Overview

Snapping Hip Syndrome is a musculoskeletal condition marked by a distinct snapping or popping sound in the hip during movement. For some, it may be painless, but for others it can cause discomfort or restrict activity. This condition is most often seen in athletes and dancers whose activities require repetitive hip motions, making early evaluation and treatment crucial to avoid worsening hip pain.

When discussing rib-related conditions, such as those involving the 8th, 9th, and 10th ribs, it’s important to note that these are known as false ribs and are not directly attached to the sternum. In slipping rib syndrome, excessive movement of the rib tip can result in a popping or clicking sensation. This is sometimes referred to as a ‘slipping sensation’ and can be associated with ‘rib tip syndrome’, ‘clicking rib syndrome’, and ‘Cyriax syndrome’—the latter historically described by Cyriax in 1919. The hypermobility of the rib tip may cause the ribs to slip, leading to displaced ribs or ‘interchondral subluxation’, where the rib tip moves out of its normal position due to weakness or injury to the fibrous tissue (ligaments) connecting the false ribs.

A common symptom of these conditions is chest pain, which may be sharp, stabbing, or dull, and can radiate to the back or abdomen. Activities such as deep breathing can provoke or worsen symptoms by causing the ribs to slip. During the diagnostic process, localized pain is often present in the affected area, and the intercostal nerve or intercostal nerves may be irritated or impinged by the excessive movement of the rib tip.

Introduction to Slipping Rib Syndrome

Slipping rib syndrome, sometimes referred to as painful rib syndrome, is a condition that causes intermittent and often intense pain in the lower chest or upper abdomen. This discomfort is typically the result of excessive movement of the lower ribs—most commonly the 8th, 9th, and 10th ribs. When these ribs move more than they should, it can lead to a distinctive popping or clicking sensation, which many patients describe as a slipping feeling in the rib area. The pain may be sharp or aching and is often triggered by certain movements or postures.

To diagnose slipping rib syndrome, a healthcare provider will usually begin with a careful clinical history and a thorough physical examination. One of the key diagnostic tools is the hooking maneuver test, where the provider gently hooks their fingers under the lower ribs to reproduce the pain or clicking sensation. This hands-on approach, combined with a detailed understanding of the patient’s symptoms, helps rule out other causes of abdominal pain and ensures an accurate diagnosis of rib syndrome.

What Is Snapping Hip Syndrome?

Also known as Dancer’s Hip or Coxa Saltans [1], Snapping Hip Syndrome occurs when tendons or muscles slide over bony structures in the hip joint, creating an audible snap or palpable click. While it affects just 5–10% of the population, it is significantly more common in athletes, gymnasts, and dancers. [2]

Causes and Severe Pain

The main causes of Snapping Hip Syndrome include overuse, trauma, and anatomical variations.

Overuse

Repetitive flexion and extension of the hip cause muscles and tendons to thicken or become irritated. Around 90% of professional dancers who develop this condition experience it bilaterally, with females at higher risk. [3]

Trauma

Direct trauma such as falls, sports injuries, or prior hip surgery can alter the way tendons and muscles interact with bone, leading to snapping hip. [4]

Anatomical Variations

Hip bone shape, femur structure, and the presence of bony prominences like the greater trochanter or iliopectineal eminence can predispose individuals to this condition. [5] Narrow pelvic width, tight iliotibial bands, or developmental dysplasia may further increase risk.

Risk Factors for Slipping Rib Syndrome

There are several risk factors that can make someone more likely to develop slipping rib syndrome. Engaging in activities that involve repetitive upper body movements—such as certain sports, weightlifting, or manual labor—can put extra strain on the rib cage and increase the risk of a slipping rib. Direct trauma to the ribs, like a fall or blow to the chest, is another common cause. People with joint laxity, where the connective tissues are more flexible than usual, or those with underlying thoracic disease, may also be more susceptible. Certain postures that place ongoing stress on the lower ribs can contribute to the problem as well.

Types of Slipping Rib Syndrome

Slipping rib syndrome can present in different forms, generally classified as either acute or chronic. The acute form is characterized by a sudden onset of pain, often following a specific movement or injury, while the chronic form involves ongoing or recurring pain that may persist for weeks or months. The condition is also categorized based on which rib is affected, with the 8th, 9th, and 10th ribs being the most commonly involved. The location of the affected rib can influence the type and severity of pain experienced.

Risk Factors for Snapping Hip Syndrome

Several risk factors can increase the likelihood of developing snapping hip syndrome. Engaging in activities that involve repetitive lower-body movements—such as certain sports, dancing or physical routines—places additional stress on the hip and surrounding muscles. Individuals who have experienced trauma or injury to the hip are also at greater risk. Conditions that alter movement patterns, including rib syndrome or slipped rib syndrome causing upper abdominal pain, may contribute indirectly. Weak or tight muscles around the hip, poor posture, and specific anatomical features can also play a role.

Types of Snapping Hip Syndrome

Snapping Hip Syndrome is classified into three categories based on the anatomical site:

External

Occurs when the iliotibial band (IT band) moves over the greater trochanter, or when the proximal hamstring tendon rolls over the ischial tuberosity. Thickened gluteal muscles may worsen symptoms. [6]

Internal

Caused by the iliopsoas tendon snapping over the femoral head or iliopectineal eminence. Patients often feel or hear a click in the anterior groin during hip flexion. [7]

Intra-Articular

Arises from labral tears, cartilage damage, or loose bodies in the hip joint, which can mimic or coexist with other snapping hip types. [8]

Understanding Referred Pains

One of the challenges in diagnosing slipping rib syndrome is the phenomenon of referred pains. Because the rib cage and surrounding muscles are innervated by complex networks of nerves, pain from a slipping rib can sometimes be felt in areas away from the actual site of the problem. For example, irritation of the 8th or 9th rib may cause pain in the upper abdomen or lower chest, rather than directly over the affected rib. This can make it difficult for both patients and healthcare providers to pinpoint the source of discomfort. A careful clinical history and a thorough physical examination, including the hooking maneuver test, are essential for identifying these referred pains and arriving at a correct diagnosis.

Costal Cartilage and Slipping Rib Syndrome

The costal cartilage plays a central role in slipping rib syndrome. This flexible cartilage connects the ribs to the sternum and allows for normal movement of the rib cage. In slipping rib syndrome, the costal cartilage of the affected rib becomes weakened, stretched, or disrupted, which allows the rib to move excessively or even subluxate (partially dislocate). This abnormal movement can irritate the surrounding muscles and nerves, leading to pain and inflammation. In some cases, conservative treatments may not provide sufficient relief, and more advanced options such as costal cartilage excision or rib stabilization surgery may be considered. These procedures aim to restore stability to the affected rib and reduce pain, helping patients return to normal activities without ongoing discomfort.

Symptoms of Snapping Hip Syndrome

The symptoms of snapping hip syndrome often mirror those found in conditions like slipped rib syndrome and rib syndrome. A hallmark sign is a distinct snapping, clicking, or popping sensation in the hip, especially during certain movements such as bringing the knee toward the chest or rotating the hip. This may be accompanied by sharp pain, a dull ache, or stiffness in the hip area. Some people experience referred pains, where discomfort is felt in areas away from the actual source—similar to the referred pains seen in rib syndrome. The pain can range from mild to severe, and in some cases may be persistent or worsen with activity.

Diagnosis and Evaluation: How to Diagnose Slipping Rib Syndrome

Diagnosis typically involves a clinical examination and physical assessment by a physician or physical therapist, along with a careful review of the patient’s medical history to help differentiate slipping rib syndrome from other similar conditions. A thorough clinical examination helps establish a possible diagnosis before confirming with imaging. Imaging such as X-ray, MRI, or ultrasound may be used to confirm the diagnosis and rule out other conditions. Dynamic ultrasonography is particularly effective in detecting internal snapping hip and related dynamic abnormalities. (See referenced literature.)

Treatment Options and Treatment Modalities

Not all cases require treatment, but when hip pain or restricted mobility occurs, treatment options include:

• Activity modification – avoiding movements that worsen symptoms
• Physical therapy – guided exercises to improve flexibility and hip alignment
• Stretching – including targeted stretches such as piriformis and IT band stretches
• NSAIDs – to reduce inflammation and provide pain relief
• Corticosteroid injections – for persistent inflammation and pain relief
• Rest & cold therapy – to decrease swelling and irritation
• Surgical options – arthroscopic release of tendons or labral repair for severe cases

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat slipping rib syndrome and related musculoskeletal pain. Published research has shown pain-relieving, anti-inflammatory and regenerative benefits for selected patients.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with slipping rib syndrome. Because prolotherapy targets ligament and tendon healing, it is viewed by many practitioners as an option that addresses the root cause rather than just symptoms.

Possible Complications

If snapping hip syndrome is not addressed, it can lead to a range of complications. Chronic pain and reduced mobility are common, potentially limiting daily activities and overall function. In more severe cases, compensatory movement patterns may develop, which can place additional strain on the ribs and thoracic region, sometimes leading to conditions like slipped rib syndrome or other rib-related issues. Persistent pain and discomfort can also impact quality of life, making it important to seek timely intervention.

Prevention

Preventing snapping hip syndrome involves a proactive approach to strengthening and flexibility. Regular exercise that targets the muscles around the hip, combined with stretching routines, can help maintain joint health and reduce the risk of injury. It’s also important to avoid repetitive movements that may irritate the hip, and to take breaks for stretching during prolonged activity. For individuals with rib syndrome, maintaining good posture and being mindful of postures that could aggravate the ribs or hip is essential. Consulting with a healthcare provider or physical therapist can provide tailored prevention strategies.

Case Study: Prolotherapy for Athletes

A 2021 review found that athletes with chronic hip pain who underwent prolotherapy reported significant pain reduction and returned to sport faster than with traditional rehabilitation alone. [11]

When to Contact a Medical Professional

If you experience severe pain, significant loss of movement, or if your symptoms persist or worsen, it’s important to contact a healthcare provider. This is especially true for individuals with a history of rib syndrome, slipped rib syndrome, or other thoracic conditions, as changes in symptoms may indicate a related issue. A thorough physical examination, which may include the hooking maneuver or dynamic ultrasound, can help diagnose snapping hip syndrome or rule out other causes of pain. Early recognition and intervention can provide temporary relief and help prevent long-term complications.

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Author Bio

Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating hip pain, with patients travelling from across the UK, Europe, and the Middle East.

With over 12 years of clinical experience, Oliver helps patients understand their symptoms associated with hip pain and provides effective treatment solutions. He trained in Prolozone Therapy and Prolotherapy in the USA with the American Academy of Ozonotherapy, and continued further qualifications at the Royal Society of Medicine, Charing Cross Hospital, Keele University, and Heidelberg University.

Oliver has also treated elite-level athletes, including Olympic and Commonwealth medallists.
LinkedIn: Oliver Eaton

References

1. Musick SR, Varacallo M. Snapping Hip Syndrome. StatPearls. 2022. Link
2. Yen YM, Lewis CL, Kim YJ. Understanding and Treating the Snapping Hip. Sports Med Arthrosc Rev. 2015;23(4):194-199.
3. Badowski E. Snapping hip syndrome. Orthop Nurs. 2018;37(6):357-360.
4. Lewis CL. Extra-articular Snapping Hip: A Literature Review. Sports Health. 2010;2(3):186-190.
5. Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3(5):303-308.
6. Cheatham SW. Extra-articular hip impingement: a narrative review. J Can Chiropr Assoc. 2016;60(1):47.
7. Piechota M, et al. Internal snapping hip syndrome in dynamic ultrasonography. J Ultrasonogr. 2016;16(66):296.
8. Kyin C, et al. Mid-to long-term outcomes of hip arthroscopy: a systematic review. Arthroscopy. 2021;37(3):1011-1025.
9. Ilizaliturri VM Jr, et al. Internal snapping hip syndrome: outcome after endoscopic release. Arthroscopy. 2015;31(10):1991-1995.
10. Case study: Athletes with hip pain treated by prolotherapy. PubMed. 2021. PMID: 33450012.