I have had a string of patients with hip labral tears recently. The one that I was thinking about is in her mid 50s and is a workout fiend. She came to therapy looking for some hip labral tear exercises. My patient walks 5 miles a day in less than an hour everyday. Or at least she used to walk 5 miles a day. She stopped when she began getting groin pain. She gave her hip several weeks of rest but the pain would return whenever she began walking again. She had walked herself into a labral tear. Read on to learn about this condition. Let’s start with anatomy!
Let’s talk about the hip joint
Before getting into labral tears, it is important to know the basics about the hip joint. The hip is a ball and socket joint. The ball is the head of the femur (thigh bone) and the socket is the acetabulum. The acetabulum is the area where the three parts of the pelvis come together. These three parts are the pubis, ilium, and ischium.
The femoral head and acetabulum form a ball and socket joint. This type of joint allows motion in all planes. These motions include inward and outward rotation, moving the leg in front of and behind the body, and away from and in towards the body. The hip joint supports the weight of the body. It supports loads 6 to 8 times body weight during normal walking or jogging. It also facilitates force and load transmission from the upper part of the body to the lower part of the body.
Okay, now let’s talk about the labrum
The labrum is a fibrocartilaginous ring which covers the surface of the acetabulum. It aids in keeping the femoral head in the acetabulum. It also has several other functions. These include:
- Improving joint stability
- Lubricating the joint
- Distributing pressure along the joint
- Shock absorber
- Decreasing stress between the femur and the acetabular surfaces
The blood supply is mostly on the periphery of the labrum. The majority of the labrum is avascular which means that it does not have a blood supply and will not heal if injured or torn.
There are different classifications of labral tears.
- Anterior labral tears
- This is a tear in the front of the hip joint.
- Pain will be in the front of the hip and/or at the groin.
- This type of tear occurs more frequently in Europe and the United States.
- This type of tear will cause pain with the action of bringing the knee to the opposite shoulder. That movement is a combination of flexion (marching action), adduction (moving the leg in towards the body), and internal rotation (rotating the knee and hip inward).
- Posterior labral tears
- This tear is toward the outside or back of the hip joint.
- Pain will be on the outside of the hip and/or deep in the buttocks.
- This type of tear occurs more commonly in Japan but is less common in the United States and Europe.
- This type of tear will cause pain with extension (moving the leg behind the body), abduction (moving the leg away from the body), and external rotation (rotating the hip and knee outward).
How does the labrum get torn?
A hip labral tear occurs when the labrum is torn, frayed , or damaged. It is most commonly caused by repetitive stress and loading at the hip joint. However direct trauma like a motor vehicle accident or a fall could also cause a labral tear.
Risk factors
A labral tear can happen to anyone at any age. However, there are several risk factors for a hip labral tear. They are divided into 2 categories.
- External
- Long distance running
- Sports or activities that require frequent external rotations or hyperextension – e.g. ballet, figure skating, yoga, soccer, hockey, sprinting
- Hip muscle tightness
- Hip muscle weakness
- Improper technique
- Internal
- Hypermobility at the hip joint (also known as double jointed)
- Acetabular dysplasia – This is a condition where the acetabulum is immature and shallow.
- Degeneration of the hip joint
- Femeroacetabular impingement – This condition occurs when the femoral head pinches up against the acetabulum. This can cause damage to the labrum and arthritis.
What are the symptoms of a hip labral tear?
There are many symptoms associated with a hip labral tear. These include:
- Pain at the groin, front of the hip, or buttocks
- Pain worsens with movement
- Pain with prolonged walking, sitting, and standing
- Clicking, locking, or catching of the hip
- Limping
Do I need surgery if I have a labral tear?
The answer to this question is maybe. Many people can recover with physical therapy. In fact, there are many people out there with hip labral tears that are completely asymptomatic. The labrum is not going to heal itself but the pain and symptoms can often be managed with conservative treatments such as physical therapy and medication. If conservative methods do not work in controlling the pain and symptoms, then surgery would be the next step.
Who do I see if I suspect a labral tear?
- Physical therapist – Conservative, or non surgical, treatment is tried first for hip labral tears. A physical therapist can help decrease the pain and inflammation while working on strengthening the muscles in and around the hip. Your PT can help slowly return normal motion to the hip and restore normal walking with minimal to no pain. Depending on the severity of the tear or the episode of inflammation, your activities might need to be altered to prevent further degeneration of the hip and labrum. For instance, my patient who walks 5 miles a day is going to need to switch to an activity that is far less stressful on the hip. This could include swimming or maybe using an elliptical.
- Orthopedist – A hip specialist would be needed especially if the person is not responding to physical therapy. Anti-inflammatory medication or a corticosteroid injection might be useful in calming down the pain and inflammation. Imaging is helpful in diagnosing the tear and abnormalities in the hip joint. Consulting about surgical options would be the next step if all conservative measures fail.
What can I do?
- Relative rest – Resting the area will decrease further pain and damage from occurring and allow the inflammation to decrease. Swimming or water walking/running are good alternate activities that would decrease the load and stress to the hip joint. Once the pain has decreased and you begin to return to your previous activities, it would be wise to incorporate more activities that are less stressful on the hip joint. So for my patient who likes to walk 5 miles a day, she could decrease this to walking 2 times per week but include swimming, pilates, or elliptical on the other days.
- Ice – Ice can help decrease the pain and inflammation at the hip. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or there is still swelling present. Ice immediately after activity.
- Strengthening – It is important to really strengthen the muscles in and around the hip. These muscles can support the hip joint and decrease the amount of stress on the joint. These include hamstrings, gluteals, quadriceps, abdominals, and back extensors. Using loop resistance bands can help increase difficulty and strength. See the videos below.
In review
- The hip is a ball and socket joint. The ball is the head of the femur (thigh bone) and the socket is the acetabulum.
- The labrum is a fibrocartilaginous ring which covers the surface of the acetabulum.
- A hip labral tear occurs when the labrum is torn, frayed, or damaged.
- There are 2 types of hip labral tears.
- Anterior – more common in US and Europe
- Posterior – more common in Japan
- Most labral tears are from repetitive stress and loading on the joint.
- Many labral tears are asymptomatic.
- There are many symptoms associated with labral tears including pain at the hip and/or groin.
- Conservative measures, including PT and medication, can often successfully manage the symptoms.
- Surgery is an option if conservative measures fail.
- There are things that you can do.
- Relative rest
- Ice
- Strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Overview_of_hip_labral_tears?lang=en
https://www.orthobullets.com/knee-and-sports/3097/hip-labral-tear
https://www.choosept.com/guide/physical-therapy-guide-hip-labral-tears