Do your dancers ever say, ‘My hip snaps or pops when I do grand battement or developpe´ devant or a´ la seconde’?
The snap sometimes presents with pain but sometimes not, and happens either on the up phase or down phase of the movement. Dancers might also notice decreased range of motion through multiple planes of movement. .
Snapping or clicking hip is common in dancers and athletes who regularly move through range of motion extremes, experience some degree of tendinitis, and repeat abduction of the legs above waist level. With proper diagnosis and care, the condition can be addressed in a timely way so that the dancer does not lose too much rehearsal and class time.
Usually painless and harmless, a snapping hip can happen as a result of a tendon or muscle passing over a bony structure. It can occur frequently in dancers in three ways:
· Lateral Snapping Hip (Iliotibial band syndrome), which is more common, involves movement of the iliotibial (IT) band moving over the greater trochanter (large bony structure on the head of the thigh bone) and is also referred to as external snapping hip syndrome. A clue to diagnosis of this condition may be the inability to adduct past anatomic neutral, an anatomical position where the two bones that form a joint are parallel to one another, - with the bones parallel and joint space uniform, this creates ‘anatomical neutral’. A more likely indicator, however, is the location of the pain along with palpable tenderness. Pain to the lateral (outside) side of the knee as well as pain at the lateral hip can occur simultaneously and could be symptomatic of lateral snapping hip. Initially, there may be a sensation of stinging or needle-like pricks that are often ignored. This can gradually progress to pain every time the heel strikes the ground and finally can become disabling with pain when walking or when climbing up or down steps. (1,2,3)
· Anterior Snapping Hip presents as a kind of clicking or snapping, as the iliopsoas tendon passes over the iliopectineal eminence on the front of the pelvis or pelvic brim. This can be caused by inflammation of the bursa that lies between the front of the hip joint and the iliopsoas muscle. A cartilage tear or bits of broken cartilage or bone in the joint space can cause snapping, or a loose piece of cartilage can cause the hip to ‘lock up’. (2)
· Intra-Articular Snapping Hip (intra-articular meaning inside the joint) results from capsular instability caused by muscular imbalance, skeletal inconsistencies, such as a leg length discrepancy or bony deformity, or previous injury to the hip joint or from a labral tear. Dancers with this condition may experience decreased range of motion in the hip and a painful click directly inside the joint caused by bony instability resulting from hip dysplasia or excessive congruency resulting from Femoral Acetabular Impingement (FAI). (2)
Treatment: Dancers could benefit from physical therapy to strengthen the surrounding musculature, improve flexibility, restore function, and prevent re-injury. Movement reeducation and progressive resistance training might also prove effective. (6) Dancers may need to temporarily reduce rehearsal/class regimen as part of recovery/management of the syndrome.
Please refer to the examples below.
Resources for further reading:
1. Keene S, Coxa saltans: iliopsoas snapping and tendinitis. Hip Arthroscopy and Hip Joint Preservation Surgery.2014; 64(1):1-16.
2. Lewis CL. Extra articular snapping hip: A literature review. Sports Health.2010; 2(3):186-90.
3. Grumet RC, Frank R, Slabaugh M, Verkus W, Bush-Joseph C, Nho S. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):191–196.
4. Battaglia M, Guaraldi F, Monti C, Vanel D, Vaninni F. An unusual cause of external snapping hip. J Radiol Case Rep, 2011; 5(10)1–6.
5. Reiman, M P, Thorborg K. Clinical examination and physical assessment of hip joint‐related pain in athletes. International J Sports Phys Ther.2014; 9(6): 737–755.
6. Laible C, Swanson D, Garofolo G, Rose DJ. Iliopsoas syndrome in dancers. Ortho J Sports Med.2013; 1-3.
7. Weber A E.The hyperflexible hip: Managing hip pain in the dancer and gymnast. Sports Health 2015:7(4); 346–358.
8. Frank RM, Slaubaugh M, Grumet RC, Verkus W, Bush-Joseph C, Nho S. Posterior hip pain in an athletic population: Differential diagnosis and treatment options, Sports Health.2010; 2(3): 237–246.
9. Lee S, Kim I, Lee SM, Lee J. “Ischiofemoral impingement syndrome.Ann Rehabil Med. 2013; 37(1): 143–146.
10. Sobrino, F J, Crótida C, Guillén P.Overuse injuries in professional ballet: Injury-based differences among ballet disciplines.Orthopaedic J Sports Med, 2015; 3(6).
11. Smith PJ, Gerrie BJ, Varner KE, McCulloch PC, Linter DM, Harris JD. Incidence and prevalence of musculoskeletal injury in ballet: A systematic review.Orthop J Sports Medicine, 2015; 3(7).
12. Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT. Iliopsoas impingement: A newly identified cause of labral pathology in the hip. HSS J.2011; 7(2): 145–150.
13. Pun S, Kumar D, Lane NE. Femoroacetabular impingement, Arthritis Rheumatol, 2015; 67(1): 17–27.
14. Sajko S, Stuber K. Psoas major: A case report and review of its anatomy, biomechanics, and clinical implications. The J Canadian Chiro Assoc. 2009; 53(4): 311–318.
Janine Bryant, BFA, PhD (ABD) is Senior Lecturer at the School of Arts at The University of Wolverhampton in the UK. She is also a Registered Safe in Dance International Certificate Provider and member of the IADMS Education Committee.