The typical snapping hip syndrome exercises you see don’t get to the real root cause of the problem. Today, we’re going to show you what you can do for your snapping hip. (Hint: it’s not surgery.)
Watch 4 Exercises to Fix Internal Snapping hip Syndrome on YouTube if you want to follow along with a video.
What is a snapping hip?
There are two types of snapping hip.
- External Snapping Hip – the iliotibial band snapping over the greater trochanter
- Internal Snapping Hip – a tight iliopsoas jumping over a portion of bone
Today, we’re focusing on the internal snapping hip. What happens is when the psoas muscle becomes too tight, as you flex and extend your hip, the muscle flips or clicks over the front of your pelvis.
In the background research before putting together this routine, we found a great ultrasound video showing this phenomenon.
VIDEO: Dynamic Ultrasound for Snapping Hip Syndrome 
In the video above, you can see a pathologic example of internal snapping hip. The two abrupt movements as the leg goes into extension are what you feel in the snap/clunk.
Why does this happen?
If your psoas muscle is too short when you extend your hip, the muscle becomes trapped by a portion of it’s sister muscle, the iliacus and then has to jump over a portion of the bony pelvis.
The best way to determine whether or not your psoas is too short is the Thomas Test.
The Thomas Test
The Thomas test will tell you if you have internal snapping hip syndrome. You’ll feel the snap if you do. It’s an unmistakable experience.
- Place your butt right at the very end of a bed or bench.
- Lie back and bring both thighs up onto your chest
- Hug your knees
- Lower one leg into extension
If your hip snaps into extension, you have snapping hip syndrome. You should be able to lower your leg parallel to the bed/bench while keeping your other thigh up against your chest.
If it’s not parallel, you have a shortened psoas.
If you can get almost parallel, like Coach E in the picture above, the limited shortness may be that your rec fem is a little bit short.
So the real question becomes, what do we do about it?
Snapping Hip Syndrome Exercises & Root Cause
I used to do that whenever I would lower my leg doing a leg-lowering type of exercise.
What I found was to work the eccentric, which is the lengthening of the psoas, but use active control, so the psoas is contracting when it’s lengthening at the same time.
When I did that exercise, my leg didn’t clunk when I lowered it, and then I kept that psoas on. During the leg lowering and again, it didn’t clunk.
So what I discovered was the real root cause was not just the shortness or the limited range of motion of the psoas, but it was the lack of control, especially as it was lengthening as the psoas was getting longer.
If that muscle wasn’t working properly, then the clunk would happen, and I could reproduce it really, really easily.”
We always like to comb through the literature when filming videos and writing these articles. In one study called “Understanding and Treating the Snapping Hip,” the researchers found that excessive muscle activation increases the tension in the muscle, then the intervention is directed at modifying neuromuscular control to allow muscle lengthening while still maintaining eccentric control. 
This failure to appropriately relax the muscle is commonly seen in patients with snapping hip syndrome.
So why do we get a shortened or uncoordinated psoas muscle?
By far and away, the most common cause is sitting!
When we sit, the psoas goes into a shortened position, and many of the muscles in the core fall asleep. Plus, for women, pregnancy/childbirth can create a clunking hip.
What About Surgery?
Many patients are being offered surgery now to lengthen the psoas muscle. This can be something occasionally needed. Dr. B’s concern as a surgeon is that just lengthening the muscle doesn’t address the root cause – the ability to control the contracting of the muscle as you’re lowering your leg or as the muscle is lengthening.
If you’re contemplating surgery, try these exercises first. Hopefully, it’ll address the issue, and we think you’ll find results really quickly once you follow these exercises.
The snapping hip syndrome exercises aren’t very fancy, but it’s the cueing and how you do them that’s most important. You might find that the clunking hip you had just kind of disappears when you get the psoas muscle turned on.
So let’s get to the exercises.
Exercise 1: ASMR Iliopsoas
The first exercise we’re going to do is active self-myofascial release of the iliopsoas.
You might be wondering why we don’t start with stretching. Dr. B has a great story answering that.
We love active self-myofascial release because it releases the muscle allowing us to then activate it better.
You’ll need a ball for this technique. A lacrosse ball or massage ball works well.
- Lay on your back and place the ball in the area just between your belly button and your hip bone
- Apply pressure
- Slow flex and extend your leg
- Move the ball around every couple of flexes
- Continue for 2 minutes
- Switch sides and do another 2 minutes.
You shouldn’t be causing yourself a lot of pain, but you want enough pressure to break up any adhesions (this helps release the Psoas from the Iliacus muscle so that it can glide properly). If you’re just starting out with ASMR, start at one minute and see how it feels.
If you find a spot where it’s a little tight, do a couple extra repetitions of the flexion and extension.
If you feel like you’re not able to put enough pressure with just your hands, you can take a weight and put it on top of the ball. Otherwise, just use the pressure of your hands.
Now we’re ready to activate the psoas.
Exercise 2: Hip Extension ERE Technique
Hip Extension ERE stands for end-range expansion. This will activate the hip flexor muscles in their lengthened position.
First, we lengthened it and got rid of any adhesion/scar tissue. That kind of stuff can limit a muscle’s ability to lengthen.
Now we’re going to activate the muscle in the lengthened position. Then we’re going to go on and activate it in the shortened position through the full range of motion.
- Lie on your side, you’ll be working the bottom leg
- Use your glutes to get your bottom leg into full hip extension by bringing the foot back and your leg behind you without overextending your lumbar spine
- Fire the glutes as hard as possible
- Hold for 10-15 seconds
- Put your other foot onto your knee
- Drive your knee into your foot
- Hold for 10-15 seconds
- Fire your glutes back up to bring your foot and leg behind you again
- Hold for another 10-15 seconds
That’s one cycle. Switch sides and do the next cycle on the other side before performing the exercise with this leg again. Try to breathe naturally and not hyper-tense your shoulder or lower back.
Start with 2 cycles on each side. Then work your way up to 4 cycles on each side.
If you find that your hamstrings are getting too tight while activating your glutes, you can straighten the leg out a little bit, and it’ll get more glute activation without too much tension in the hamstrings.
Exercise 3: Slumpy Psoas Activator
The next exercise we’ve got for you is called the Slumpy Psoas Activator. This does exactly what it’s named for – activating the psoas muscle.
Starting out in this shortened, sitting position is really important because when you’re sitting down, oftentimes, you’re slouching. That’s when the psoas shuts off. But because it’s in a shortened, shut-off position, it gets restricted to boot. It doesn’t know how to work in this position.
So now, we’re going to wake it up while seated so that we can use it through the full range of motion.
In the previous exercise, we activated it in the lengthened range. Now we’re covering the shortened range. Then we will put it all together.
- Sit on something stable in a slouchy position (think horrible posture)
- Lift one foot off the ground
- Press the opposite hand into the knee of the lifted foot
- Maintain the pressure while slowly straightening your back
- Sit up nice and tall and stick your butt out a little
- Hold for 5 seconds
- Gradually lower your foot back to the floor
Do 2 sets of 4-6 repetitions.
It’s really important here that you pay attention to what this exercise feels like. Develop that mind-to-muscle connection because we’re going to use this for the next exercise.
Lifting the foot turns on the psoas at the same time that it turns off the tensor fasciae latae.
As you’re doing the Slumpy Psoas Activator, the muscle is going to fatigue. You’ll feel the lactic acid build-up. That’s good! That’s what we want you to feel. Because once the psoas is activated, now we can use it through the full range of motion.
Which is ultimately how we’re going to get rid of the snapping hip syndrome.
Exercise 4: Supine Leg Slide
The last exercise in the progression we’re going to do here today starts off with the Supine Leg Slide.
The setup is really key here. Make sure you’re starting off with your feet flat on the ground. Bring your feet in close to your butt, but not too much. You don’t want there to be too much of a stretch on the quads. You also need a little bit of space in the lumbar spine (lower back) area, just the natural lumbar extension, which you’ll maintain the whole time.
The second point before we get started is to be aware of your sit bones. Those are the bones you’ll be feeling against the ground or mat if you’re using one. You can increase your kinesthetic awareness here by rocking your legs back and forth a little bit to feel that area of your body. When you do this exercise, make sure those bones are evenly touching the floor.
- Lay on your back on the ground, with your knees bent and feet flat on the floor
- Activate the pelvic floor muscles slightly (Kegels or stopping your pee midstream)
- Start by slowly sliding one leg out with your foot along the ground
- Straighten it, keeping the psoas activated
- Use your psoas to slowly bring your leg back to the starting position
Do 2 sets of 4-6 reps per side. Then, when you feel like you’ve done every rep in both sets and there’s no clunking or snapping, then progress to the next variation.
- Instead of sliding back to the original position, bring the knee even a little higher, lifting your foot off the ground
- Then slowly put it back down.
- Start with both knees up, so both feet are off the ground
- Relax your keels to your butt, relax your quads
- Slowly straighten one leg to full extension
- Slowly bring it back in
Don’t use your hamstring to control the movement. Keep the activation isolated to just your psoas.
Go nice and slow so that you can control the full range of motion.
As you do this, you might be distracted thinking of something else, and you’ll feel that clunk. Chances are that you’ve lost the lumbar lordosis (the curve in your lower spine), the even pressure on the sit bones, or control of your psoas.
Keep going! Getting distracted and feeling that clunk is just a reminder to focus and keep up the effort in retraining your neuromuscular system.
The other thing is that as you progress to more advanced variations, you’ll need greater activation through the abdominals and through the core. We can get the deep core muscles on, bring the belly button in a little, or brace a little bit to get the obliques and the rectus abdominis activated. Those can help further stabilize so that the psoas can control through that full range of motion.
These snapping hip syndrome exercises should make a big difference in how your hips feel. You might find your hip is still clunking but stick with the routine. Keep practicing and developing that mind-to-muscle connection.
But what if you still have stiffness or pain in your hips even after they’ve stopped snapping?
Hip Pain Solution targets the major hip dysfunctions and compensations (like iliopsoas tendonitis) but is tailored to meet your level of pain. Correct the root causes of hip pain in only 20 minutes a day.
This article was reviewed and updated on January 24, 2023 by our Chief Medical Officer, Dr. Erin Boynton, MD, FRCS to include new research and information on latest surgical developments. Read more about Dr. B here.