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Snapping Hip Syndrome

Posted By Janine Bryant on behalf of the IADMS Education Committee, Wednesday, October 5, 2016

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 jointrelated 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.

 

Tags:  dancers  hips  injury  pain  teachers 

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What has the “Anatomy of the Hip Joint” got to do with Louis XIV?

Posted By Maggie Lorraine on behalf of the IADMS Education Committee, Tuesday, January 13, 2015

Classical Ballet is a dynamic art form. The art of ballet has undergone change since its birth in the mid-17th to early 18th Century. It is interesting to review the description of the organization of the body, codified by Pierre Beauchamp (1631-1705). The five positions of the feet are described as turned out from the hip to an angle of 45 degrees. It was emphasized that the feet should never be turned out more than 45 degrees.

Over time, there has developed an expectation for Ballet dancers to turnout each foot to 90 degrees creating a 180 degree shape with the feet.  By studying human anatomy it appears that Beauchamp was more anatomically sound in his recommendation of the 45 degree turn out “from the hip” than the current 180 degree placement “of the feet” that we now often see.  There are many anatomical factors contributing to the effective use of turn out.

The Bone Anatomy of the Pelvis

The pelvis is formed from the fusion of three bones: ilium, pubis, and ischium. Each of the three bones contributes to the hip socket or acetabulum.


The Ball and Socket

The hip joint includes two main parts, the ball and socket. The ball of the hip joint consists of the round head of the femur or thigh bone and the femur articulates with the hip joint to enable the leg to rotate outwards.

There are three factors that affect turnout from the bony structure of the hip joint and most researchers agree that these conditions cannot be altered with training:

1.      Angle of femoral anteversion

On average, the neck of the femur is angled 15 degrees forward relative to the shaft of the femur (see Figure 3A). An increase in this anterior angulation, called anteversion, often will cause someone to toe in when they walk, (see Figure 3B). People who are born with more anteversion, the orientation of the femoral shaft in the hip socket makes the knees face towards each other when standing or walking. In ballet class, when they turn out their legs from the hip, the knees face the front, leaving little additional hip rotation to create the expected angle of outward rotation visible at the feet.

However, a decrease in this angulation, called retroversion, will allow one to have greater turnout (see Figure 3C). People born with retroversion have a much easier time with turnout. Just standing in neutral, the knees and feet tend to face outward. By adding external rotation at the hip, they can achieve a larger angle of outward rotation visible at the feet than the average person.


2.      Orientation of the acetabulum

The socket of the hip faces out to the side and somewhat forward.  The socket that tends to face more directly to the side with a less forward facing will allow a greater amount of turnout to come from the hip therefore greater movement range.

3.      Shape of the femoral neck

The neck of the femur is subject to some variability. A longer and more concave neck allows a greater range of motion at the hip and is therefore considered to be advantageous.  A shorter and less concave neck will have the opposite effect and limit turnout resulting in less movement range.

Bearing these anatomical differences in mind, it is more important to encourage dancers to use the turnout they have, rather than working against their anatomical make-up to achieve an unrealistic position.  Louis XIV was happy with 45 degrees, we can safely move beyond that if we apply a good understanding of anatomical structure and function.

Further Resources:

Wilmerding V, Krasnow D.  Turnout for Dancers - Hip Anatomy and Factors Affecting Turnout, IADMS Resource Paper. 2011.
Available HERE

Krasnow D, Wilmerding V. Turnout for Dancers – Supplemental Training. IADMS Resource Paper. 2011.
Available HERE

A useful tutorial on the hip joint, range of motion and function:
Sechrest R. Hip Anatomy Animated Tutorial, 2012.
Watch it HERE

A great tutorial on hip function in squats with additional images on bone structure, which may govern why people may need to approach movement in different ways:

De Bell R. The Best Kept Secret: Why People Have to Squat Differently, 2015.
Watch it HERE

Tags:  anatomy  dancers  hips  teachers  turnout 

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