Musculo-skeletal   [back to the Category]

Snapping or Clicking Hip   [read the french version]

Author :   Docteur Anne Thiescé

Clicking hips are extra - articular. They are common to all activities, such as ballet or gymnastics, that use extreme hip amplitudes. 90% of ballet dancers would present this symptomatology. Clicking hips become apparent during "arrondis" and external rotation when assuming 5th position.
The cracking that dancers can produce is usually painless, sometimes audible sometimes not.
This clicking is due to a tendon or an aponeurotic lamina catching on an osseus protuberance. Such repeated catching can cause a painful inflammatory reaction.

There are two types of clicking hips;

EXTERNAL CLICKING

This is where the posterior part of the iliotibial band crosses brutally over the trochanter during the change from extension to adduction flexion.

The iliotibial band or Maissiat's band is an aponeurotic lamina which crosses over the trochanter and merges with the musculus tensor fasciae latae lower down.
This gives the dancer the impression that his hip has become dislocated when assuming 5th position, in the "grands arrondis" and sometimes, quite simply, when walking.

Treatment is usually medical. It includes local, pain-relieving physiotherapy and a re-education aimed at stretching the abductor muscles; these are muscles that are stretched very little in ballet and are often hypertonic. Infiltrations as a treatment for dancers should be rare.
Surgical treatment is only used as a last resort and aims at lengthening the musculus tensor fasciae latae with a cross section: dancers are up and walking immediately, authorization to resume sport is given as of the 6th week.

ANTERIOR CLICKING

This is a catching of one of the tendons of the flexor muscles: iliopsoas, rectus femoris and sartorius or the iliofemoral ligament.


- Clicking of the psoas

This clicking is usually linked to the close relationship existing between the psoas tendon and the iliopectineal eminence of the pelvis. It is a deep, dull cracking that occurs during the change from flexion to extension.

This clicking is neither obvious nor visible, it is discerned in the inguinal hollow.

The clicking of the psoas can also be linked to its catching on the lesser trochanter.


-Clicking of the rectus femoris

This is the direct rectus femoris tendon catching on the anterior inferior spine of the ilium during circumduction movements of the lower limb in external rotation.

Anterior clicking can also be due to anterior hip ligaments, the iliofemoral in particular, catching on the femoral head.

At the start of limbering-up exercises, dancers feel that their articular amplitudes of the hip are restricted. This feeling of restriction stops with the cracking, caused by reducing the lower limb, placed at a 120° flexion, to 60°, or during a "grand arrondi".

Treatment need only concern painful anterior clicking and is based mainly on rest.
Infiltrations are rarely effective. Surgical therapy can be considered if symptoms require.

The differential diagnosis of anterior clicking is sometimes difficult especially with intra-articular pathologies such as foreign bodies present in the articulation and acetabular labrum pathologies which give pseudo jamming.


Bibliography:

Badnin, Myronova:Traumatismes et maladies de l’appareil locomoteur chez les danseurs (russe); chapître VII. Moscow Medecine 1976 sous la direction du Pr Volkov.

Fitt S. A few thoughts on snapping hip. Dance magazine

Howse A.J.Orthopaedist aid ballet. Clin orthop no.89 52-63 Nov-Dec 1972

Howse A.J.LA. Dance clinic: Hip problems. Dance magazine 99 May 1985

Kouvalchouk J.F, Durey A., Paszkowski A., Watin-Augouard L.Les ressauts antérieurs de hanche. J. Traumatol. Sport., 1989, 6, 171-176

Kouvalchouk J.F, Ressauts de hanche – Editions techniques – Encycl. Méd. Chir.(Paris – France), Appareil locomoteur, 14-320-c-101993, 6p

Quirk R.Ballet injuries: The Australian experience. Clin in sports medicine Vol. 2 no. 3 507-514 Nov1983

Sammarco GJ. The dancer’s hip - Injuries to dancers. Clin in sports medicine 2(3) 557-61 Nov1983

Thiescé A. - Hanche et Danse professionnelle.Thèse Med., Cochin, 1988.

Thomassen E: Diseases and injuries of ballet dancers. Universitet forlaget I Arhus 1982 Denmark