The popping or snapping noise you hear from your hip while walking is a common phenomenon known medically as coxa saltans, or snapping hip syndrome. In the vast majority of cases, the sound is harmless and not a sign of a serious problem. The audible pop is usually the result of a tendon or muscle gliding over a bony prominence in the hip joint, creating a quick, snapping sound when the tissue returns to its normal position. The snap itself can occur in different areas around the hip, depending on which specific soft tissue structure is involved.
The Two Primary Causes of Snapping Hip Syndrome
The most common types of snapping hip are categorized as “extra-articular,” meaning they occur outside of the actual joint capsule, and involve friction between soft tissues and bone. These are divided into internal and external types, based on the location of the snapping mechanism.
External Snapping
External snapping is felt on the side of the hip and typically involves the iliotibial (IT) band or the tendon of the gluteus maximus muscle. The IT band is a thick, fibrous strip of tissue that runs down the outside of the thigh, connecting the hip to the knee. As the hip moves from a flexed to an extended position, the IT band or the gluteus maximus tendon can momentarily catch as it slides over the greater trochanter. The greater trochanter is the large, bony knob on the side of the upper thigh bone.
Internal Snapping
Internal snapping occurs deeper in the groin area, toward the front of the hip, and is most frequently caused by the iliopsoas tendon. The iliopsoas is a powerful hip flexor muscle group whose tendon passes over the front of the hip socket or the head of the femur. When the hip is moved, particularly from a bent position to a straightened one, the iliopsoas tendon can catch on underlying bony ridges, such as the iliopectineal eminence. The resultant snap is often heard and is the most common form of snapping hip syndrome.
When is Hip Popping a Problem
While most snapping is painless and simply a mild annoyance, the sound can become a concern when it is accompanied by other symptoms. The presence of pain that accompanies the popping sensation is the primary indicator that a medical consultation is warranted. This pain is often the result of constant friction leading to inflammation of the tendon or the surrounding fluid-filled sac, a condition known as bursitis or tendinitis.
A more serious cause of hip popping involves issues within the joint itself, referred to as “intra-articular” causes. Warning signs of an intra-articular problem include mechanical symptoms like the hip feeling as though it is locking, catching, or giving way during movement.
The most common intra-articular cause of painful popping is a tear in the acetabular labrum, which is the ring of cartilage that rims the hip socket. A labral tear can cause a distinct, sharp clicking or catching sensation deep within the joint, often felt in the groin area. If the snapping is new, painful, or associated with instability or a limited range of motion, consulting a physical therapist or a physician is advised.
Management and Treatment Options
For snapping hip syndrome that is painful or persistent, conservative, non-invasive management is the standard first-line approach. The initial goal is to reduce inflammation and avoid activities that trigger the snapping sensation to allow the irritated tissue to rest. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help manage the pain and swelling associated with tendinitis or bursitis.
Physical therapy (PT) plays a substantial role in resolving symptomatic snapping hip by addressing the underlying mechanical tightness or muscle weakness. A PT program typically includes specific stretching exercises to lengthen tight structures, such as the iliotibial band and the hip flexors. Simultaneously, strengthening exercises focus on the surrounding muscles, like the core and the gluteal muscles, to improve overall hip stability and alignment.
If conservative measures, including a dedicated PT program, do not provide relief after several months, other medical interventions may be considered. These options can include a corticosteroid injection directly into the inflamed area to reduce localized swelling and pain. In rare instances where the symptoms remain severe and unresponsive to all non-surgical treatments, a surgical procedure to lengthen or release the tight tendon may be an option.