The Pelvic Girdle and Hip Joint 233band and strengthening the hip abductors. Anti-
inflammatory medication is sometimes prescribed. In
the author’s experience, the snapping often occurs
when the dancer excessively shifts the pelvis later-
ally relative to the support leg and fails to maintain
turnout on the support leg. Hence, strengthening
the deep outward rotators, hip abductors, and hip
adductors and applying use of these muscles to
maintain full turnout with the pelvis appropriately
positioned over the support foot will often be helpful
for successful reduction of snapping and pain.
Trochanteric Bursitis
Sometimes independently or in association with
external snapping hip, the bursa that lies over
the greater trochanter and beneath the iliotibial
band—the trochanteric bursa—becomes inflamed.
When this bursa becomes inflamed and swollen it
is readily further irritated by compression or move-
ment of the overlying iliotibial band as seen in figure
4.42. Occasionally, calcium is deposited within the
inflamed bursa. In dance, the mechanism of injury
is theorized to be overuse from factors such as unbal-
anced pressures from dancing on a raked stage or
alignment problems such as scoliosis, pelvic rota-
tions, leg length differences, or excessive foot pro-
nation on one side that cause weight to be unevenly
borne by the legs. Tightness of the iliotibial band, a
wide pelvis, inadequate hip abductor strength, and
technique errors such as “sitting in the hip” may also
increase injury risk (Desiderio, 1988; Lieberman and
Harwin, 1997).
Pain is generally present along the side of the
hip, and palpation over the greater trochanter usu-
ally reveals localized tenderness and in some cases
crepitus. Pain can often be reproduced if the dancer
lies on the affected side or if the leg is passively or
actively adducted across the midline of the body
(Teitz, 2000). As with the external snapping hip,
this pain is often exacerbated by rond de jambe or
in landing on one leg from a leap or jump.
Treatment may include anti-inflammatory medica-
tion, heat application prior to class and ice after class,
stretching of the iliotibial band, strengthening of
the hip abductors, and working on dance technique
to avoid excessive lateral tilt (Trendelenburg sign)
or lateral shift of the pelvis. In some cases, aspira-
tion of the fluid from the bursa and corticosteroid
injection may be medically prescribed (Sammarco,
1987). If such conservative measures fail, recent
research suggests that the gluteus medius tendon
may be torn (Kagan II, 1999); this tear is similar to
rotator cuff tears seen at the shoulder and discussed
in chapter 7.Piriformis Syndrome
Pain in the buttocks with or without pain radiating
down the back of the ipsilateral thigh may be due
to the piriformis syndrome. Spasm of the piriformis
muscle, one of the DOR of the hip, can compressFIGURE 4.42 Trochanteric bursitis includes inflamma-
tion of the bursa located superficial to the greater
trochanter and deep to the iliotibial band (right hip,
anterior view).FIGURE 4.41 Snapping hip (right hip, lateral view). The
iliotibial band snaps (A) forward with hip flexion and (B)
backward when the hip extends.