Rowing Injury Prevention Series: Snapping Hip Syndrome

This article is Part 4 of the Rowing Injury Prevention Series. This series of articles will take us right up to February 14th when the three of us will be featured on “RowingChat” right here on Rowperfect. These resources are presented to help you learn the specifics of strength training for rowing to improve performance and enjoy a healthier career. We hope that these will help you avoid making the same mistakes we have, and prevent you from having to re-invent the wheel. In the meantime, you can find the previous articles below:

Blake Gourley: General Tips for Injury Prevention

Will Ruth: Rib Stress Fractures

Joe Deleo: Low Back Pain, Part 1


Snapping Hip Syndrome (SHS) is another common injury in rowing. The most noticeable characteristic of SHS is a palpable or audible “snapping” sensation around the hip joint that may be painful or not painful. This is a common injury in rowing due to the seated and bilateral nature of the sport, resulting in chronically tight hip flexors that can lead to SHS. Prevention revolves around care of the hip flexors and muscles involved at the pelvis as well as strengthening of the antagonist groups to prevent chronic hip flexor tightness and move through a full range of motion.

There are two types of SHS, Internal and External. Anecdotally, External SHS is more common with rowers than Internal SHS. The snapping sensation in external SHS is felt on the outside of the thigh around the head of the femur, and is associated with the IT band tendon or gluteus maximus tendon. Internal SHS is felt more toward the groin and is associated with the iliopsoas tendon. Both forms of SHS are uncomfortable, often painful, and are usually a chronic injury, not a traumatic injury. [2]

I personally dealt with external SHS as a rower after a particularly vigorous early winter season of training. I have since learned a lot about the mechanism of injury and the anatomical causes, but the real problem was adding too much training volume too quickly. In Part 1, Blake mentioned the 10% rule for increasing training volume. I ramped up volume quickly on my own, adding sessions of lifting and erging to my coach’s team program without her advice or input, and suffered the consequences. This is lesson #1: always consult with your coach before adding extra work on your own.

The Cause

Most rowers have chronically tight hips. For players of other sports, practicing their sport is an opportunity to break from the daily lifestyle of sitting in the car, sitting in a desk at school, sitting at work, and sitting at home watching TV. For rowers, practicing your sport just means more sitting.

In addition to the seated element, rowing also emphasizes the muscles of the quadriceps and minimizes involvement of the gluteal muscles. The main muscle of the quadriceps, the rectus femoris, is also a primary hip flexor, while the glute muscles are the antagonist, or opposite-acting, hip extensor muscles. Furthermore, other hip flexors like the psoas, iliacus, and tensor fascia lata (TFL) are constantly engaged when rowing and erging to maintain upright posture, stay balanced in the boat, and maintain body angle on the recovery. It’s easy to see how rowers can develop chronically tight hip flexors that lead to this condition.

To prevent SHS, we focus on increasing hip flexor flexibility to alleviate the wrenching effect on the tendons, then strengthening the glute muscles relative to the quadriceps to restore postural balance and prevent the hips from getting so tight in the first place.

Diagnosing Tight Hips

First, if you feel the symptoms of SHS, you should consult a doctor or physical therapist rather than trying to self-diagnose. Most athletes wait until they feel pain associated with the snapping, but because this is a slow-developing injury, it’s vital to catch it early on.

If you don’t have SHS symptoms, you can use the Thomas Test to quickly figure out if you have tight hip flexors so you can take action to prevent this injury.

Preventing Snapping Hip Syndrome

The prevention plan for SHS revolves around stretching and manual therapy for the hip flexors and quadriceps in addition to strength training for the glute muscles and unilateral exercise to work the muscles of the hip and legs through a complete range of motion.

  1. Warming Up

A proper warmup is also critical to preventing most muscular injuries. The Comprehensive Lower Body Warmup that my rowing team does includes exercises to stretch the hip flexors, activate the glutes, and move through a complete range of motion before getting into a seated position in the boat. Warming up is good for injury prevention as well as for rowing performance, as warm and pliable muscles perform better than cold and tight muscles.

  1. Stretching and Self-Massage Therapy

Focus on hip flexors, quadriceps, and groin muscles. I recommend at least 10 minutes a day, and even better if you can do two separate bouts of 10 minutes. Consider all the time you spend sitting and using these muscles and the amount of time and consistency it will take to offset that. A warmup with some specific hip flexor stretches in the morning before training and then an evening 10 minute bout of focused hip flexor rolling and stretching is a great way to fit it in.

  1. Strength Training

In the weight-room, the focus of developing the muscles of the hip and lower body through compound exercises like the squat and deadlift will remain the same as when we’re training for performance. The squat, front squat, and deadlift or Romanian deadlift are important exercises because they develop the quadriceps, glutes, hamstrings, and finer muscles of the pelvis in coordinated activity, not in isolation like leg extensions and leg curls. This is more beneficial for muscular growth as well as carryover to athletic activity.

However, some isolation exercises will be useful for fixing specific muscular imbalances. While these are included in the warm-up routine, more exercises for the hip abductors and external rotators such as clamshells and x-band walks could be added in to further develop the glute muscles and increase their strength relative to the quadriceps muscles. [1,4]

One assistance work exercise that every rower should be doing is a single leg squat exercise. I use the rear-foot-elevated split squat most with my team, but a reverse lunge would also be fine. Both of these exercises can be weighted once bodyweight is no longer challenging. Unilateral exercises are great for rowers for a few reasons. One is that they force development of opposite sides evenly. Sweep rowers often have strength imbalances between outside leg and inside leg and, if they aren’t very attentive to technique, can often shift balance to the stronger outside leg when doing a bilateral exercise. Another is that single leg exercises stretch the back leg (the one not doing the work) through each repetition for the front leg. This accomplishes two goals at once, as the front leg is getting stronger while the back leg is getting a good stretch for the hip flexors on every rep. Both the strengthening and the stretching effect of this exercise is great for preventing SHS [1-4].

Click here for a playlist of all exercises in this article

Tight hips aren’t just bad for SHS, they’re bad for rowing technique. Everyone focuses on hamstring flexibility for more reach, but I have found that hip flexor tightness is more often a limiting factor for reach. If the hip flexors are so tight that the pelvis is pulled into anterior tilt, the athlete will often be unable to maintain an upright posture, forcing them to round their back to reach rather than maintaining a braced torso. Clear up hip flexor tightness to allow the athlete to sit upright and engage their core, and reach problems often disappear.

In the short run, SHS caused me to take about three weeks off of training to ice, massage, stretch, and reduce the inflammation before I could start building again. Long-term, it took me almost a year before I didn’t have any symptoms after running or lifting. Any practice or water time missed is frustrating, but this injury in particular can cause a lot of missed time and frustrating sessions. The hip flexors are a vitally important muscle group for rowing, but because rowing is unique as a seated sport, there is a lack of sport specific injury prevention information out there.

We’re trying to fix that! For more discussion of strength training for rowing performance and injury prevention, check out my website at www.strengthcoachwill.com/rowing and stay tuned for the final installment on Friday of the Rowperfect Rowing Injury Prevention Series. Make sure to get your tickets at the link below for the Strength Coach Roundtable on February 14th as I come to Rowing Chat with fellow rowing strength coaches Blake Gourley and Joe Deleo for an hour-long conversation about strength training for rowing.

Join the 90+ others signed up for the Strength Coach Roundtable

References:

[1] Cheatham, S., Cain, M., Ernst, M. “Snapping hip syndrome: a review for the strength and conditioning professional,” Strength and Conditioning Journal 37(5), October 2015.

[2] Garry, J. “Snapping hip syndrome,” Medscape.com, November 2014.

[3] Hannafin, J. “Common rowing injuries,” Worldrowing.com, 2011

[4] Jacobsen, J., Thorborg, K., Soballe, K., Ulrich-Vinther, M. “Eccentric hip abductor weakness in patients with symptomatic external snapping hip,” Scandinavian Journal of Medicine and Science in Sports, July 2012.

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