Progressive Resistance Training for Adults With External Snapping Hip (Snappy Hip)

Snappy Hip Trial: A Randomized Crossover Trial Comparing the Clinical and Cost-effectiveness of Progressive Resistance Training Compared to Usual Care on Pain for Adults With External Snapping Hip

External snapping hip is characterised by an audible and painful snap during hip movement among physical active people around 15-40 years old. Progressive resistance training has been suggested as a new potential treatment path in treating patients with external snapping hip. The investigators conducted a feasibility study and found that patients reported less pain and improved their physical function, quality of life and muscle strength after 12 weeks of progressive resistance training. The overall aim of the project is to compare hip pain in patients with external snapping hip treated with progressive resistance training to a wait-and-see approach, in a randomised controlled trial. This study has the potential to establish a new and specific treatment option for patients with external snapping hip, to be used nationally and internationally.

Study Overview

• Status: Recruiting
• Conditions: Coxa Saltans External; External Snapping Hip
• Intervention / Treatment: Other: Progressive resistance training; Behavioral: Waiting time; Behavioral: Self guided exercise

Detailed Description

This trial is an international multicentre randomised controlled assessor-blinded crossover trial, following the CONSORT guidelines. The intervention is a 12-week progressive resistance training programme, and the trial is designed with three follow-up time points. After the baseline test, the patients will be randomised in a 1:1 ratio to either the intervention or the control group using the Research Electronic Data Capture (REDCap) source hosted at Aarhus University. For both groups, the first test will be the baseline test, conducted before the randomisation. The second test will be conducted 6 weeks after randomisation, the third test will be conducted 12 weeks after randomisation and the fourth and last test will be conducted 24 weeks after randomisation. The primary outcome will be the change from baseline to the third follow-up, and the trial will be powered based on this period. The lasting effect of the intervention will be evaluated from baseline to the fourth follow-up test for the intervention group.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Lisa U Tønning, MHSc; Phone Number: +4526474080; Email: lisatoenning@clin.au.dk
• Study Contact Backup: Name: Inger Mechlenburg, DMSc; Phone Number: 4521679062; Email: lisatoenning@clin.au.dk

Study Locations

• Denmark
  • Aalborg, Denmark, 9000
    • Not yet recruiting
    • Aalborg Universitetshospital
    • Contact: Jens Kristinsson; Phone Number: 004597660000; Email: hjk@rn.dk
  • Aarhus N, Denmark, 8200
    • Recruiting
    • Aarhus University Hospital
    • Contact: Inger Mechlenburg, DMSc; Phone Number: +4521679062; Email: inger.mechlenburg@clin.au.dk
    • Contact: Lisa U Tønning, PhD; Phone Number: +4526474080; Email: lisatoenning@clin.au.dk
    • Principal Investigator: Lisa U Tønning, MHSc
  • Copenhagen, Denmark, 2400
    • Not yet recruiting
    • Bispebjerg og Frederiksberg Hospital
    • Contact: Søren Overgaard; Phone Number: 004538635000; Email: soeren.overgaard@regionh.dk
  • Copenhagen, Denmark, 2100
    • Not yet recruiting
    • Rigshospitalet
    • Contact: Peter Horstmann; Phone Number: 004535453545; Email: peter.frederik.horstmann.02@regionh.dk
  • Herning, Denmark, 7400
    • Not yet recruiting
    • Regionshospitalet Gødstrup
    • Contact: Christina F Frandsen; Phone Number: 004578430000; Email: chrifroe@rm.dk
  • Hillerød, Denmark, 3400
    • Not yet recruiting
    • Nordsjællands Hospital - Hillerød
    • Contact: Samir Sarvan; Phone Number: 004548294829; Email: samir.sarvan@regionh.dk
  • Horsens, Denmark, 8700
    • Recruiting
    • Regionshospitalet Horsens
    • Contact: Jeppe Lange, PhD; Phone Number: 004578425000; Email: jeppe.lange@clin.au.dk
  • Hvidovre, Denmark, 2650
    • Not yet recruiting
    • Hvidovre Hospital
    • Contact: Per Hölmich; Phone Number: 0045 38623862; Email: per.hoelmich@regionh.dk
  • Køge, Denmark, 4600
    • Not yet recruiting
    • Sjællands Universitetshospital - Køge
    • Contact: Eva Wetke; Phone Number: 004556631500; Email: ewe@regionsjaelland.dk
  • Næstved, Denmark, 4700
    • Not yet recruiting
    • Næstved, Slagelse og Ringsted Hospital
    • Contact: Henrik Vilsner; Phone Number: 004556512000; Email: hvl@regionsjaelland.dk
  • Odense, Denmark, 5000
    • Not yet recruiting
    • Odense Universitetshospital
    • Contact: Louise D Petersen; Phone Number: 004566113333; Email: louise.dyhring.petersen@rsyd.dk
  • Randers, Denmark, 8930
    • Not yet recruiting
    • Regionshospitalet Randers
    • Contact: Daniel Wæver; Phone Number: 004578420000; Email: DANWAE@rm.dk
  • Vejle, Denmark, 7100
    • Not yet recruiting
    • Sygehus Lillebælt - Vejle
    • Contact: Henriette Holm; Phone Number: 004579405000; Email: Henriette.Bruhn.Appel.Holm@rsyd.dk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion criteria:

• Age 18-40 years (10)
• Experienced lateral hip joint "snapping" with pain discomfort within the last 14 days
• Able to demonstrate the audible and/or visible lateral "snapping" during lateral hip joint movementor popping sound when the hip joint moves
• Capable of commuting to the training facility
• Proficient in reading and understanding Danish or English

Exclusion criteria:

• Previous surgery on the affected hip
• Planned surgery on lower extremities within the trial period
• Anterior or medial hip discomfort that substantially exceeds the lateral hip discomfort
• Any contraindication to exercise
• Neurological, rheumatoid, or mental conditions affecting the hip function
• Ongoing active cancer treatment
• Planned vacation for more than 14 days within the intervention period
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control group: Wait and see approach; The control group are randomized to 12 weeks of waiting time followed by 12 weeks of progressive resistance training.	Other: Progressive resistance training; The progressive resistance program consist of a five-minute aerobic warm-up on either an ergometer bike, treadmill or rowing machine followed by six resistance training exercises: landmine twist, walking lunges, leg press, hip abduction, hip adduction and hip flexion. All training sessions (three per week) will be supervised for the first two weeks. After that, there will be one weekly supervised training session and two self-directed sessions. The subjects will be scheduled for 36 training sessions over 12 weeks, of which 16 will be supervised. Each training session is designed based on the findings from the feasibility study and is expected to last approximately one hour. If a subject cannot perform all scheduled sessions in a week, additional sessions will be planned for the following week to obtain the 16 supervised sessions.; Other Names: Exercise therapy; Behavioral: Waiting time; 12 weeks of waiting time; Other Names: Waitlist; Wait
Experimental: Intervention group: progressive resistance training; The intervention group are randomized to 12 weeks of progressive resistance training followed by 12 weeks of self guided exercise	Other: Progressive resistance training; The progressive resistance program consist of a five-minute aerobic warm-up on either an ergometer bike, treadmill or rowing machine followed by six resistance training exercises: landmine twist, walking lunges, leg press, hip abduction, hip adduction and hip flexion. All training sessions (three per week) will be supervised for the first two weeks. After that, there will be one weekly supervised training session and two self-directed sessions. The subjects will be scheduled for 36 training sessions over 12 weeks, of which 16 will be supervised. Each training session is designed based on the findings from the feasibility study and is expected to last approximately one hour. If a subject cannot perform all scheduled sessions in a week, additional sessions will be planned for the following week to obtain the 16 supervised sessions.; Other Names: Exercise therapy; Behavioral: Self guided exercise; 12 weeks of self guided exercise; Other Names: Wait; Self training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
HAGOS Pain	The HAGOS is a patient-reported questionnaire consisting of six different subscales. The pain subscale consists of 10 questions, which are all answered using standardised answer options following a 0-4-point Likert Scale. The scores are transformed into a subscale score ranging from 0 (worst) to 100 (best). A minimal clinically relevant difference of the HAGOS pain subscale has been reported to be 9.7 points among a group of patients undergoing hip arthroscopy for femoroacetabular impingement.	Baseline, week 6, week 12 and week 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
UCLA-AS	The patient-reported questionnaire: the University of California Los Angeles Activity Scale. There is only one question with 10 answers, ranging from 1 (worst) to 10 (best).	Baseline, week 12 and week 24
GPE	The patient-reported questionnaire: the Global Perceived Effect, where the participant answers four questions about the effect of the treatment received. Each question has 7 possible answers, ranging from 1 (best) to 7 (worst).	Baseline, week 12 and week 24
Single leg hop test	The objective measures include the single-leg hop for a distance test to test hip function. The hop distance is measured in cm.	Baseline, week 12 and week 24
30 second unilateral sit-to-stand test	The unilateral 30 second Sit to Stand test (unilateral 30STS) is a clinical test of lower extremity function. The unilateral 30STS tests how many correct repetitions of a sit to stand from a chair, a participant can complete in 30 seconds.	Baseline, week 12 and week 24
Number of training sessions the participant participated in	Adherence to the exercise protocol will be evaluated based on information from the physiotherapists and a self-reported training diary. Good adherence will be defined as participation in more than ≥70% of all training sessions (both supervised and self-training).	Throughout the study, summed in week 24
Adverse events	The physiotherapist will record any adverse events occurring during the study period.	Throughout the study, summed in week 24
HAGOS	The remaining five subscales of HAGOS: symptoms, function in daily living (ADL), function in sport and recreation (Sports/Rec), participation in physical activities (PA) and hip and/or groin-related quality of life (QOL). The scores are transformed into a subscale score ranging from 0 (worst) to 100 (best).	Baseline, week 6, week 12 and week 24

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
EQ-5D-5L	The patient-reported questionnaire: the European Quality of life 5 Dimensions with 5 Levels (EQ-5D-5L) where the participant answers six questions in relation to health-related quality of life	Baseline, week 12 and week 24
iPCQ	The patient-reported questionnaire: the Productivity Costs Questionnaire, where information on productivity is collected .	Baseline, week 12 and week 24
HUQ	Health Utilisation Questionnaire (HUQ) where information on healthcare and medicine is collected.	Baseline, week 12 and week 24
Usage of analgesics due to hip-related pain	The participants will be asked if they take any analgesics due to hip-related pain. If yes, they will be further asked what type of medicine (Paracetamol/NSAID/Morfin/Other) and how often (Never/Monthly/Weekly/Daily).	Baseline, week 12 and week 24

Collaborators and Investigators

• Sponsor: Aarhus University Hospital
• Collaborators: University of Aarhus
• Investigators: Study Director: Stig S Jakobsen, PhD, Department of Orthopedic Surgery, Aarhus University Hospital, DK; Principal Investigator: Lisa U Tønning, MHSc, Department of Orthopedic Surgery, Aarhus University Hospital, DK; Study Director: Inger Mechlenburg, DMSc, Department of Clinical Medicine, Aarhus University, DK; Study Director: Ulrik Dalgas, PhD, Department of Public Health, Sports, Aarhus University, DK; Study Director: Troels Kjeldsen, PhD, Department of Orthopedic Surgery, Aarhus University Hospital, DK; Study Director: Cara Lewis, PhD, Department of Physical Therapy, Boston University, Boston, US; Study Director: Martin Lamm, MSc, Department of Orthopedic Surgery, Aarhus University Hospital, DK; Study Director: Joanne L Kemp, PhD, La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2025
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: March 28, 2025
• First Submitted That Met QC Criteria: April 4, 2025
• First Posted (Actual): April 11, 2025

Study Record Updates

• Last Update Posted (Actual): July 10, 2025
• Last Update Submitted That Met QC Criteria: July 4, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Keywords: Exercise; Progressive resistance training; External snapping hip; Coxa saltans external
• Additional Relevant MeSH Terms: Wounds and Injuries; Leg Injuries; Knee Injuries; Cumulative Trauma Disorders; Sprains and Strains; Iliotibial Band Syndrome
• Other Study ID Numbers: Snappy Hip Tirial; 4308-00012B (Other Grant/Funding Number: Independent Research Fund Denmark)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Anonymized patient-level data will be made available if required by the scientific journal, in which the results of the trial are published. Additionally, researchers presenting a justified cause for receiving the data can obtain it after a data access agreement has been signed.
• IPD Sharing Time Frame: Data will be available after publication of the trial upon reasonably request.
• IPD Sharing Access Criteria: Applications for data access will be reviewed by the author group. The applicant will be required to sign a data access agreement.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No