The iliopsoas is the main hip flexor. Its tendon crosses the front of the hip joint before attaching to the thigh bone. When this tendon becomes irritated (iliopsoas tendonitis or bursitis) or catches as it slides over the front of the hip (internal snapping hip), it can cause pain in the front of the hip and groin.
- A snap or clunk in the front of the hip, often when straightening the hip from a bent position
- Painless snapping usually needs no treatment
- Most painful cases improve with therapy and an image-guided injection
- When they don’t, an arthroscopic psoas release can help
Symptoms
- A snapping, clunking or popping feeling deep in the front of the hip, sometimes audible
- Groin or front-of-hip pain with lifting the leg, getting out of a car, or climbing stairs
- Pain with running, kicking, dance or hurdling
Snapping on the outside of the hip is a different problem (external snapping hip), usually related to the IT band. See IT band syndrome.
Diagnosis
Dr. Dold can often reproduce the snap during the exam. A dynamic ultrasound can show the tendon snapping in real time, and an MRI can show related problems such as a labral tear or hip impingement. An image-guided injection into the psoas bursa can confirm the source of the pain and relieve it.
Non-surgical treatment
- Physical therapy focused on hip flexor flexibility, core and hip strength, and movement patterns
- Activity changes while symptoms settle
- Anti-inflammatory medicine
- An image-guided cortisone injection into the psoas bursa
Most patients improve without surgery.
Arthroscopic psoas release
If painful snapping or tendon irritation continues despite non-surgical care, Dr. Dold may recommend an arthroscopic psoas release. Using a camera and small instruments through small incisions, the tendon portion of the iliopsoas is carefully lengthened so it no longer snaps or pinches. The muscle remains attached and continues to work. The procedure is done as outpatient surgery and is often performed together with hip arthroscopy to treat a labral tear or impingement at the same time.
Psoas pain after hip replacement
Occasionally, the iliopsoas tendon can rub on the edge of the hip socket component after a hip replacement, causing groin pain with lifting the leg or climbing stairs (iliopsoas impingement). Dr. Dold evaluates this with an exam, imaging and a diagnostic injection. Many patients improve with therapy and an injection. When pain persists, an arthroscopic psoas release may be an option.
Recovery
Most patients walk with crutches for about 2 to 4 weeks, then begin physical therapy. Some temporary hip flexor weakness is expected and improves with rehab. Return to sport depends on any other procedures performed at the same time.
Why see Dr. Dold
- Hip arthroscopy research in AJSM and JBJS Reviews; Stryker Advanced Hip Arthroscopy Course (2018)
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Fellow of the American Orthopaedic Association (FAOA), the American Academy of Orthopaedic Surgeons (FAAOS), the American College of Surgeons (FACS) and the Royal College of Surgeons of Canada (FRCSC)
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Member of the International Society for Hip Arthroscopy (ISHA)
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
What causes a snapping hip in the front?
Usually the iliopsoas (hip flexor) tendon catching as it slides over the front of the hip joint or pelvis, called internal snapping hip.
Is a snapping hip serious?
Painless snapping is common and usually harmless. Snapping with pain, weakness or catching should be evaluated, because it can be linked to tendon irritation or a labral tear.
Can iliopsoas tendonitis be treated without surgery?
Yes. Most patients improve with physical therapy, activity changes and, if needed, an image-guided injection.
What is a psoas release?
A minimally invasive, arthroscopic procedure that lengthens the tendon portion of the iliopsoas so it no longer snaps or pinches. The muscle stays attached and continues to work.
How long does it take to recover from a psoas release?
Crutches for about 2 to 4 weeks, then physical therapy. Hip flexor strength improves gradually with rehab.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. This page is general information, not medical advice.
