The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
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Hip

Snapping Hip Syndrome (Coxa Saltans)

Snapping hip syndrome — known medically as coxa saltans — describes a snapping, popping, or clicking sensation at the hip during movement. While often painless and merely annoying, it can become painful and functionally limiting in active individuals. Understanding the precise source of the snap guides targeted, effective treatment. At Maryland Orthopedic Specialists, hip arthroscopy specialist Dr. John Christoforetti evaluates and treats all forms of snapping hip, including intra-articular causes that require arthroscopic intervention.

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What is snapping hip syndrome (coxa saltans)?

Snapping hip has three distinct anatomic sources: 1. Internal (iliopsoas) — most common: The iliopsoas tendon snaps over the iliopectineal eminence (a bony prominence at the anterior pelvis) as the hip moves from flexion to extension. The snap is felt and heard at the anterior hip and groin.

Snapping hip has three distinct anatomic sources:

1. Internal (iliopsoas) — most common: The iliopsoas tendon snaps over the iliopectineal eminence (a bony prominence at the anterior pelvis) as the hip moves from flexion to extension. The snap is felt and heard at the anterior hip and groin. It is especially common in dancers, gymnasts, and athletes performing repetitive hip flexion.

2. External (IT band) — second most common: The posterior edge of the iliotibial band (or the anterior border of the gluteus maximus) snaps over the greater trochanter during hip flexion/extension. The snap is felt on the lateral hip and is often visible. Frequently associated with greater trochanteric pain syndrome.

3. Intra-articular — least common but clinically important: Snapping or catching originating from inside the joint — caused by a labral tear, loose body (fragment of bone or cartilage), ligamentum teres tear, or articular cartilage defect. This type requires hip arthroscopy to address.

Treatment options

Physical therapy and stretching: - Internal: Iliopsoas eccentric strengthening, hip flexor stretching, core stabilization - External: IT band stretching and foam rolling, hip abductor strengthening, gait modification - Most patients with painless snapping require only reassurance and patient education; PT is reserved for symptomatic cases Ultrasound-guided iliopsoas injection: An image-guided injection of corticosteroid or local anesthetic into the iliopsoas bursa reduces inflammation and pain associated with internal snapping. Diagnostic utility: temporary relief confirms the iliopsoas as the pain source. Endoscopic iliopsoas release: Arthroscopic or endoscopic partial release of the iliopsoas tendon at the hip joint level or lesser trochanter is indicated for internal snapping that has failed 4–6 months of PT and injection. Dr. Christoforetti performs this with simultaneous treatment of any intra-articular pathology identified. Endoscopic IT band release: For symptomatic external snapping refractory to conservative care, endoscopic release of the posterior IT band fibers over the greater trochanter with concurrent bursectomy provides reliable relief. Hip arthroscopy for intra-articular causes: Labral tears, loose bodies, and chondral defects causing intra-articular snapping are addressed arthroscopically by Dr. Christoforetti.

Surgical Procedure

Iliopsoas Release / Tendon Lengthening

Arthroscopic lengthening of the iliopsoas tendon — at the hip joint level or at the lesser trochanter — to resolve internal snapping hip (coxa saltans interna) and painful anterior hip impingement.

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Hip Arthroscopy

Minimally invasive hip scope performed at our ambulatory surgery center, addressing labral tears, cartilage defects, femoroacetabular impingement, loose bodies, and synovial disease through small portals with same-day discharge.

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Frequently Asked Questions

Does a snapping hip always need treatment?
Not if it is painless. Many people have audible hip snapping with no functional limitation — this can be observed without intervention. Treatment is indicated only when snapping causes pain, affects performance, or limits activity.
Can snapping hip lead to joint damage?
External snapping does not directly damage the joint. Internal snapping that causes bursitis or tendinopathy may worsen without treatment. Intra-articular snapping from a labral tear or loose body can cause progressive cartilage damage if untreated.
Is this condition related to a labral tear?
It can be. Intra-articular snapping is caused by labral or chondral pathology inside the joint. Your evaluation at MOS will include imaging to determine whether arthroscopic treatment is indicated.
Will snapping hip go away on its own?
Painless snapping hip that does not interfere with activity often does not require any treatment and can persist without causing harm. When the snapping is caused by a tight iliotibial band or iliopsoas tendon, a dedicated stretching and strengthening program frequently reduces or eliminates the snap over weeks to months. Painful snapping that does not resolve with conservative therapy may require additional evaluation to rule out an underlying labral tear or hip joint problem. At MOS, we help you determine whether your snapping hip needs treatment or can be safely monitored.
What does surgery for snapping hip involve, and is recovery long?
Surgery for snapping hip is rarely needed but is available for patients with persistent painful snapping that has not responded to physical therapy and injections. For internal snapping (iliopsoas tendon), arthroscopic or endoscopic lengthening of the tendon is performed through small incisions. For external snapping (IT band), an arthroscopic or open Z-plasty lengthens the band over the greater trochanter. Most patients are walking normally within 2–4 weeks and return to sports at 3–4 months. Your MOS surgeon will only recommend surgery after a thorough trial of conservative management and a clear understanding of which structure is causing your symptoms.

Meet the specialists

John J. Christoforetti, MD

John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery

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Related conditions

Hip Flexor Strain / Iliopsoas TendinopathyGreater Trochanteric Pain Syndrome
Medically reviewed by John J. Christoforetti, MD, MD, FAAOS
Last reviewed May 1, 2026

References

  1. Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3(5):303–308. https://doi.org/10.5435/00124635-199509000-00006
  2. Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol. 2008;190(3):576–581. https://doi.org/10.2214/AJR.07.2375
  3. Wahl CJ, Warren RF, Adler RS, Hannafin JA, Hansen B. Internal coxa saltans (snapping hip) as a result of overtraining: a report of 3 cases in professional athletes with a review of causes and the role of ultrasound in early diagnosis and management. Am J Sports Med. 2004;32(5):1302–1309. https://doi.org/10.1177/0363546503262162
  4. Ilizaliturri VM Jr, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22(5):505–510. https://doi.org/10.1016/j.arthro.2005.12.016