Snapping Hip Syndrome

Do you have a snapping hip or a hip that makes other noises during certain movements?

Do you want to know what’s going on and whether or not you should be worried?

The purpose of this blog is tell you everything you need to know about snapping hip syndrome, and provide exercise progressions and modifications to help!

Looking to improve the strength, range of motion, and control of your hips to enhance your function and performance? Check out our Hip Resilience program!

Snapping Hip Syndrome

Snapping hip syndrome refers to a snapping sensation felt on the front or side of the hip that occurs with various motions. The snapping can be painful or painless, and loud, quiet, or completely inaudible. There are 2 primary types: external and internal.

Snapping Hip Syndrome

External snapping is usually attributed to the iliotibial (IT) band or gluteus maximus moving back and forth over a bony prominence on the side of your hip known as the greater trochanter. It can be felt during side lying flexion and extension of your hip, or during different weight bearing movements, such as a single leg deadlift.

Internal snapping, also sometimes called “Dancer’s Hip”, refers to the iliopsoas tendon (hip flexor) snapping over one of two locations: the head of the femur or a bony prominence on the front of your pelvis known as the iliopectineal eminence. It can be felt when the hip is moved from flexion, abduction, and external rotation (FABER) to a more extended, adducted, and internally rotated position.

Whether you noticed the snapping develop randomly or shortly after an injury, it’s typically nothing to worry about. Snapping is common, often happens in people without any pain, and does not mean that anything is wrong with your hip or that issues will arise in the future.

I’ve had external snapping of my right hip during single leg deadlifts and single leg hip thrusts for as long as I can remember, but it’s never been problematic. And I know for some people reading it can feel like the hip is subluxing or dislocating, but rest assured that your hip is securely in place. 

I like this quote from world-renowned hip specialist, Dr. Thomas Byrd – “For most patients, the treatment is then little more than assurance that this is a normal variant and that the snapping is not indicative of future problems.”

There’s no reason to create a problem that doesn’t exist. For this reason, I also like to drop the word “syndrome” because it attaches an unhelpful label to you and makes things sound scarier than they are.

No one knows exactly why people begin experiencing snapping of their hips. Sometimes it’s attributed to a lack of flexibility, which I think is a poor explanation considering that it’s common in dancers and gymnasts. Other times it’s supposedly due to a lack of strength, which is also an oversimplification.

Regardless of the reason, if you’re experiencing pain associated with the snapping that’s affecting your daily life or limiting your activities, I’m going to provide strategies and exercises to help. The goal, though, is to reduce symptoms and improve function because there’s no guarantee that the snapping will completely go away.

Activity Modifications

Whether you’re dealing with a painful external or internal snapping hip, one of the first things you want to do is modify any aggravating activities. You don’t necessarily have to discontinue what you’ve been doing, but you want exercises and activities to be tolerable enough that you’re not causing flare-ups on a regular basis, and your symptoms and function are slowly improving over time. 

There are a lot of variables that you can attempt to modify, but some of the easiest relate to the intensity, complexity, and time spent performing the movements or sports exacerbating your symptoms.

Here are a few examples:

  • If you’re a runner whose symptoms are worse with faster running speeds, you might dial back the intensity of your runs. Similarly, if running hills, trails, or sloped surfaces is provocative, you might stick with straight-line running on flat ground temporarily.
  • If you’re a ballet dancer, you may continue practicing while minimizing movements that are more explosive or require a greater range of motion. A paper by Nolton and Ambegaonkar in 2018 suggests that if a grand plié is too painful, you can perform a demi-plié at a comfortable depth.
  • If you’re a soccer player, you can change how high you bring your foot up to receive the ball, how hard you’re kicking, how fast you’re running, how much you’re cutting and changing directions, etc. 
  • There’s also a case report by Wahl et al in 2004 documenting how an NFL offensive lineman irritated his hip during two-a-day practices while performing bucket steps, knee-high running, and stance drills.

With regards to time spent, you could reduce the duration of single training sessions, the frequency of training sessions throughout the week, or just the amount of time spent performing the specific aggravating activities. You’re trying to temporarily reduce the total volume of things that increase your symptoms.

If it’s a movement or activity that you don’t have to do or there’s a reasonable alternative, you can obviously just avoid or minimize it.

I mentioned that I have external snapping when I do single leg deadlifts. If they ever became problematic for me, there are plenty of other exercises that accomplish similar goals. In fact, I don’t have any snapping when I do regular deadlifts, so that’s a reasonable alternative.

Exercise Rationale

When it comes to exercise prescription for a snapping hip, I approach the management of symptoms similar to tendon issues. You’re aiming to find a tolerable starting point for loading the specific tissues involved, and then gradually increasing that load until you’ve met the demands of your preferred activity or sport. The main variables I suggest manipulating initially are range of motion, speed, and intensity or effort.

Let me give an example for each.

Let’s say that you have internal snapping at the bottom portion of a straight leg raise. Since the snapping is occurring at a known range of motion, you can temporarily adjust your training to avoid that part of the exercise. You’re purposely performing a shorter range of motion overall.

With regards to speed, some people notice that their popping can be reduced just by slowing things down. Perhaps it has to do with the fact that the slower you perform the exercise, the better control you should have of your leg.

If we combined the range of motion and speed recommendations, you could also perform isometrics, which are just static holds, at every portion of the straight leg raise that doesn’t recreate your snapping.

Intensity or effort relate to the difficulty of an exercise. For the straight leg raise, it’s typically harder if you keep your leg fully straight or do both legs at a time. You can make the exercise easier by doing one leg at a time, bending the opposite knee, and bending the knee of the involved leg as much as needed.

What are the exact exercises that you should do for an internal or external snapping hip? There are a lot of options. I’ll give a few, but the most important thing is to understand these principles so you can apply them to any exercise relevant to your goals.

Internal Snapping Exercises

For internal snapping, the primary focus should be training the hip flexors through as much range of motion as you can initially tolerate. Here are 3 options:

Option #1: Supine Hip Flexion – Lie on your back, keep one leg straight, and bring the other thigh toward your chest.

If it’s too difficult or uncomfortable, you can keep your foot in contact with the ground. If you want to make it more challenging, you can add a band around your feet.

Option #2: Standing Hip Flexion – While using one hand for balance, stand tall and slowly lift your thigh until it’s parallel with the ground.

Shorten the range of motion to make it easier, and add resistance using a band or weight to make it harder.

Option #3: Straight Leg Raise – Lie on your back with one knee bent, straighten the other leg, and then lift that leg until your thighs are in line with one other.

If you want to make this exercise more difficult, you can perform it on an elevated surface to increase the range of motion or add resistance.

Since hip flexion doesn’t always happen in a perfectly straight line like I just demonstrated, you can eventually explore moving through different ranges of motion. For instance, you can drive your knee outward during supine or standing hip flexion, or make small arcing motions during the straight leg raise.

External Snapping Exercises

For external snapping, the main goal should be training the glute muscles in different positions. Here are 3 options:

Option #1: Split Squat – Start in a stride stance and lower yourself down so that your back knee taps an egg that you don’t want to crack.

If it’s too difficult or uncomfortable, shorten the range of motion or use your hands for assistance. If you want to make it more challenging, add weight or elevate your front leg.

Option #2: Single Leg Hip Thrust – Set up with your shoulders on a bench or elevated surface, bend one hip and knee, and then lift your hips up toward the ceiling.

If it’s too challenging, perform a single leg bridge on the floor. Add weight to make it harder.

Option #3: Single Leg Deadlift – Stand on one leg while keeping a slight bend in both knees, hinge at your hips until your trunk is almost parallel with the ground, and then return to the starting position. Repeat this movement without touching your foot to the ground.

To make it easier, use your hands to help with balance, shorten the range of motion, or tap your foot to the ground. Add weight to make it harder.

Like the previous examples, you can explore various ranges of motion. For the split squat, you can rotate toward or away from the lead leg. For the single leg deadlift, you can perform reaches in different directions.

Snapping Hip Programming

In terms of programming, you can perform 1-2 exercises from each category every other day. For example, you might do supine hip flexion and split squats on Monday, standing hip flexion and single leg hip thrusts on Wednesday, and straight leg raises and single leg deadlifts on Friday. 2-4 sets of 10-20 repetitions per exercise is a good starting point.

Concentrate on executing the exercises slowly and with as much control as possible. And yes, you’d do the exercises on both legs.

If you choose to do isometrics because they’re more tolerable, you can aim for 30-45 second holds instead. Isometrics can also be used as part of a dynamic warm-up prior to running, dancing, or playing sports.

Other than the options already shown, some people seem to respond well to the multi-planar nature of banded fire hydrant isometrics in standing or quadruped.

Additional warm-up exercises can include any general movements targeting the trunk and hips like planks and side planks, or hip circles in standing, side lying, or quadruped.

Regardless of what you choose, remember your intention should be to find a tolerable baseline and slowly progress your function over time. 

Snapping Hip Summary

In summary, there are 2 primary types of snapping hip: external and internal.

External snapping can be felt on the outer part of your hip during side lying flexion and extension, or during different weight bearing movements, such as a single leg deadlift.

Internal snapping can be felt on the front of the hip when it’s moved from flexion, abduction, and external rotation to a more neutral position.

Although the snapping sensation can be worrisome, especially if it feels like your hip is subluxing or dislocating, it’s important to know that it’s common in people without symptoms and usually doesn’t mean that anything is wrong with your hip or that problems will develop in the future. 

If you are dealing with a painful external or internal snapping hip, one of the first things you want to do is modify the intensity, complexity, and time spent performing any aggravating activities. You don’t necessarily have to discontinue what you’ve been doing, but you want exercises and activities to be tolerable enough that you’re not causing flare-ups on a regular basis, and your symptoms and function are slowly improving over time. Additionally, you can gradually perform the exercises presented in this blog.

Finally, sometimes intra-articular snapping, which refers to popping, clicking, catching, and locking within the hip joint, is discussed alongside internal and external snapping, but it actually falls into a category of its own. Therefore, it wasn’t the purpose of this blog.

However, once again, joint noises, especially if they’re pain-free, are usually nothing to to be concerned about and may respond to the same types of activity modifications and exercise progressions mentioned here. We also have a blog about femoroacetabular impingement that might provide some insight.

Do you want to read other similar blogs? Check out these topics:

 Groin Pain Rehab, Hip Bursitis, Adductor Strain Rehab

Thanks for reading. Check out the video and please leave any questions or comments below.

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