Iliopsoas Tendinopathy: Managing the "Snapping Hip"

Is the front of your hip sore, and does it click or snap when you stand up, swing your leg, or climb stairs? You have probably tried resting it, stretching it, or pushing through, and the pain keeps coming back. That pattern is common with iliopsoas tendinopathy, an irritated hip flexor tendon, and it helps to break it into parts. 

This guide from Integra Health in Toronto covers what is happening in the tendon, why resting and stretching alone often fall short, and a step-by-step plan that calms the pain first and then builds strength in your hip flexors, side hips, and knees.

What Is Iliopsoas Tendinopathy?

Your iliopsoas is the main muscle that lifts your knee toward your chest. Its tendon runs across the front of your hip joint and attaches to the top of your thigh bone. When that tendon is asked to do more than it is ready for, it becomes irritated and sore. This is called tendinopathy. It is irritation from overload, not a tear.

"Snapping hip" is a related but separate problem. In the iliopsoas type, the tendon catches on a bony part of the hip as you move, and you may feel or hear a snap. The snap can be painless or painful, and it can happen with or without tendinopathy (Walker et al., 2021). Some people have both, which is why the two terms often get mixed up.

Causes and Risk Factors

Iliopsoas tendinopathy usually builds up over time instead of starting with one injury. Common contributors include:

• repeated hip lifting in running, dance, gymnastics, and kicking sports
• sudden jumps in training, such as adding hills, speed, or mileage too quickly
• weak hip and glute muscles that leave the hip flexors doing extra work
• long hours of sitting followed by hard workouts

Dancers, gymnasts, and people who exercise a lot are at higher risk, and women are diagnosed with internal snapping hip more often than men (Walker et al., 2021). Whether you are running the Martin Goodman Trail or taking the stairs at a TTC station, the same tendon is doing the work.

Symptoms and How It Is Diagnosed

Typical signs include:

• a deep ache at the front of the hip or groin
• pain when you lift your knee, climb stairs, get out of a car, or run
• a snapping or clicking feeling at the front of the hip
• tightness or a shortened stride when you move quickly

A physiotherapist can often diagnose this from your history and a hands-on exam. We look at pain with resisted hip lifting, hip movement, and how you walk, and we may use a test such as the Thomas test to check hip flexor length. Imaging is not always needed. When the picture is unclear, an MRI or an ultrasound that shows the tendon moving can help confirm the diagnosis and rule out other causes (Walker et al., 2021).

Managing Iliopsoas Tendinopathy Step by Step

Most people improve with a plan that moves from calming pain to gradually loading the tendon. Much of the research on tendon loading comes from other tendons, such as the Achilles and patellar tendons, so this plan relies on those principles and clinical practice. Here is how the stages fit together:

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Stage 1: Calm Down the Pain

Early on, the goal is to settle the tendon without stopping all movement. Try these steps:

• Cut back on the activities that flare it up, such as hill running, high kicks, or high-speed sprinting, but keep walking if it is comfortable.
• Interrupt long periods of sitting with short walks.
• Try gentle isometric holds, where you press your knee into your hand or a band without moving, and hold for about 30 to 45 seconds.
• Avoid hard stretching of the front of the hip, which can irritate the tendon further.

Stage 2: Build Hip Flexor Strength

Once the pain is calmer, the tendon needs gradual, progressive loading to rebuild its capacity. A band march is a common starting exercise:

1. Loop a resistance band around both feet and stand holding a wall or counter for support.
2. Lift one knee slowly, only as high as your hip, then lower it with control.
3. Repeat on each side for a small number of controlled reps.

Over the next weeks, a physiotherapist adds resistance, reps, and range of movement as your pain allows. Mild discomfort that settles within a day is usually acceptable. Sharp pain, or pain that lingers, is a sign to scale back.

Stage 3: Support the Hip and Knee

The iliopsoas does not work alone. Weak hips and knees can leave it doing extra work. Strengthening down the chain gives the tendon more support:

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What to Avoid at First

Early on, some positions squeeze the tendon over the front of the hip and can flare your pain:

• deep squats or deep lunges
• pulling your knee tightly to your chest
• sitting in very low chairs for a long time
• hard stretching of the front of the hip

These do not need to be off limits forever. As the tendon gets stronger, we bring them back in a planned, gradual way.

What About Corticosteroid Injections?

Many people ask about a cortisone shot when the pain will not settle. A corticosteroid injection can calm pain quickly, and doctors sometimes use one to help confirm whether the snap is coming from the iliopsoas (Walker et al., 2021). The relief is usually short-lived, though, and an injection does not make the tendon stronger.

Research on tendons in general raises some cautions. A 2024 review by Visser and colleagues, which draws on systematic review evidence, concluded that corticosteroid injections are not effective for tendinopathy beyond the first few weeks. They are linked with worse long-term outcomes than other treatments, a higher chance that pain returns, and a risk of tendon rupture (Visser et al., 2024). This was a viewpoint article, and it covers tendons in general rather than the iliopsoas specifically, so it is a reason for caution, not a final answer.

Our advice is to think of an injection as temporary pain relief, not a cure. If you are considering one, talk with your doctor about the benefits and risks. An injection can also be a poor fit if you have diabetes, since it may raise blood sugar for a short time. Whatever you decide, the exercise plan above is still what builds long-term strength.

When to See a Doctor or Physiotherapist

Consider booking an assessment if you notice:

• front-of-hip pain that is not settling after a few weeks
• pain that limits walking, stairs, running, or sleep
• a snap that is getting more painful
• pain that keeps returning each time you go back to your activity

Get medical care promptly for hip pain with fever, sudden severe pain after a fall, the inability to put weight on your leg, or numbness or weakness in the leg.

Find Relief for Your Hip

You do not need to give up what you love. You need a plan that matches your tendon's capacity to what you ask of it. At Integra Health in Toronto, we offer physiotherapy assessments, manual therapy and soft tissue care to ease pain, and exercise rehab with progressive loading. We will find out what is driving your hip pain, calm it down, and build your strength step by step. Reach out to book an assessment whenever you are ready.

References

Visser, T. S. S., Linschoten, R. V., Vicenzino, B., Weir, A., & de Vos, R.-J. (2024). Terminating corticosteroid injection in tendinopathy? Hasta la vista, baby. Journal of Orthopaedic & Sports Physical Therapy, 54(1), 10-13.

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping hip syndrome: A comprehensive update. Orthopedic Reviews, 13(2). https://orthopedicreviews.openmedicalpublishing.org/article/25088-snapping-hip-syndrome-a-comprehensive-update

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