Internal Snapping Hip Syndrome Exercises

What is Internal Snapping Hip Syndrome?

Internal Snapping Hip Syndrome is a condition that is characterized by an audible click, pop or snap sensation in the front of the hip with certain movements.

The 3 types of snapping hip syndrome:

1. Internal (Front of hip)
   • (This blog post will specifically address this.)
2. External (Side of hip)
3. Intra-articular (Inside hip joint)

Disclaimer: The content presented on this blog post is not intended to be used as a substitute for professional advice, diagnosis or treatment. It exists for informational purposes only. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.

What is making the sound?

The snapping sound is produced as a result of the iliopsoas tendon (Hip flexor) flicking over a bony prominence in the pelvis (called the iliopectineal eminence).

It generally occurs as the hip extends (+/- externally rotates +/- abducts) from a flexed position.

Internal Snapping Hip Syndrome Test

a) Leg lower test

Instructions:

• Lie down your back.
• Hug both knees to your chest.
• Slowly lower and straighten one leg towards the floor.
• Perform on both sides.

Results: If the front of the hip produces a popping/snapping noise as the leg is lowered, this suggests Internal Snapping Hip Syndrome.

b) Scans

Real-time Ultrasound can be used to visualize the hip flexor tendon flicking over the bony prominence.

Xrays can be used to detect the presence of an enlarged bony prominence.

Causes of Internal Snapping Hip Syndrome

a) Tightness in the Iliopsoas muscle/tendon

Having a tight iliopsoas will limit the amount of pure extension available in the hip.

(The snapping sensation usually occurs when the hip moves towards extension from a flexed position.)

As a compensation for the lack of hip extension, the hip will tend to externally rotate/abduct as it extends and direct the tendon to flick over the bony prominence.

Tightness in the iliopsoas could be related to:

• Injury to the Hip Flexors
• Position-related (eg. prolonged sitting)
• Repetitive hip flexion/external rotation
• Weakness hip flexors
• Past injuries/Trauma
• Thickening of the tendon (Post-inflammatory)

b) Enlarged bony prominence

If the bony prominence (of which the tendon tends to flick over) is large, this can increase the likelihood of the tendon producing the snapping sensation.

c) Rotated pelvis

If your pelvis tends to rotate AWAY from the snapping hip, this will encourage more external rotation/abduction of the hip.

As a result – this can lead to the iliopsoas tending flicking over the bony prominence.

Is Snapping Hip Syndrome serious?

No – there is is no pain associated with the snapping hip in most cases.

However, in some people, can develop symptoms if left unaddressed.

Exercises for Snapping Hip Syndrome

1. Addressing pain

As previously mentioned, there is usually no pain associated with Internal Snapping Hip Syndrome.

However – if there is pain present, it is generally due to the inflammation of the hip flexor tendon (called “Iliopsoas tendonitis”).

This will need to be addressed before commencing the exercises that help reduce the snapping sensation.

How to reduce inflammation:

• Reduce exposure to any activity or movement that aggravates the pain.
• Anti-Inflammatory medication
• Cold therapy
• Cortisone injection

2. Releases

I would only recommend the following release technique if you are very confident you can locate the exact location of the iliopsoas tendon. If not – feel free to focus on the other exercises mentioned.

Instructions:

• Accurately locate the Iliopsoas tendon.
  • (Ask a healthcare professional to show you if you are not certain!)
• Apply an appropriate amount of pressure directly on top of the tendon using your finger tips.
• Continue for 1 minute.

Note: There are sensitive structures such as nerves and arteries that run through this area! Please be careful. If any doubt – consult your healthcare provider.

3. Snapping Hip Syndrome Stretches

Instructions:

• Assume the lunge position.
  • The hip at the back will be the side that will be stretched.
• Keep the pelvis facing directly forwards.
• Tilt the pelvis backwards.
  • “Tuck your tailbone underneath you.”
• Lunge forwards.
• Push the hips forwards.
• It is essential that you can feel a stretch at the front of the hip.
• To increase the stretch: Lean backwards and tilt your torso away from the side being stretched.
• Hold for 2 minutes.

4. Strengthening exercises

The following exercises are designed to strengthen the hip flexors. Make sure to move into the range where the snapping occurs. They are ordered by level of difficulty.

a) Glute loading (resistance band)

Instructions:

• Lie down on your back.
• Bring the knee towards your chest.
• Wrap a resistance band around the bottom of your foot.
• Hold the band with your arms directly in front of you.
  • Make sure to pre-tension the band.
• Proceed to push the resistance band with your foot as you lower and straighten the leg into the range where the snapping usually occurs.
• Only apply as much resistance required to stop the hip from snapping.
• Perform 20 repetitions.
• Continue for 3 sets.
• Progression: Reduce the amount of resistance being applied.

b) Supported leg lower (non-stretch band)

Instructions:

• Lie down on your back.
• Bring the knee towards your chest.
• Wrap a non-stretchable band around the base of the feet.
• Support the weight your leg by providing assistance with your hands.
• Slowly lower and straighten your leg into the range where the snapping usually occurs.
• Provide just enough support to allow for the full movement of the hip without the hip snapping.
• Perform 20 repetitions.
• Continue for 3 sets.
• Progression: Reduce the amount of support provided.

c) Isometric 

Instructions:

• Lie down on your back.
• Bring the knee to your chest.
• Lower and straighten your leg. Take note of the exact leg position when the hip produces the snapping sensation.
• Place your leg in the position just before it usually starts to produce the snap sensation.
• Place your hand on your knee.
• Push down onto your knee as hard as you can without letting the leg drop.
• Hold for 5-10 seconds.
• Perform 10 repetitions.
• Progression:
  • Apply more pressure to the knee.
  • If you can not generate enough force through your hair, you can hook your foot under a stationary object.

d) Unsupported leg drop

Instructions:

• Lie down on your back.
• Bring both knees up towards your chest.
• Slowly lower and straighten your leg without allow the hip produce a snapping sensation.
• Perform 20 repetitions.
• Continue for 3 sets.
• Progression: Lower the leg slower.

e) Full range with resistance.

Instructions:

• Lie down on your back.
• Wrap a resistance band around both feet.
• Keep both knees straight.
• Slowly lift and lower leg without allow the hip produce a snapping sensation.
• Perform 20 repetitions.
• Continue for 3 sets.
• Progression:
  • Increase the resistance.
  • You can also use an ankle weight instead.

4. Address Pelvis rotation

If your pelvis tends to rotate AWAY from the leg as it is lowered down, maintaining a more stable pelvis position may help reduce the snapping sensation.

… Give this a try!

Instructions:

• Lie on your back with both knees pointing towards the sky.
• Elongate the knee (non-snapping side) towards the sky and Pull your leg back into the hip socket (snapping side).
  • This helps prevent the pelvis from rotating away from the leg that is being lowered down.
• Maintain this position throughout this exercise.
• Slowly lower the leg down on the side which makes the snapping noise.
• Keep both knees facing upwards.

… Did it still make a noise?

If the hip still produced a snapping noise, I would recommend that you continue with the strengthening exercises for the hip flexors.

If the snapping completely disappeared: Practice maintaining this more stable pelvis position (by preventing pelvis rotation) as you perform the hip flexor strengthening exercises.

If you would like more exercises that will help correct a rotated pelvis, check out this post: How to Fix a Rotated Pelvis.

5. Address Anterior pelvic tilt

It is common to see a tight iliopsoas tendon associated with an anterior pelvic tilt.

Check out this blog post: How to fix Anterior Pelvic Tilt.

6. Do you need surgery?

If conservative management has failed to resolve the symptoms associated with Internal Snapping Hip Syndrome, surgical intervention may be considered. (… but should never be the first thing you try!)

a) Resection of bony prominence

This involves shaving down the size of the bony prominence.

b) Iliopsoas tendon release

This involves cutting a portion of the tendon to reduce tightness and improve the ability to stretch.

Conclusion

Internal Snapping Hip Syndrome is mostly a harmless condition of the hip.

However- if you would like to eliminate this issue, the exercises mentioned in this blog post will help!

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