Snapping Hip Syndrome (SHS), also known as Coxa Saltans, is a condition in which one may hear a popping sound or an audible click in the hip when the joint moves.
This condition can occur in one or both hips.
It does not always cause pain.
It is also called dancer's hip
It is typically an overuse injury with a higher occurrence in activities that involve repetitive hip flexion and extension, like with:
-Soccer players
-Ballet dancers
-Horse riders
-Track and field athletes
-Excessive weightlifting or -Running
Causes
Snapping hip is most commonly an overuse phenomenon, but may be precipitated by trauma, including intramuscular injection into the gluteus maximus and surgical procedures.
Anatomical variations may predispose to coxa saltans including an increased distance between the greater trochanters, prominent greater trochanters, and narrow bi-iliac width.
Additionally, iliotibial band tightness, shorter muscle or tendon lengths, muscle tightness, or inadequate relaxation of the muscles may contribute to snapping hip development.
Sometimes no etiology is uncovered at all, resulting in an idiopathic classification.
Classification of snapping hip syndrome based on the cause:
1.External (most common):
Iliotibial band snaps over the greater trochanter of the femur.
It is not associated with a traumatic event, but mostly with a minor mechanism of injury.
The onset is gradual with sapping or pain located laterally over the greater trochanter (on the side of the hip)
The snap occurs when the leg moves back and forth.
2.Internal:
It happens in front and just inside the hip.
It has a gradual onset, not usually associated with a traumatic event.
There will be a painful sensation deep within the anterior groin as the hip is moved from flexion into extension or external rotation.
Internal snapping hip most commonly occurs as the iliopsoas tendon snaps over underlying bony prominences, such as the iliopectinal eminence or the anterior aspect of the femoral head. Other causes include paralabral cysts and partial or complete bifurcation of the iliopsoas tendon.
The affected flexor muscle stretches, gets caught on the hip bone, then snaps when it releases or slides back into place.
It is usually associated with bursitis
The snapping movement can produce an auditory clunk or click
3.Intra-articular (least common):
Report a sudden onset of snapping or clicking from an injury or traumatic event to the hip capsule.
The sources of this snapping can come from intra-capsular lesions, loose bodies settling in the acetabular fovea or synovial folds or a torn acetabular labrum,
Symptoms of SHS
Symptomatic people may experience pain or weakness during hip flexion and extension that limits participation in their activities
Management
Majority of SHS cases are asymptomatic and usually don’t require intervention. However, in more persistent cases which cause pain and/or activity limitations, the following form of intervention may be adopted.
Rest, ice, non-steroidal anti-inflammatory medication (NSAIDs), corticosteroid or lidocaine injections and physiotherapy.
Surgical (arthroscopic)intervention is the last resort aiming to lengthen or relax the tight tendon or ligament to eliminate the snapping as well as to correct any associated/contributing pathologies.
Physical therapy management
Physical therapy aims at identifying and correcting the source of the muscle tightness that is causing the snapping.
Stretching of anterior hip structures or the iliotibial band and its associated structures
If the muscle is too short or rolled up into a ball, the treatment will be directed at increasing muscle length through passive and active stretching.
If the problem is that excessive muscle activation (overuse) is increasing the tension in the muscle, the intervention is directed at modifying neuromuscular control by means of eccentric exercise . It is effective in decreasing pain and increasing function, when compared to other physiotherapy interventions.
Myofascial release , general stabilization and strengthening program of the affected muscles have been found effective.
Educating the patient to avoid motions that cause pain and/or the snapping sensation will be a great step in the treatment plan.
Points worth knowing
Do stretches before starting any physical activity. Stretch the muscles on the front, side and back of the hip. Repeat those stretches after you finish a sport.
Develop a daily exercise routine to improve muscle strength and flexibility.
Increase the intensity of a sport slowly. Do not push too hard, too fast or too soon. They should back off on the intensity if they feel pain again.
Do different types of sports so that the same muscles are not used over and over again.
Wear well-fitted shoes that give good support.
Researches
We report a case of a bifid iliopsoas tendon leading to internal snapping hip syndrome which was ultimately successfully treated with surgical release, including review of the clinical presentation, pathophysiology, and dynamic sonographic findings.
Treatment is recommended for symptomatic SHS and begins conservatively with physical therapy, rest, and anti-inflammatory medications.
Conservative management through rehabilitative therapy is the standard for initial management.
Eccentric strengthening exercises showed the greatest value in decreasing pain and increasing function, when compared to other physiotherapy interventions.
There is mounting evidence that eccentric exercise is not only a therapeutic intervention influencing muscle morphology but also targets unique alterations in neuromuscular control, influencing injury risk.
A case study has been published which documents the complete resolution of pain in a case of lateral coxa saltans. Myofascial release of the tensor fascia lata, gluteus medius and gluteus maximus, and adductors was performed, and the patient was prescribed a general stabilization and strengthening program focusing on the abductors.[22]
A Cochrane review showed no increased benefit of transverse friction massage, when compared to other interventions, for iliotibial band friction syndrome.
Your Physical therapist will be the right person to teach you umpteen number of stretches and exercises that will hasten your recovery. At Valley Healing Hands, Brownsville, Texas, we provide the best Physical therapy treatment for snapping hip syndrome. Our therapists are highly skilled and are more than dedicated when it comes to planning a personalized treatment routine as per your condition and goals that must be met. Our patients are completely satisfied with our services. You may learn about what they have to say about us here and get connected to us here. Our patients love us, You too will!!!.
Sources:
https://www.webmd.com/a-to-z-guides/snapping-hip-syndrome-causes-symptoms-treatments https://doi.org/10.1002/jcu.22846/
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