Psoas snapping hip management?

[Danny]

In my limited reading about snapping hip, I have found recommendations of hip flexion exercises and psoas massage.

Is this it?

I was wandering if you know the mechanism behind WHY the psoas gets into this predicament of passing over and then snapping back past the greater trochanter. Is it a flexibility thing, or a pelvic stability thing or something else?

Cheers
Dan

[injuryupdate]

Snapping hip is divided into many causes, but the main three are:

(1) external snapping hip - ITB over the greater trochanter
(2) internal snapping hip - Iliopsoas over a femoral prominence between the neck and the head (?intertrochanteric groove)
(3) intra-articular snapping - caused by subluxation or loose bodies within the hip

Internal snapping hip is the most common and is found in athletes with a hypermobile joint (esp. ballet dancers) and is usually painless. If painless, ignore, but if painful, conservative treatment usually doesn't work. A cortisone injection (ultrasound guided) to the iliopsoas bursa may help (deep to the iliopsoas tendon). Surgery may also fix the problem but is quite major.

[Bob]

Snapping hip is secondary to either intra-articular or extra-articular conditions. Intra-articular causes include loose bodies, synovial chondromatosis, hip subluxation, osteocartilaginous exostoses and labral tears. Extra-articular causes include more commonly a thickening of the posterior border of the iliotibial band over the greater trochanter and less commonly the iliopsoas tendon over the iliopectineal eminence, the iliofemoral ligaments over the femoral head, or the long head of biceps over the ischial tuberosity.

It is more a complaint of clicking than pain, with the patient localizing the problem to the groin or anterior hip if the psoas is involved.

Testing may show postive Obers, short iliopsoas or hamstrings, snapping reproduced by abduction and external rotation (if psoas involved).

Treat with fascial release and friction massage over the involved areas. Do stretching and postfacilitation stretching of tight muscles. Improve the biomechanics of gait, and correct leg length deficiencies.

[Danny]

Thanks, only new at this, but with a negative quadrant test I ruled out an intra-articular cause, and pain was localised to the anterior hip groin area.

Very difficult case here because he is a bowler (cricket) and the snapping hip is his front leg. In the bowling action at back foot impact his front leg comes into flexion and slight adduction then transits to extension, abduction, external rotation for front foot impact.

Do you think a correction of bowling action to limit these movements producing the snapping is a possible area to investigate, along with the other conservative management suggested?

Cheers
Dan

[Bob]

I would attempt to improve the pelvic mechanics. That is a lot easier than getting a bowler to change an action that is engrammed into him. Most cricket fast bowlers will have pelvic biomechanical faults given the amount of force produced by delivery. This will predominantly effect the front leg side of the body producing imbalances. You only have to look at the number of lumbar stress fractures, hamstring strains and other injuries in fast bowlers to be convinced. As you touched on in your first posting, core stability will also be important, particularly the obliques and transversus to counter the torque effect of bowling and multifidi to stabilise the lumbar spine and to create force closure of the sacroiliac joints. Try to make these exercises has specific and functional as possible to mimic the bowling action. A factor you have to consider is what level of cricket does he play and whether changing his action is worth it if it will cause a decline in pace or bowling ability. Also, do you feel confident in altering his action or will you need a cricket specialist?

Good luck

Emeritus Professor Bob

[Danny]

Thanks Bob, really appreciate that.

Cheers
Dan

[Krista18]

I had the iliopsoas lengthening surgery and all 6 doctors I saw thought it was internal. I eventually had the lengthening after all conservative treatments failed for 2 years. I snapped on the first day of my surgery. I would suggest having it done orthscopicly because the open surgery took me out of school for three months. Make sure you find a doctor who has done lots of the surgires not just 10. Many will be willing to try because its rare but many have not done it. I went to St.Louis childrens hospital for mine but I was young. Less then a year after my surgery I was in an incredible amount of pain. The orthoscopy revealed a torn labrum and cartilage. My two athroscopies of my hip missed it. Please make sure that everything else is ruled out and that you are diagnosed with the correct type. Find a great surgeon and good luck!!! It is painful but if it works for you it will be completly worth it. Have you ever tried prolotherapy? I have heard it can work for snapping hip but I dont know the success rate.

[misshilde]

Hi, I'm new to this board...I have a snapping iliopsoas...very loud...triple clicks on the right hip ..single on the right. I am a former dancer and have never had any problems prior to a lateral release of the right knee in Dec 05..I am sceduled for surgery in 3 weeks., but thought I'd get more info on this..My doc says I have stage 2 oa of the hip and several small tears...the surgery notes says labral debridement and if he(doc) can make the psoas snap under anesthesia he'll perform a release...does this seam right??

Hilde

[soccermom]

i have clicking, popping and ant groin pain....mri and mra all neg. so i am going to have an intra-articular injection as well as a psoas injection to see what happens. anyone have a psoas injection (or i guess, alongside the psoas)? i am also wondering how i will know what worked if i have both done at once (not that i really want to have them done on 2 different trips since it has to be done under fluoro).
soccermom

[Emilyonice]

I starting feeling snapping hip 5 years ago, and thought it was a muscle-based thing, which started off painless. It became sore especially with flexion and after a few years I could feel myself it was located in the joint. The snapping calmed down but hip pain stuck around and I am now a recovering hip arthroscopy patient, after labral debridment....I have the same thing on both sides, too.
In hindsight, I found that physiotherapists and other medical experts didn't investigate fully beyond simply measures to strengthen other pelvic, core and butt muscles, whereas when I did basic reading of literature off of Google searches I could trace that my once-snapping would become a torn labrum issue...
I would advise to anyone to make sure their snapping is fully investigated, to prevent it from escalating...

[Hekate01]

Hi i had surgery back in August 07 for a hip bursitis and they did Z-plasty on the IT band, but the symptoms have come back 4 months down the line. The hip definitely snaps but not having much luck with doctor's here. I'm being referred back to my consultant but i'm not sure what the next step is?? I have a 6 inch scar, will they just open that up again and do the same surgery as before?? I had been exercising but it wasn't exercising that brought the pain and the snap back it was just walking!! Any advice gratefully received x