SNAPPING HIP SYNDROME IN DANCERS

Snapping Hip Syndrome:  I am a dancer with a snapping and popping sensation in my hip. What could this be and how can it be addressed?

Anatomy/Pathology: Snapping hip syndrome refers to snapping of a tendon over a bony prominence, or snapping caused by an intra-articular pathologic condition. External snapping is attributed to the iliotibial band (ITB) or gluteus maximus snapping over the greater trochanter. Internal snapping can be caused by the iliopsoas tendon snapping over a bony prominence, typically the iliopectineal eminence, the femoral head, or the lesser trochanter. Intra-articular causes can be attributed to loose bodies, osteochondral fractures, labral tears, or synovial chondromatosis. For the majority of dancers, the cause is a snapping tendon. The iliopsoas and ilitibial band are muscles involved with forward and lateral leg lifting which is a common movement in all types of dance.

Prevalence: A large percentage of dancers experience the snapping hip sensation, often on both sides, throughout their dance careers. With dancers, these symptoms are frequently ignored by the dancer themselves, and instructors. Many can voluntarily reproduce the snap and it is often not painful, but more uncomfortable. The majority of dancers experiencing this do not have to stop dancing as a result of the snapping hip.

Addressing the Cause.  A common cause of the snapping hip is errors with technique and alignment during basic dance moves which will cause abnormal mechanics and instability through the hip. There are things to remember that can assist with appropriate technique to help keep anatomical structures in their correct working position to avoid this instability and reduce or eliminate the snapping sensation. Here are some things that can be addressed:
​

• Turnout should come from isolated hip rotation. If hip rotation is limited, dancers often obtain turnout position from using movement from the pelvis. This is often tucking the pelvis under to attain the illusion of more turnout. There should be no change in pelvic alignment when moving into turnout. Stretching into hip external rotation and strengthening the external rotators can assist with the ability to do this properly.
• Maintain appropriate alignment with plies. When moving into plies, the hips should open up, staying in full rotation, with the knee pointed directly over the 2nd and 3rd toes. Letting the knees fall inward can cause deactivation of crucial gluteal muscles that assist with hip stabilization during these motions. Movement should be relaxed, with the tailbone dropping straight through the heels to avoid overuse of hip flexors (see below).
• Avoid “gripping” (over activation) of hip flexors. “Gripping” and overuse of the hip flexors can often occur when moving into grande battement motions or sinking into grand plies, which are frequent motions that reproduce the snapping sensation. The way to reduce hip flexor “gripping” and over activation is to maintain a strong core. If the core is weak, it is difficult to lift the legs without excessive activation of the hip flexors or pelvic/low back compensations. Pliates, Swiss ball exercises, and plank strengthening are activities that can help increase core strength appropriately for dance.
• Maintain good balance/proprioception. It is surprising that many dancers cannot balance on a single leg for more than a moment. This again results from poor core strength and also from hip and gluteal weaknesses that will contribute to poor hip stability. This causes the tendency to over-utilize the iliopsoas and hip flexors when moving through the single leg positioning. This can be improved with practice such as performing single leg balancing in parallel and turnout positions with the knees bent and straight. The hips should always be facing forward and symmetrical, and the spine should remain in neutral with a small inward curve. It can be made more challenging by standing on a cushion or uneven surface.

There are a large number of medical professionals, including physicians and physical therapists, whom are experienced with working with dancers and understand the demands that these athletes are placed under on a daily basis. If symptoms persist and become painful or begin to limit the ability to dance, it is advised to seek medical assistance from a physician with possible course of physical therapy treatment to appropriately address this syndrome.
​
This article was written by Emily Ralph, PT, DPT, CSCS from AthletiCo-Lincoln Park/Lakeview..