It’s one of the most common questions we get asked in the clinic: “why does my hip click?”
It’s often described as a weird snapping sensation or a thud that feels better afterwards. And it’s not predictable – it happens at random times.
So what is this mystery hip click and should you be worried?
What causes a hip to click?
There are three main causes and only one worth worrying about.
The most common cause of hip clicking
The most common cause is a hip flexor muscle “snapping” over a bump on the pelvis (aka. Iliopectineal eminence) or over the ball of the hip joint (aka. Femoral head).
If you then rotate your leg with the muscle still under tension, the tendon snaps over one of these bumps and gives you a thud or clicking sensation.
Importantly there’s no pain associated with this mechanism. It’s pain free and usually just described as a weird sensation.
If you do experience pain, it’s more likely that you have the 3rd cause on our list or a concurrent pathology along with hip flexor snapping (such as a tendon injury).
Hip flexor clicking is harmless and doesn’t require treatment. You can reduce the frequency of clicking by improving your hip mobility and hip flexor length but it’s completely optional.
Clicking on the outside of the hip
A less common cause of clicky hips can occur on the outside of the hip.
The Iliotibial Band, commonly referred to as the ITB, wraps around the outside of the hip and runs down past the knee.
Depending on the angle of the leg and activation of the muscles, this band can pull tight against the hip.
Under tension, it can snap over the bony bump on the outside of the hip and give the sensation of hip clicking.
So if you hip click happens when the leg is angled inwards and the hip begins to flex/bend forwards, ITB snapping is likely to be your issue.
Similar to hip flexor snapping, it’s painless and just feels weird. And it doesn’t need any specific treatment or fixes.
It can improve with hip mobility work but because the condition is harmless, this isn’t essential.
Painful hip clicking
A less common cause of hip clicking, but one that does cause pain, it’s a hip labral tear.
The hip has an O ring of fleshy cartilage that runs around the edge of the socket called the labrum.
Over decades, this labrum gradually degenerates as part of the osteoarthritic process. Typically it doesn’t cause pain because by the age of 80, your hip doesn’t move far enough to pinch the labrum.
In your younger years, it’s possible to tear your labrum with particular forceful movements. These movements often occur in contact sports, agility/field sports and dance.
Once the labrum is torn, and depending on the location of the tear, it’s prone to getting pinched.
In this situation, you’ll feel a click as the joint bumps past the tear along with a nasty stabbing pain. There is usually a residual ache after the pinch for a few minutes up to a day or two.
This cause of hip clicking is almost always painful and can worsen over time. So if your hip click only occasionally causes pain, it’s unlikely to be caused by a labral tear.
What’s the fix for a hip labral tear?
As recent as 2016, the consensus on hip labral tears is that surgery was the way to go once a tear was found on MRI.
In the last few years, we’ve moved away from surgery as a primary option for labral tears. Here’s why:
- Hip labral tears on MRI are now considered a normal part of hip wear and tear. So having a tear on scans may not be the cause of your pain
- Exercises have an excellent success rate with both current symptoms and long term outcomes
- There are several options between simple exercises and surgery. Given the risks associated with any surgery, we’ll usually escalate the approach to include medication and/or injections before we decide on surgery
The recommended approach to exercise is to improve strength and control without risking further pinching of the tear.
It means you’ll avoid full depth squats and lunges while building hip and leg strength to control hip rotation and balance.