Recognizing and Managing Snapping Hip Syndrome in Dancers

BACKGROUND: Snapping hip syndrome (SHS) is a common hip pathology in dancers. SHS can be either internal or external, resulting from muscle tendon tightness from repetitive hip flexion and extension, accompanied with hip abduction and/or external rotation. Muscular tightness may cause the tendon to become taut and snap over a bony prominence during hip movement, leading to muscular weakness and reduced range of motion from pain. Because SHS is poorly identified and can present similarly to other hip pathologies, many SHS incidences are underreported or misdiagnosed. Though SHS can begin as a harmless popping sensation, pain can become severe enough to limit dancers' activities and potentially result in the development of concomitant issues. EVALUATION: Physical examination for snapping hip includes moving the hip from flexion, abduction, and external rotation (FABER) into extension, adduction, and rotated to a neutral position. Dynamic ultrasound can also be used to study SHS, as using this method allows clinicians to observe the snapping tendon in real-time. Radiographs and magnetic resonance imaging may serve to rule out other differential diagnoses. MANAGEMENT: Conservative management through rehabilitative therapy is the standard for initial management. In severe cases, arthroscopic intervention may be useful in releasing tension in the pathological tendon. Active rest with training modifications should be attempted to mitigate further injury. CONCLUSION: Early and comprehensive examination and management can help to reduce SHS risk and potentially decrease the ability of this debilitating condition to derail a dancer's career.