You come up out of a deep lunge, or swing your leg through in a dance class, and something at the hip goes clunk. Sometimes you feel it on the side of the hip. Sometimes it's a deep click at the front that other people can hear. A clicking or snapping hip that doesn't hurt is usually nothing to worry about. Once it hurts, or you're dodging movements to avoid it, it's worth sorting out.
A hip can snap in three different ways 1.
External snapping is the most common 1,6. The thick band down the outside of your thigh (the iliotibial band, or ITB), or the front edge of your buttock muscle, flicks over the bony point on the side of your hip (the greater trochanter) 1. You feel it on the outside of the hip 2.
Internal snapping happens at the front. The iliopsoas tendon, from your main deep hip flexor, catches on a ridge of the pelvis or on the ball of the hip joint 1. You feel it at the front of the hip or towards the groin 2.
Intra-articular snapping comes from inside the joint. The cause can be a tear in the labrum (the rim of cartilage around the socket), a loose fragment or a torn ligament 1. It often follows an injury and comes on quickly 3.
It's common with repeated hip bending and straightening 6, especially in dancers, who combine that with turning the leg out and lifting it sideways 5. Tightness is part of it 5, but so is control. A muscle can be short, or it can be switching on too hard at the wrong moment, which is common at the front of the hip 1. Weakness in gluteus medius, a stabilising muscle on the side of the hip, often goes with internal snapping. An imbalance between gluteus maximus and a smaller muscle, tensor fasciae latae, is a feature of external snapping 1. The internal type is reported more often in women than in men 4.
Which snap you have changes the plan.
| External | Internal | Intra-articular | |
|---|---|---|---|
| Where you feel it | Outside of the hip 2 | Front of the hip or groin 2 | Deep in the joint |
| What's catching | ITB or gluteus maximus over the greater trochanter 1 | Iliopsoas tendon over the pelvis or ball of the hip 1 | A labral tear, loose fragment or ligament tear inside the joint 1 |
| How common | The most common type 1,6 | Less common than external 1 | Often follows an injury 3 |
Snapping hip is often missed because it can look like other hip conditions 5. We try to reproduce the snap with specific movements, such as the Ober's, Thomas and hula-hoop tests 1,3. If it's still unclear, imaging, including real-time ultrasound of the snap itself, can confirm it and rule out other causes 2,4. For a snap from inside the joint, see hip labral tear.
A snapping hip is usually worked out in the room, without a scan. You'll be asked where it hurts, what sets the snap off, whether the hip has been injured, and whether you can make it snap on demand 6. Point to the spot with one finger and you've more or less told us which type it is 1. The outside type is the easy one. Stand, let the hip drift out to the side and circle it like you're spinning a hula hoop, and the snap can usually be seen 1.
X-rays generally look normal. They're there to rule out a problem with the bones or the joint 6. If nobody can see the snap, an ultrasound taken while the hip moves can catch the band or tendon flicking across 1.
First, we'll tell you whether you need treatment at all. A painless snap usually doesn't 1. If it hurts, the plan depends on which snap you have and why.
With a structured program, getting back to normal hip function without the snap can take 6 to 12 months 1.
We sometimes use manual therapy to make early exercise more comfortable. It supports the program. It isn't the fix. There's no specific evidence for it in snapping hip. A Cochrane review found no significant benefit from adding transverse friction massage for ITB friction syndrome, a related problem of the same band 7.
Both are listed in early management 3. Medication is a decision for your GP or pharmacist. Well Motion physiotherapists don't prescribe it.
For persistent pain, surgery can lengthen or release the tendon 1,3,5. It relieves symptoms, but it can weaken the hip flexors, and most of the evidence comes from small case series 1. It's considered only after non-surgical treatment fails 2, which is rare 1. It's not something we perform.
The reviews describe conservative treatment in broad terms: stretching, avoiding what aggravates it and retraining muscle activity 4. The sources agree on physiotherapy first 1,2,3,5, but which exercises work best is unsettled, so we adjust the plan to how your hip responds.
A painful snapping hip follows The Well Motion Recovery Path™. You move up a phase when the hip copes with more, not when a month ticks over.
How long it usually takes. Painful cases usually settle over 6 to 12 months of conservative care 1,3. No source splits that by phase. Surgery is rare 1 and runs on a separate clock. In one 2007 series of six patients, with no comparison group, all used crutches for 5 weeks and hip scores kept improving up to 12 months 8.
Nobody has run a trial on stopping a snapping hip from coming back, so these go after its known causes:
None of this is cause for alarm. Most snapping hips are harmless, and most painful ones settle without surgery 1,3.
We start by listening: how it began, what makes it worse, and what it's stopping you from doing. Then we examine the area, explain what we find in plain English, and agree a plan with you. Your first visit is 40 minutes at Engadine and 30 minutes at our other clinics.
We see patients at Engadine, Mount Annan, Narellan and Appin, and at home through our mobile physiotherapy service. If you have private health cover, here's how health fund rebates work for physiotherapy.
If it's painless, usually nothing. It generally needs no treatment 1. If it hurts, an external snap can come with an inflamed bursa 1, and the pain can build until it limits activity 5. That's the reason to act once it hurts.
A tendon or band of tissue catching over bone: the ITB or gluteus maximus on the outside, or the iliopsoas tendon at the front 1. Less often, it comes from inside the joint, such as a labral tear 1. Repetitive hip movement, tightness and poor control contribute 1,4,5.
Most painful cases settle within 6 to 12 months of conservative management 1,3. If you keep up the stretching and movement changes afterwards, it's less likely to come back 1.
Pain on the outside of the hip, usually worst lying on that side and on stairs. Often called trochanteric bursitis.
Read moreTight, sore hip flexors at the front of the hip. Common in runners, tradies and anyone whose day is mostly seated, and it deserves a better answer than "just stretch more."
Read moreA hip socket that's shaped differently from the start. For parents of a child who's been diagnosed, and for adults managing it long-term.
Read moreHip osteoarthritis is a long-term condition that affects the whole joint (cartilage, bone, joint lining, ligaments, tendons and muscles), not just "worn cartilage".
Read morePiriformis syndrome is when the piriformis, a muscle deep in your buttock, puts pressure on the sciatic nerve. It usually affects one side
Read moreIn FAI, the ball and socket of your hip meet too early as it bends, because one or both have an unusual shape, called cam or pincer
Read moreGluteal tendinopathy is irritation of the tendons that attach two of your buttock muscles, gluteus medius and gluteus minimus, to the bony point on the outside of your hip. You may also hear it called greater trochanteric pain syndrome, or GTPS.
Read moreThe labrum is a rim of cartilage around your hip socket. It helps absorb shock, spread pressure and keep the joint stable
Read more
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