Hip pain/snapping

I've had hip problems of some sort for nearly four years now. My right hip has been scoped twice for labral tears and femoroacetabular impingement (cam type), the most recent being just shy of two years ago. My left hip was scoped once, a year ago, for the same and has had an excellent outcome. The right hip, while good for about a year following the second surgery, is now a very different story.

As of my most recent MRI/arthrogram in December, I had no further labral tears or arthritis. It also does not appear as if have any additional impingement--either regrowth or residual.

My hip feels tight and I have lots of tenderness/soreness in my hip flexers, particularly my psoas and sartorius. I experience snapping with most movements as well as some catching/pinching sensations (though the pinching is not as extreme as it was with the labral tears in the past). The joint itself also seems to be swollen and inflamed.

At this point, I am at my wits end. I was in physical therapy for 4 months with very little improvement. I had a cortisone injection into both the joint space and the psoas back in December and, though it did help somewhat, the effects were very short lived.

I am 20 years old and a ballet dancer--this is killing me. My surgeon (one of the best for my problems) has adopted a wait and see approach on the foundation that things aren't likely to get much worse than they are. The PTs that I've worked with are all puzzled. Any ideas?

As someone who works on a weekly dancers here in London I can suggest you need to break down the biomechanics with your physio/pilates/gyro/ballet masters.

The long history means that you are fundamentally performing an action that you just don't have the facility to do with the correct motion. Repeated attempts x 000's will lead to a problem. Surgery will not fix any issue it will merely postpone it again for a while. And if the surgeon is removing and labral material that 'adds' to the stability then this could resolve the pain but make things less stable thereafter?

I know it's a real pain in the backside but perhaps you need to take 12 months and break down your strengths and weaknesses and work one on one with a good ballet teacher outside of whatever else you're doing. As you know a clunking hip is pretty normal in ballet, perhaps due to excessive movement that the body isn't really designed to do. As 20yrs old you have the luxury of having time on your side to put this right but you need a good team around you. Perhaps get the physio to come to a class and do some videoing so you can look at the mechanics.

You can read more about this condition here Snapping hip syndrome. Note the fact that this is sometimes the psoas rubbing over the anterior inferior iliac spine. The shape of the pelvis is therefore a potential genetic risk factor that we can't do much about.

Also perhaps some regular deep tissue work on psoas etc might assist the whole process. Unfortunately much of this will come with $$ attached and I know dancers have not much of that :(