Winnipeg Free Press - PRINT EDITION

Clicking, painful hip not a snap to diagnose

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Q: I have heard that if you have a click in your hip, you might have "snapping hip." Is this a real condition? What is "snapping hip"?

 

A: As funny as it sounds, snapping hip is no laughing matter if you have the constant clicking and/or pain that goes with this problem. It is not as common of an injury as shin splints or Achilles tendonitis, but it can be very annoying. It is more often found in individuals who participate in a demanding activity for the hip such as ballet or track and field events. But, it can also occur with more common activities such as walking or jogging, especially if you increase your volume. The constant, repetitive movement of the hip in a training situation is believed to put you at risk for a snapping hip.

 

What causes the snap?

THERE are two main structures that cause the majority of snapping hip cases. The first is the iliotibial band (IT band). This tissue runs along the outside of your thigh. It is common for runners to get IT band pain, especially if you like running up and down hills. The clicking with snapping hip involving the IT band usually starts gradually, as the snapping or clicking is felt along the side of the hip (the side of your upper thigh). The click/snap is from the IT band moving over the outside of your hip bone as your thigh goes from being bent to straight.

If the pain and snapping is over the front of your hip, then the hip flexor muscle, iliopsoas, may be the source of the snapping hip. In an activity such as ballet, it is the movement of the hip forward and to the side that can cause the iliospoas tendon to slide, resulting in a snapping sensation. If a sac of fluid swells over the tendon, you will have a bursitis and this can cause pain and snapping, too. A more painful and serious cause of snapping in the hip involves a cartilage tear in the hip joint. This cause is may be preceded by an injury and not just repetition of an activity.

Silencing the snap

SO, if snapping hip is your problem, how do you get rid of it? First of all, make sure you actually have the right diagnosis. The physician examination should focus on leg-length assessment, hip movements and strength tests for the hip

Investigations such as X-rays and MRI scans are not routinely done for this problem if snapping hip is the diagnosis. Snapping hip does not produce an abnormality on an X-ray or an MRI.

If you do have a history of trauma or limited hip range of motion, then further tests might be recommended.

If you have no pain with your snapping hip and you are not uncomfortable with the problem, you can do a series of stretches and strengthening exercises for the hip and pelvis to relieve the problem. A physiotherapist or athletic therapist can construct a home rehab program for you. If you have pain, the exercises are important, but you will also need to reduce stressful activities with the hip and consider an anti-inflammatory medication treatment for a speedy recovery.

Readers can ask Dr. Kennedy questions, but due to the volume of requests, replies are not guaranteed. Email askthedoctor@freepress.mb.ca

Republished from the Winnipeg Free Press print edition March 1, 2011 C1

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About Dr. Maureen Kennedy

Born and raised in The Pas, Dr. Kennedy graduated from the University of Winnipeg Collegiate, earned a BSc and BA from the University of Winnipeg and an MD from the University of Manitoba in 1994. After certifying in family medicine at the University of Manitoba, Dr. Kennedy was awarded a two-year fellowship in primary care sport medicine at the University of Calgary Sport Medicine Centre. She completed this fellowship along with a MSc in Kinesiology at the University of Calgary. Her research focus was exercise counselling by family physicians. Dr. Kennedy further explored the use of exercise in medicine with PhD projects examining aerobic exercise in individuals scheduled for total hip or knee replacement surgery. She holds a diploma in sport medicine from the Canadian Academy of Sport Medicine and has served on numerous provincial and national committees for organizations such as the Alberta Medical Association, Canadian Academy of Sport Medicine, College of Family Physicians of Canada and Canadian Society for Exercise Physiology.

For the past 11 years, Dr. Kennedy has practised as a consultant in primary care sport medicine.

Dr. Kennedy's practice focuses on the diagnosis and treatment of injuries, muscle, bone and joint problems, orthopedic triage, weight management, osteoarthritis and dance medicine. She has served as the head physician for Alberta Ballet for the last nine years and has worked with the national women's hockey team along with many elite and amateur athletes in various sports. She points out that sport medicine physicians provide a tremendous service to the general public and the health-care system by shortening orthopedic waiting lists and providing non-surgical treatment options. "It's great to be back home in Manitoba and Winnipeg is a fantastic city," she adds. Readers can expect coverage on a wide range of fitness and health topics, including insider's tips on how to navigate the health-care system.

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