The Athletic Hip Series: Labral Tears
Post by Maggie Gebhardt, PT, DPT, OCS
For all of you clinicians out there who participated in our journal club in June you were able to hear from one of Atlanta’s preeminent hip surgeons, Dr. Cliff Willimon. He addressed the assessment and treatment of hip pathologies primarily related to labral tears. So, it is only natural that I follow my last blog on hip impingement with a discussion on hip labral tears.
For the layperson out there, you may be asking, “What is a labral tear and could I have this tear?”
Well, the labrum of your hip is a cartilaginous ring that runs around the perimeter of your hip socket. This allows the ball to sit deeper in the joint which provides more stability for the joint. The labrum has been a source of pain in the hip for many, many years. Recently, it has come under much more focus as the culprit in many patient’s undiagnosed chronic hip pain.
Labrums can be torn in many different places, but the most common is on the underside of the hip joint. Due to its location, many people will complain of groin pain. However, this is not always the case and can have a variety of symptoms mostly around the hip area. Commonly a patient’s hip feels unstable and clicks or pops. They will also feel more limited in their hip range with stiffness in certain motions. The labrum can be torn or irritated due to trauma or just abnormal mechanics causing rubbing of the head of the femur on the rim of the joint. While some tears require surgery, most labral tears have a good prognosis with rehabilitation.
In treatment, I usually tell patients I cannot change the fact they have a tear- only surgery can do that. Instead I work on changing the mechanics of your hip and leg to normalize function and prevent any further aggravation. As long as we can maintain ideal hip mechanics the tear should not be a constant source of pain. However, if you turn the wrong way or do a sudden movement that hits the tear- you will feel it. It is possible to return to your level of activity (running included,) as long as you commit to your maintenance program to keep the hip’s integrity. A labral tear is not a death sentence!
If you have had surgery, often there is a plan of rehabilitation before and after your surgery. Depending on the severity of the surgery, you may be looking at a certain length of time in a brace and/or on crutches. Rehabilitation before surgery is important for overall treatment for two reasons. One, we may be able to eliminate the possibility of surgery through correcting the mechanics of the hip. Second, the goal would be to get you as strong as possible prior to surgery to raise the chance of success in rehabilitation. According to Dr. Willimon, a delay in deciding to do surgery in an attempt to rehab first does not negatively affect the surgical outcomes. Usually it is preferred to start therapy prior to surgery.
Labral tears are hard to diagnose for therapists and physicians alike. It can often be frustrating to get an accurate diagnosis. Often a diagnosis will require imaging to be certain. If this sounds like something you may be experiencing it is important to find a physician and therapist who specialize in treating this specific hip pathology.