Snapping hip (coxa saltans), intern, extern and intra-articular
Description of snapping hip
A snapping hip also called coxae saltans is a state where the tendon “snaps” over the bones, mostly because the muscles are too tight, thus making with the movement a click or clonking sound. One can divide the snapping hip state into whether it is an internal or external snapping hip, depending on which tendon / muscle causes the condition. As well as intra articular, if this click sound does not originate from the muscles around the hip but on the other hand from the actual hip joint.
An external snapping hip is as the word suggests a problem related to the tendons on the outside. There may be several reasons for this, but typically the iliotibial band (the broad band on the outside of the thigh) slides too hard over the trochanter major (the hip’s outer bone protrusion) resulting in the clicking sound and causing the tendon to “snap” as the hip moves. The iliotibial band usually won’t be overly tight as it is made of collagen tissue- Instead it is often the muscles that insert (attach) onto it. There are two muscles that attach to the iliotibial band, and it is the small hip flexor (m. tensor fascia latae) and the large seat muscle (m. Gluteus maximus). When these become too tense (hypertonia), the band becomes tight and thusly slips too hard over the trochanter major. These two muscles are actively used for running and any sport where the hip bends or stretches a lot. It is not a serious condition, and it can often be relatively easy to treat. Sometimes the bursae is annoyed by the trochanter major (bursa subtendinea trochanterica), thus the condition is aggravated by a mechanical bursitis.
Rarely it may happen that the problem is not that these muscles are too tight, but that the attachment point of the iliotibial band is “moved” on the tibia. This occurs when the tibia is medially rotated (a torsion inward) thusly creating a pull on the band from below. This torsion typically occurs because the arch of the foot has collapsed, for example flat foot, hyper-pronation or misalignment of the foot bones.
An internal snapping hip is when the same problem arises on the inside, when m. Iliopsoas is too tight and runs over the symphysis / ramus superior. The problem is exactly the same as an external snapping hip and the treatment as well, i.e. there is hypertonia in m. Iliopsoass and this should be treated or trained with the muscular techniques available. One should remember that iliopsoas is actually two muscles, and one of the two muscles can be suffering from isolated hypertonia (tightness). It is a little harder to examine an internal snapping hip, as it does not often produce the clicking sound- or at least the condition must be extreme before a clicking sound becomes audible. Here the patient often senses a slipping sensation when he / she bends the hip. Again, as on the outer side, iliopsoas can irritate the bursae, bursa iliopectinea and thus make a mechanical bursitis.
Intra articular snapping hip. This condition is something more serious than those that are muscularly conditioned. An intra articular snapping hip is a result of direct damage to the hip’s passive stability, which causes the hip to become unstable and loose. The injury may be directly on the acetabulum (acetabular lesion), overcurrent ligaments, repetitive subluxations (partial joint dislocations) that have loosened the joint.
Symptoms of snapping hip
- In the external snapping hip there will often be a clicking sound and sensation from the outside of the hip, which can lead to pain, fatigue, and overtraining of the area.
- In an internal snapping hip, there will often be a clicking sound and sensation from the inside of the hip / high in the groin, which can lead to pain, fatigue and overtraining of the area.
- In the intra-articular snapping hip there will often be a clicking sound and sensation from the inside of the hip joint. This can lead to pain, often in a deep hip bend, as well as a feeling of fatigue and overtraining in the area. Just as it can give a sense of looseness and instability in the joints.
Examination of snapping hip
The diagnosis for external snapping and internal snapping is based on the symptoms the patient has and how much the examiner can provoke the condition by passively performing the movements. A musculoskeletal ultrasound examination can confirm the condition.
An intra-articular snapping hip is found through MRI scanning.
Treatment of external and internal snapping hip
- For external snapping hip: Muscular therapy of tensor fascia latae and m. Gluteus maximus; which can be muscle energy technology (MET).
- For internal snapping hip: Muscular therapy of m. Iliopsoas; which can be muscle energy technology (MET).
- Massage.
- Stretching.
- PNF teknikker.
- MFR.
- Heat therapy.
- TNS on the hypertone muscle at 10 Hz for 10 min.
- Spascupreel.
- If tibia is medially rotated with an external snapping hip, insoles are necessary to prevent the foot from falling into a flat foot / hyper-pronation as this is the reason for the rotation, and thusly also the pull on the iliotibial band. Furthermore, training of the arch of the foot out of pronation is necessary, learn more about this here under foot.
Treatment of intra articular snapping hip
If the intra articular snapping hip does not provoke prain, or is not limited movement than nothing needs to be done. It does make sense to train the active stability around the hip, meaning the hip muscles.
If, on the other hand, there is pain related to the condition, the only real treatment is an operation.
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