Over the years, I've spoken with a lot of people who were concerned about noises they heard coming from some part of their body when they moved a certain way: a neck that grinds, a knee that pops, or a hip that snaps. The natural assumption is that your body shouldn't be making these odd noises kind of like how your car shouldn't rattle when pull out of the driveway.
Sometimes these sounds are indicators that something really is wrong and sometimes, we - those of us in the health professions - can figure it out and do something about it. Other times, we don't have a clue and some of us hide by saying, "Oh, it's nothing to worry about," or "It's not a big deal."
The problem is that sounds or sensations that come from your body during a movement involve either a mechanical element (something is too tight, too loose, too weak, too strong), or a tissue component (a joint surface is damaged, a tendon is frayed, an adhesion is in the way), or both.
So, to solve the problem, you have to understand the biomechanics of the area (the involved joint and related joints) and mechanobiology (how force affects tissue) and if there is any associated tissue damage. To illustrate this, I'll use the snapping hip syndrome.
A hip that snaps when you walk, get out of a chair, get up and down from the floor, or climb stairs among other things, is often diagnosed as "snapping hip syndrome". A syndrome, by the way, is a term used to describe a collection of symptoms and findings that characterize the disease or condition but do not necessarily describe the cause. So, in many cases, when a specific cause cannot be isolated, the word 'syndrome" is used to create a label; a way of communicating the nature of the condition.
The most common explanation of snapping hip syndrome is that a muscle, usually the Iliotibial Band, is too tight. The logic goes something like this: the Iliotibial band normally rests behind the head of the femur. As you bend the hip, the IT Band slides over the femur but because the IT
Band is too tight, it gets caught in front of the femur and as you straighten the hip, the IT Band then snaps back over the bone. It seems to make sense and it may be true. But, there are three things to consider in this argument.
First, why is the IT Band the culprit? Why not a loose hip joint? What if, just imagine for a moment, that the hip joint is a little loose, perhaps from a prior injury, maybe from development, so that when you bend the hip it shifts under the IT Band. The result would be the same. The IT Band would make a snapping sound. And, the reason this is important is because what you do for it is entirely different than if the IT Band is truly tight.
Second, a tight IT Band is also given as the reason for a patella (knee cap) that tracks too far to the outside (laterally tracking patella). So, if your IT Band is tight, then why don't more people have both a snapping hip and a laterally tracking patella? I don't think I've ever seen or heard of a case with both conditions.
Third, if you do come to the conclusion that the IT Band is tight, then you should have data to support it: hip motion is less than normal by measurement, not eye-balling it, and a positive Ober Test (If you're wondering what a Ober Test is, click here).
So, here's the problem. You can have loss of motion in the hip and a positive Ober's Test in the presence of a loose hip joint. Just like in the shoulder when you have a loss of internal rotation with a loose or hypermobile shoulder joint. And, just like the shoulder, when you stretch a muscle over a loose joint, you almost always run into trouble. Why try to make something more mobile that is inherently instable? The solution, somewhat counter-intuitive, is to stabilize the joint through use of selected positions and exercises and allow the body to adapt. As the joint becomes more stable, the slipping and sliding subsides and as a result, so does the snapping.
The easiest way to check if stabilizing exercises might help your snapping hip, although this is not the solution just a quick screen, is to contract the abdominal muscles as if you're about to be punched in the stomach, and tighten the buttock muscles at the same time just prior to making a move that would normally cause the snap and sustain the contractions all the way through the move. These actions increase the tension in the supporting muscles and often, the snapping will stop or be dramatically reduced. If so, you have a clear answer as to what to do. If not, it doesn't mean that stabilizing exercises won't work. It just means that you may not have been able to generate enough force to hold the joint in place or that your issue is something other than a joint that is little loose.
Obviously, I can't solve your individual issues via the Internet but I can at least help you think and most importantly, think twice if you hear, "Oh, it's not a big deal" without a sound explanation.
Make today count.
Doug Kelsey
