Snapping Hip / Coxa Saltans

April 30th, 2012

Snap, crackle, pop.  If you hear these noises more often from your hips than your cereal bowl then you might have a farily common problem known as snapping hip /coxa saltans, or “dancer’s hip” (how many names does one condition need?).

What the heck is snapping hip anyway?  Well it’s pretty simple to describe in general terms, but to understand it more in depth, you’re gonna need a bit of an anatomy lesson.  So I hope you’re ready for that.  Simply put, what happens in this condition is that a muscle or tendon rub across a bone or ligament  in the hip and causes an audible and sometimes painful click or pop.  Where that click or pop is coming from is really in the details, and as you may have heard… That’s where the devil lies.  There are four types of snapping hip, so let’s get crackin’ and start with the most common type.

  1. Lateral / External – The snap that occurs with this type happens when the iliotibial band (a dense band of connective tissue that runs from the outside of your hip down to your knee) rubs over the prominent bony portion of your thigh bone (femur).  If you missed theblog about IT band syndrome, you should really check it out as it best describes exactly what is going on and how best to approach treatment.
  2. Anterior/ Internal – This version is less common, but in my experience tends to cause patients more discomfort.  What happens here is that the tendon of the iliopsoas muscle (a muscle that originates from your lower spine and pelvis that allows you to bring your knees to your chest) rubs over a bony prominence on the front part of your pelvic bone.  There is some debate on whether or not the tendon is rubbing on the bone or a muscle nearby, but I think it’s really kinda splitting hairs and doesn’t make this whole thing easier to understand.  So let’s just say for argument’s sake that it rubs on the bone.  Check out the diagram below to see more of what I’m talking about.  Image A shows the femur in an extended and externally rotated (frog leg) position and B shows the thigh in a neutral position.  You can see that the tendon of the iliopsoas muscle shifts over the lower portion of the pelvic bone, which causes the click.
  3. Posterior – Posterior snapping hip is extremely rare, but is usually caused by rubbing of the hamstrings over the ischial tuberosity (your sit bones).
  4. Intra-Articular –  This type refers to some sort of pathology with the hip joint itself, whether it be a tear in the cartilage cup that holds the femur in the socket, a bone fragment within the joint, or instability that leads to chronic dislocation of the hip.  These types of issues usually require surgery for correction and need to be ruled out as the cause of your snapping hip.

As I mentioned earlier, this condition can sometimes be painful and sometimes painless.  The reason for this has to do mostly with which structures are being rubbed over and how frequently it happens.  Typical pain generators in the case of snapping hip tend to be the smallbursae (connective tissue bags that pad muscles / tendons / bones and help them glide over one another) and small tears and inflammation in the tendons which cause tendonitis / tendonosis.  Treating these things will tend to give patients relief from their symptoms, but doesn’t go a long way in adressing the actual problems which can lead to chronic recurrence of pain.

It really boils down to addressing biomechanical faults in the low back, hip, knee and ankle and correcting them with adjustments and exercises.  Speaking of exercises, the best recommendation really depends on the type of snapping hip that you have.  For the lateral / external type a regimen like this may be helpful.  For the anterior / internal type focus should be placed on strengthening of the adductors,internal / external rotators, and extensors of the hip as well as stretching of the adductors and hip flexors.  Either way you go, if these types of exercises give you no relief or are difficult to perform due to pain, it’s a good idea to get evaluated by a musculoskeletal specialist like a chiropractor or orthopedist who tend to be more well trained to deal with these issues.

If you live in Denver and are in need of a chiropractor to help whip your hip into shape give us a call or find a great chiropractor near you, here.  As always, BE WELL!