Hip clunks and pops!...HELP!!

Hi guys

i'll get straight to the point! about february time I was doing some kick variations in my muay thai class and on the front push kick (teep) my right hip gave an almighty clunk!! it wasn't painful but since then it has stuck with me i can re-create the clunk by lifting my knee up (standing position) and lowering past 90 degrees to my body. This doesn't seem to be so prominent when my knee is coming straight down beside the supporting leg but more when it is tranversely abducted slightly and even more so if at 60-75 degrees to the support leg. As soon as my knee goes past half way...CLUNK! after a couple of times i start to feel soreness/almost stiffness in my hip flexors and groin area. It doesn't hurt when i walk or run but any intense knee raising exercise that isolates the flexors like knee lifts, leg raises or static holds just makes it feel sore and fatigued quickly. I can put my fingers on my groin area and feel the pop when i lower my knee, the pop seems to come around the illiopsoas/pectineus region.

My left side pops when doing a side kick or any abduction movement but it's no way near as bad as the situation i have with the right side!!

I have been scanning the forum for articles on hip problems and so far the only thing i can find is Ido Portals comment on training more internal rotation and a few suggestions on stretching aggressively. I am quite flexible to so stretching is helping abit but doesn't really get rid of the symptoms of soreness or the clunks/pops, it only seems to stretch my ITb's and releasing my knees.

Coach said to try the hip extensions exercise that he states in one of the forum pages but it just gives me pain in my flexor to benefit me at the moment. I have tried to cut sitting down so much out of my day to day routine (I'm a lifeguard so sitting and watching does not help this in the slightest. I now keep moving and walk around the pool and when i get a break i stretch my hips.)

Now my hips just feel so unstable and i feel that my hip flexors were never conditioned properly for the amount of speed and power i was putting into kicks - I will also admitt to sometimes not warming up properly if not at all! And since the injury i have stopped going to my class and stopped kicking completely. I am thinking of going to see a ART specialist and chiropractor about the matter and see what they can do.

Please please if ANYONE has any advice or suggestions ( or preferably a complete hip rehab program to get balance, stability and strength back to the my hips would much appreciated )

Thanks guys!

Basically the hip series extensions is what has been posted of the GB hip mobility series. SLS and straddle-L are good but they also focus on hip flexor strength.

You can watch MobilityWOD and learn how to test your external and internal rotation of your hip and flexibility ranges.

I'm not sure if your clunky hip`is the same as the clickety hips I am familiar with, In synchronized swimming they are really common.

There seems to be three levels of click, one is an effortless light click that happens during warm-up phases. It kind of feels good as it seems to result in better mobility or less tension. Then there is a louder pop that might come in a workout phase. It doesn't feel terrible, but every time it happens it seems to make the associated muscles/ligaments/tendons more tender. And there is a horrible clunk that sometimes comes deep in a stretch. That one feels wrong from the start, like even before it happens you feel like you should re-start the stretch in a different position and it hurts as the clunk forms.

I try and produce the light click while warming up, not really forcing anything, but just positioning my hips and relaxing. For me that means that I do a standing pancake stretch then shift my weight to one side then the other. I know other people that go into and out of a 2nd position plie while pushing their hands against their knees or put one foot up against a wall and do a standing lunge with the forward knee turned out. At any rate it makes some wakeup clicks.

After the joints are loosened working the muscles that move the thigh it seems to help. I like attempting an L-sit straddle then wiggling my legs in tiny circles. On weak days I do one leg at a time or just push against the ground instead of lifting off. Some people do slow controlled leg lifts or lie on their back and do scissor abdominals. I know one person who swears by doing a pulsating hollow hold with ankle weights, maintaining the ankles tightly pressed together.

Sometimes I do over the fence/under the fence or duck squat mobility exercises. But I prefer to do them on days when my hips feel good as it seems like they make things worse if i am already tender.

If level 2 pops happen during a workout I try to remember what movement caused the pop. Then another day I try and go over the move in a slower, more controlled less extreme way when I am fresh.

When it comes to the horrible clunk I think its just better to avoid it. That seems to mostly mean being patient when it comes to middle split stretching and hip flexor stretching.

One thing that seems to have helped the athletes I work with is improving their straight leg adductor strength with the hips slightly internally rotated. (Found that out by coincidence, not sure if its correlation or causation)

After doing abit more research...i have been trying to pin point the click and it is right in the deep hip rotators!! i have been on EX RX and seen the hip internal/external exercises but i my only problem now is that i don't know what position my hip is in. It could be that the clicks are happening because the femor is at too much of an internal position OR it is at an exaggurated external position!? i just don't know. I guess i will need an X-ray to find out...but going private is just money money money.

From what you're describing it sounds like a tight iliopsoas. Causes of snapping hips are usually broken down to intraarticular vs. extraarticular, with intraarticular being more troublesome but fortunately extraarticular more common.

Causes of intraarticular snapping hips: loose bodies, labral tears, synovial chondromatosis, osteochondral fractures, femoral acetabular impingement

For causes of extraarticular you need to distinguish medial vs. lateral snapping. External = most common = ITB or glut max snapping over greater troch. Internal = iliopsoas snapping over deeper osseous structures (iliopectineal eminence, femoral head, lesser troch). This is typically heard when hip is abducted flexed then brought to neutral by other leg lying supine.

So, first identify the cause. You can search SCOUR test to try to rule out intraarticular pathology. Treatment/therapy is going to be stretching whatever is tight, which I believe will be iliopsoas in your case (hip flexor).

XRay will not tell you much.

Nothing to add to that!

OP, Iliopsoas is one of those muscle groups you will have a very hard time treating manually on your own. It's on the front of your spine in the lumbar region, underneath all your organs and abdominal muscle as seen from the front of your body. It extends from top of the lumbar spine all the way along the inside of your pelvis and attaches to the lesser trochanter.

If you find that stretching doesn't help, you can try relaxing and doing deep palpations if you know where the group is, and you can also find out where the insertion on lesser trochanter is and try to palpate and massage it up to and under the inguinal ligament (this will not feel great) but to really be treated right I think you're going to need someone else to do the palpations.

If none of that made sense, please see a trained professional and don't try to self-treat this one!

thenail01 said:

From what you're describing it sounds like a tight iliopsoas. Causes of snapping hips are usually broken down to intraarticular vs. extraarticular, with intraarticular being more troublesome but fortunately extraarticular more common.

Causes of intraarticular snapping hips: loose bodies, labral tears, synovial chondromatosis, osteochondral fractures, femoral acetabular impingement

For causes of extraarticular you need to distinguish medial vs. lateral snapping. External = most common = ITB or glut max snapping over greater troch. Internal = iliopsoas snapping over deeper osseous structures (iliopectineal eminence, femoral head, lesser troch). This is typically heard when hip is abducted flexed then brought to neutral by other leg lying supine.

So, first identify the cause. You can search SCOUR test to try to rule out intraarticular pathology. Treatment/therapy is going to be stretching whatever is tight, which I believe will be iliopsoas in your case (hip flexor).

XRay will not tell you much.

I see this question come up all the time, and that was by far the best and most concise explanation of what's going on I've come across.

Are you a physiotherapist thenail01?

Dear thenail01

Thank you so much for that information...at last it seems there is light at the end of the tunnel! I will watch the CSOUR test on youtube and test myself for symptoms although from what you said it is more probable to be extra-articular. Another thing i forgot to mention (and i don't know if the two are linked but it feels like they are) if i sit down in a chair for a while, i sometimes get this slowly coming on ache in my lumbar section. If i cross my legs and straighten them, whilst at the same time try to abduct them whilst they're crossed...i feel a click in my lower back as if something has just flipped over something else and the ache disapears.

Thank you so much for your replies everyone..this forum really is fantastic!

Cheers

Ok just did the SCOUR test. http://www.youtube.com/watch?v=WOB2esGaPLM. The movement at 0.50, Adducted (or as the dude in the vid says 'a-d-ducted') I feel no pain, no discomfort and there is no click or pop. The movement at 1.18, abducted (or as the dude in the vid says 'a-b-ducted') I didn't feel any pain, BUT towards the end of internal rotation i felt mild discomfort/stiffness near the TFL/ sartorius region, and on the initial part of external rotation there was a little click/pop.

From what i wrote about the pop/click in the lower back/pelvic region after sitting down to long, and the fact that when i lay on my back doing hip flexions i get a pop in the area of the lesser trochanter and then a clunk in the lower back/pelvic region (which also happens when i front/teep kick)...it would seem to be sensible to say that there's a good chance it would be the iliopsoas!?

thenail01, what do my results mean to you?? and where do i go from here with regards to treatment/rehab??

cheers all and thankyou

From your original post, the first paragraph description, early fatiguability, worse after prolonged sitting... I'm still thinking it's your iliopsoas. Medscape has a decent excerpt on iliopsoas tendinitis. When you sit your hip is in flexion, so when you stand up your extending an inflammed or 'tendinopathic' muscle/tendon. The scour test you need someone to do to you since there needs to be an axial load. Basically, someone needs to press your leg bone into the socket with a lot of force and rotate, trying to catch on a torn labrum, and this would likely hurt like hell and you would probably not let someone do this to you (like if you have a meniscal tear in your knee).

I really doubt the problem is intraarticular (within the joint). The intraartiular problem that would make the most sense, assuming your reasonably young and healthy, would be a labral injury, and the mechanism (teep'ing) doesn't seem to fit (forced extension and external rotation is typical mechanism of labral injury).

So that's good news. Intraarticular issues typically need intervention beyond just simple PT.

Either way, if it's really bothering you, I wouldn't rely on some sort of online diagnosis. I'm not sure if you're US-based, but in the states you can go probably even to your PCP and they can write a script for physical therapy so it will be at least covered in part by insurance.

I'm sure others on the forum could give you better ideas on a PT program than me. But for tendinopathies (dysfunctional tendons) [opposed to tenditis = acutely inflammed] the working idea is to stretch... your hip flexors in this case... strengthen both the hip flexor group and opposing muscle group (hip extensors), and work high volume repeated eccentric strengthening to the intensity it hurts slightly. Off the top of my head I'm thinking if you put some sort of ankle weight on, start supine, flex your knee flex your hip (bicycle up your leg), then straighten your leg and slowly lower it down to the ground, continue to repeat. That might be a start.

Anyway, I would go to PT. They have other modalities they can try. US is pretty helpful for tendinopathies though I'm not sure on the logistics of ultrasounding hip flexors.

Hi guys!

Just an update on my hip problem. I went to see a top sports physio today and he did all the tests. He tested for ROM and labral andi didn't feel pain on any of it nor was my movement compromised much. He narrowed it down to a weak and in-active iliopsoas. When i was 13 i had my appendix out, and i remember not being able to physically walk for 2 weeks. The physio reckoned that since the operation and the surgeons cutting through things and poking around, that it left me in with an in-active hip stabilizer. It is active when i want it to be, but not when i need it to be. so my internal rotators and adductors were compensating for it (which would explain the stiff and sore groin when side kicking). I am now on a rehab program with some rather interesting exercises!....Alot of it is mental control aswell as muscle control.

Exercise 1: Lie on your front, bend knees to 90 degrees, feet together, contract lower abs without contracting mid or upper abs so that your external obliques rise to the level of your iliac crest (helps if you rest your hand on it as a guide). Then whilst all this is going on, contract the glutes and squeeze your feet together as hard as you can for 10 seconds.

Exercise 2: Alot more mental work here....lie on your back, suck in lower abs, now attempt to pull the femor into the socket without letting your hip hike up!...This is harder than it sounds. After you have mastered that and can feel a steady amount of contraction, attempt to lift the knee as high as you can whilst keeping your heal on the floor sliding towards your glutes. After you have reached the limit, lower slowly whilst all the while maintaining that squeeze of the femor into the hip socket.

Basically, i have a mild impingement and instability and after i understood how these exercises worked, the problem came clear to me. I just have to strengthen those little stabilizer muscles so that the femor sits tight on the socket. It also explains the tight lowerback aswell.

The physio told me that people who have core dysfuntion often become QL dominant.

I will update in a month or so and let you know how i get on

cheers all

cool. good luck.

I have this CAM-type femoral acetabular impingement which causes my hip to pop. It means I have this small bone deformity on the neck of my femur that prevents it from gliding smoothly in the acetabulum. It causes some pain when in hip extension (knee to chest). I also have a little limited abduction and internal rotation. 

My condition is pretty mild and my doctor said that it doesnt have to be operated if it doesnt get worse. Does anyone know how to rehab this kind of thing? What kind of exercises or stretches could help this kind of condition?

Or what kind of professional might be the one I should ask help? Some kind of physiotherapeutist, OMT-physiotherapeutist? I live in Helsinki if someone happens to know somebody there who knows about these kind of things.

Thanks in advance.