Snapping hip or similar - something feels stuck

[June's Terry]

I'll be astounded if anyone can shed some light on this because I've been searching for ages and just go round in circles.

The issue is in the area of my left hip/pelvis. If I sit or lie with my knees bent and then try and open my knees outwards something restricts my left knee and I feel it in the area of my hip and my knee (ITB related?). It feels like something is stuck on the wrong side of something else and that if I could only get it to release then it would be ok.

Unfortunately I can't. Doing this stretch: Hip Joint Mobilization Stretch - as I push back onto my hips I can really feel in my left hip area whatever it is stuck wants to come over but just can't - it's so frustrating.

So the whole time it feels stuck I am in this cycle whereby something makes little clicking/popping noises in the same area. If I stand on my left leg and push upwards onto my toes and push my pelvis forwards, for example, like when I'm swinging my right leg over my bicycle, it pops and over the next 30 mins or so I get increasingly uncomfortable and irritable. I have to try and get it to pop back, the most reliable method (but not reliable enough) is standing doing some hip/trunk circles until I catch it right and it pops back - but inevitably it just keeps happening again and again - for 3 years now!

What is stuck, why, and how can I rectify it?.

In cycles it makes my SIJ ache, my ITB, my psoas and piriformis (or similar, all in that area anyway). Lying on my left side or my front exacerbates it.

Please, please help - this is dominating my life as it is so distracting.

Thank you

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[MrPhysio+]

Hi,
If your ITB is not snapping over your greater trochanter (place your finger over the bony point of the upper thigh when standing and twisting with the weight through this leg), you may have a labral tear in the hip joint.
The labrum is a cartilage rim that deepens the socket whilst wrapping around the femoral head, holding the ball in the socket. If you have tear in the labrum, you can be displacing it via certain movements.
A specific MRI scan may be of assistance, however the gold standard is a hip arthroscopy by an orthopaedic specialist experienced with this problem. Such specialists are not great in number.
Hope this helps.
MrPhysio+

[violablue]

A tight psoas can cause a similar snapping. The Thomas test can help determine if your psoas and other hip flexors are tight. There are a number of strategies to release a tight psoas.

Not sure about the knee aspect...I take it since you say ITB related that it's the outside (lateral) aspect of your knee that is affected? The psoas could definitely be an issue if your medial (inside) part of your knee is affected, as the adductors can also be playing a role. Where exactly is it that you feel the "catch"? The term hip can cover a lot of anatomy.

[June's Terry]

Thanks for your replies.

I really hope it isn't a labral tear, and trying to be objective, I don't think it is one. I'm not getting what I would call 'pain' from it and it hasn't deteriorated over time. The discomfort I get is more of a niggling pull or ache.

I had a quick go at conducting a Thomas Test on myself but didn't get anything obvious. I have previously thought it might be caused by an anterior pelvic tilt (brought on by a tight psoas) but after a week or two of trying to counter that I decided it probably wasn't that.

Can anyone hypothesize why lying on my problem side, lying on my front, or sitting with my legs crossed at the ankles, might aggravate the situation? I can go to bed feeling fine, allow myself the luxury of sleeping on my left/front and within half-an-hour I can feel I've irritated the problem area.

I'm afraid I struggle to be specific about where it's affecting me. It seems to migrate subtly from day to day and occasionally I get days where I feel completely fine. Sometimes I get a pull in the area of my psoas, sometimes its aching around my sacroiliac, sometimes it feels tight in my piriformis, and sometimes my ITB along the outside of my hip feels tight. When I get the clicking it is just somewhere internal that I can not place. The pull in my knee when I open my legs outwards is on the outside of the knee, not the inside.

One other symptom I haven't mentioned yet: I can run without any problems, but I can't sprint properly. Sprinting feels mechanically impeded and it also causes quite a strong ache in the back of my left knee.

[MrPhysio+]

Hi Again,
Yes, I hope that you can have the problem remedied without surgery, however your symptoms are very similar to a relative of mine that eventually had a labral tear repaired, solving the problem.
Symptoms that change position can be due to the owner (you) changing body posture subconsciously to give the damaged area some recovery time. Such postural change is not as efficient biomechanically
and alters symptom positioning. There may be a nerve entrapment, however this should not give you a click or stuck feel. If you know someone with a Sacro-iliac joint belt, give that a try, making sure you put the belt
in the correct position and do it up when laying down.
Good luck.
MrPhysio+

[June's Terry]

Just wanted to update that I've recently had an NHS physio assessment for this issue. During the assessment I had the feeling that something needed to click so I don't know how it may have affected what the physio found, but he told me that the left side of my pelvis was up compared to my right and that my sacrum appeared to not be functioning correctly.

When standing my left was up compared to the right.
When leaning forward my pelvis levelled out.
When leaning backwards the left side moved up even further compared to my right.

Does this diagnosis tie in with the symptoms I have already described? Any idea of prognosis? I've hopefully got my next physio session this week.

Thank you for taking an interest.

[MrPhysio+]

Hello June's Terry,
Thanks for the update. The assessment has found that on certain postures there is an imbalance in the muscles on one side compared to the other. It is not uncommon for this to occur around the pelvis as
the body is trying to stabilise the pelvis due to the symptoms. The pelvis is the centre of gravity of your body and is very sensitive to change. The problem is that the muscle tightening is an indicator of a
problem but is not the actual problem.
If you have a low back, sacro-iliac joint (SIJ), hip or groin pain the muscles (erector spinae & piriformis) around the sacrum can react the same way. If the muscles on one side of the pelvis are overactive trying to splint the SI joint then you may feel hitched and rotated. The muscle reaction is not specific enough for full diagnosis. I had suspected that SIJ area muscles may be contributing
which is why I suggested a support belt to assist in diagnosis. If a support belt stopped the symptoms, including the click, then it is less likely that a labral tear is present. A support belt needs to be applied when you are lying down to have the best effect. Various brands are on te market. We use a Serola, but have used other types. A belt should not be made from stretchable material, be around 50 mm (2 inches) wide, but can have extra elastic side tensioners. If the SI joint is the problem you will need to wear a support belt for at least 6 weeks to allow for settling of the joint. If this proves to be the case feel free to write again and I will add management information regarding belt use and weaning off the belt correctly.

The following link may be of assistance regarding labral tears. Labral Tear - Hip Labral Tear - PhysioAdvisor
Prognosis is good once a definitive diagnosis is made. I think your physio will need to rule out the sacro-iliac joint as a cause by treating the area and determining your response. The treatment would include
settling the tight muscles, reducing sacro-iliac joint pain (possibly by electrically stimulated dry needling - same needle as used in acupuncture) and stabilising the SI joint via belt usage.
I hope the above will be of further assistance.
Cheers,
MrPhysio+