligaments, muscles and tendons in relation to the hip, knee and surrounding systems, physiatrists utilize selective treatments. They use these treatments to obtain diagnostic information relating to a patient’s condition or injury. As an example, initial treatment will focus on reducing acute pain and inflammation. Based on the patient’s response to ice therapy or ultrasound, for instance, the physiatrist uses this information to create a suitable framework for continuing treatment and rehabilitation.
When necessary, physiatrists assemble a group of trusted medical professionals such as physical and occupational therapists, clinicians and interventionists as they develop and propose selective therapies to reduce pain and maximize function. Once pain and inflammation are managed, patients are better able to tolerate rehabilitation. For snapping hip and iliotibial band syndrome (ITB), this often begins with training to de-load the IT band, strengthening the hip and knee muscle groups and normalizing the hip and knee joint range of motion and muscle lengths.
Under the direction of the physiatrist, appointed specialists administer training, while also instructing patients on how to improve proprioception, agility, balance, and sports-specific techniques, including running or landing postures. Thus, rehabilitation is aimed at improving the patient, both physiologically and psychologically. This is as they learn how to manage their pain and movements to maximize their functioning.
As an esteemed physiatrist in Tenafly, Dr. Howard Liss, M.D. is dedicated to providing effective treatment and rehabilitation to individuals with pain from snapping hip or ITB syndrome. Contact our office today to schedule a consultation with Dr. Liss.