Hip Flexor Pain Running
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Snapping hip syndrome, also know as “Dancer’s Hip”, is when the hip joint makes a snapping noise, it is usually repeatable and can be reproduced with specific movements such as flexing the hip, walking, running, lifting the knee, and getting up from a chair, to name a few. The snapping noise and sensation are caused by a muscle or tendon moving over a boney prominence around the hip. For most people snapping hip is pain-free and more annoying than problematic. Unfortunately, for some athletes and dancers this can develop into a painful condition, it can also cause weakness and affect performance.
Snapping hip syndrome can occur at different locations around the hip, relating to different structures such as tendons, muscles or articular cartilage.
A snapping sensation at the outside of the hip, which is caused by the Iliotibial band (ITB) moving over the greater trochanter. The greater trochanter is a protruding part of the femur bone. This type is often related to glute weakness and/or ITB tightness.
A snapping sensation at the front of the hip, which is caused by one or more of the hip flexor muscles. It can also be caused by the hip flexor muscle tendons moving over the hip bone, and this can cause irritation and bursitis at the front of the hip.
A snapping sensation felt deeper in the hip joint that is caused by a tear to the cartilage of the joint. It can be either the cartilage of the joint socket, called the acetabulum, that is torn, or the cartilage on the femoral head.
Snapping hip is typically seen as a result of overuse with sports, especially those with repeated hip flexion, such as soccer, dance, and gymnastics. Hence, it is also called “Dancer’s Hip. The repeated flexion of the hip, in particular when it is done quickly, or the repeated stretch and engagement of the muscle from extension are ways that can strain the muscle and cause this condition.
It is more common to see with adolescents, in particular following a growth spurt due to an increase of muscle tension as the muscles catch up with bone growth. More females develop snapping hip than males. This may be attributed to greater flexibility in females.
Assessment for snapping hip syndrome should include thorough discussion about the symptoms experienced, the location of symptoms, and the actions and activities that can cause the symptoms.
In many cases it is possible for the individual to recreate the snapping, which can be helpful for the assessor to see the position and movement that causes it. This can often be enough to show which structures are causing the snapping.
Feeling over the area of snapping or where there is pain as the joint is moved may be a useful way for the examiner to feel what structures are moving.
It is essential to have a thorough assessment with an experienced health care professional, who will be able to rule out other possible issues with the joint. In some cases diagnostic imaging may be requested to confirm the diagnosis.
Snapping hip syndrome treatments can vary depending on several factors:
– structures involved: hip flexors, ITB, cartilage
– severity of symptoms
– duration of symptoms
– activity and sports of the individual
– health of the individual
– the individual’s response to treatment
Reducing activity is not always necessary, often snapping hip can present as an annoying noise and sensation rather than a painful and irritated condition. In these cases, the individual may well be able to continue their activities and sports as normal. If pain is present then the severity and irritability should be established and this needs to be weighed up with the benefit of continuing sport. Most of the time when a physiotherapist or sports doctor sees a case it is because it has become a problem, that might be pain or a negative effect on performance.
Modifying activity and sports is necessary for painful snapping hip cases. Rest may need to be a complete break from a particular activity or an alteration. However, the extent of the modification will depend on the individual. During this period ice can be helpful for symptom relief, and if pain and inflammation are significant, then non-steroidal antiinflammatories may be recommended.
The most valuable part of physical therapy for snapping hip syndrome is exercise prescription. This should follow a detailed assessment and be specific to your symptoms and body. Physical therapy in the form of hands-on treatment can include deep tissue massage, trigger point release of muscles and connective tissue, and joint mobilisations, and is used for short-term pain relief.
Exercises for snapping hip syndrome should combine stretching and mobility as well as strengthening exercises. Some commonly prescribed stretches include those for the iliotibial band, hip flexor, gluteal and piriformis muscles. Strengthening should be focused on the individuals’ points of weakness and the aim is to improve the condition of tissues and quality of movement. Below are 3 useful exercises, a glue bridge to strengthen the gluteus maximus, medius and minimus, a hip flexor strengthening exercise, and a core exercise working on abdominal strength with hip flexion.
Snapping hip syndrome recovery time is typically 2-6 weeks but varies. Duration of symptoms before seeking treatment, as well as the severity of pain and adherence to advice and rehabilitation, are all key factors in determining the rate of recovery.
If recovery is slow, symptoms severe, or symptoms develop close to competition events, additional treatment may be necessary or desirable. Corticosteroid injections can be helpful to reduce swelling and inflammation and can effectively reduce symptoms. It is also a useful treatment if bursitis has developed. Physical therapy and activity modification is still recommended with this option.
It is rare for surgery to be needed, but if recommended it is typically performed arthroscopically either as investigative surgery, or if a cartilage tear is present that needs removal or repair. Physical therapy will always be advised after surgery, and pre-surgery in many cases as well.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments.