If a patient is experiencing SHS without painful stimuli then appropriate individually based exercises and stretching, is considered as one of the most appropriate management and preventive care.
There are few treatment options if pain is present along with SHS. What has to be considered before treatment is the length and severity of pain, and the site where the pain is present (outside of the hip vs. inside/groin pain). Usually amongst the first treatment options the conservative treatment options are most likely in many cases. Conservative options can include:
Medication management: Anti-inflammatory medication (oral medication) or Steroid injections (corticosteroid injection) into the painful area can be used to help with reducing any inflammation and to give pain relief.
Self management: Rest and Icing the area with a cold compress for 20 minutes a few times a day can be done as this may help to reduce any inflammation.
Physical therapy (Osteopathy or Physiotherapy): The aim of hands-on treatment is to identify if the problem is due to tight muscles or muscles which are overworking (disproportionate activation) and causing heightened tension in the muscle. In addition, posture and some anomalies (such as leg length discrepancy), and repetitive movement has to be considered also in restoring the muscular balance in hip joints. The therapist will focus on helping to stretch the short or tight muscles and improve/strengthen the underworking or weak muscle structures.
In cases where conservative treatment has not helped then surgical intervention may be appropriate. Surgery is considered as a last resort intervention in SHS.
Surgical procedures are divided into two categories relating to External/Internal snapping and type of intervention Arthroscopic vs. Open surgery.
- External snapping is predominantly focusing on releasing the Iliotibial band where both open or arthroscopic surgery is an acceptable procedure.
- Internal snapping also focuses on releasing the Iliopsoas tendon, but arthroscopic surgery is a more preferred option to prevent complications from open surgery.
As with every surgical procedure there are certain risks and negative effects, and most common in SHS may be exaggerated release in affected tendons by surgery which may lead to muscle weakness. Therefore, it is always advisable to discuss risks and benefits with a surgical consultant, the consideration needs to be emphasised on what are the patient’s expectations and if they meet with the surgeon’s expectations and outcomes from surgery.