What is the best course of treatment for a 15-year-old female patient with hip popping when walking, who is actively participating in cheerleading?

Hip Popping in a 15-Year-Old Cheerleader

This patient should undergo a focused clinical evaluation for snapping hip syndrome, with initial conservative management consisting of hip flexor stretching and activity modification, while ensuring she has access to proper coaching supervision and appropriate training surfaces to prevent more serious cheerleading-related injuries.

Initial Clinical Assessment

The hip popping requires evaluation to distinguish between:

• External snapping hip: Iliotibial band snapping over the greater trochanter (most common)
• Internal snapping hip: Iliopsoas tendon snapping over the iliopectineal eminence (less common but well-documented in athletes) 1

Key examination findings to assess include:

• Reproducible audible or palpable snap with hip flexion/extension and rotation
• Location of snapping (lateral hip vs. anterior/groin)
• Associated pain or limitation of motion
• Hip flexor tightness, particularly of the iliopsoas 1

Conservative Treatment Approach

Primary treatment should focus on a structured stretching program targeting the hip flexors, as this has demonstrated effectiveness in resolving symptoms within 4 weeks with sustained improvement at 6 months 1. The treatment protocol should include:

• Daily hip flexor stretching exercises
• Activity modification during symptomatic periods
• Gradual return to full cheerleading activities as symptoms resolve 1

Critical Safety Considerations for Continued Cheerleading Participation

Given that this patient is actively participating in cheerleading, several safety measures must be addressed according to American Academy of Pediatrics guidelines:

Pre-participation Requirements

• She should undergo a pre-participation physical examination before continuing cheerleading activities 2
• Access to appropriate strength and conditioning programs, with emphasis on core and upper body strength 2

Coaching and Supervision

• Verify that her coach has proper certification and training in spotting techniques and safety measures, as cheerleaders supervised by highly qualified coaches have nearly 50% reduction in injury risk 2
• Ensure qualified spotters are present during all stunts 2

Training Surface Safety

This is particularly critical given the injury mechanism data:

• All technical skills (pyramids, mounts, tosses, tumbling) must be performed on appropriate surfaces - never on concrete, asphalt, dirt, or vinyl floors 2
• Pyramids and partner stunts should only occur on spring floors or landing mats on foam floors/grass/turf 2
• Wood gym floors have a critical height of only 4.5 feet, while spring floors and landing mats on foam have critical heights of 10.5-11 feet 2

Age-Specific Injury Risk Context

At 15 years old, this patient falls into the highest-risk category for cheerleading injuries:

• High school cheerleaders (ages 12-17) have an injury rate of 0.9 per 1000 athletic exposures, with 8.1 injuries per 1000 participants per year 2, 3
• Lower extremity injuries are most common in this age group (30-37% of all injuries), followed by upper extremity (21-26%) 2
• Strains and sprains account for 52-53% of injuries in adolescent cheerleaders 2, 4, 3

Common Pitfalls to Avoid

• Do not allow return to full stunting activities until the hip popping is asymptomatic, as repetitive stress on an inflamed iliopsoas tendon can lead to chronic dysfunction 1
• Ensure athletic trainer access: Whenever possible, a certified athletic trainer should be present at practices and competitions 2
• Monitor for progression: If conservative management fails after 4-6 weeks or if pain worsens, consider imaging and referral to sports medicine or orthopedics 1

Activity Modification During Treatment

While undergoing stretching therapy:

• She may continue cheerleading activities that do not reproduce symptoms
• Avoid repetitive hip flexion movements that trigger the snapping
• Gradually progress back to full participation as symptoms resolve 1
• Maintain conditioning for other muscle groups to prevent deconditioning

The combination of addressing the immediate hip issue while ensuring proper safety infrastructure for her cheerleading participation addresses both her acute symptom and long-term injury prevention needs 2.