Physical and Occupational Therapy

Hip Labral Tear

Hip labral tears occur when the labrum, a band of cartilage surrounding the hip joint, is injured. Labral injuries can be the result of trauma, such as a fall or a car accident, but are most commonly caused by repetitive stress to the hip joint. Individuals who participate in sports such as hockey, soccer, or long-distance running—which require extremes of motion, repetitive twisting, or sharp movements like cutting—are most often diagnosed with labral tears. To treat the symptoms associated with a labral tear, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip.

What is a Hip Labral Tear?

A hip labral tear occurs when there is damage to the labrum (ring of cartilage) within the hip joint. The hip joint is where the thigh bone (femur) meets the pelvis (ilium). It is described as a ball-and-socket joint. This design allows the hip to move in several directions. The bony hip socket is surrounded by the labrum, which provides additional stability and shock absorption to the hip joint.

A labral tear results when a part of the labrum separates or pulls away from the socket. Most commonly, a labral tear is the result of repetitive stress (loading) irritating the hip, often due to long-distance running or performing repeated, sharp, sports movements, such as twisting and cutting.

Repetitive loading is more likely to result in injury to the labrum when there are bony abnormalities at the hip joint. For example, hip impingement is a condition resulting in hip pain due to abnormal bony contact between the ball and socket. As the hip moves into specific positions, this bony contact can place more significant stress on the labrum.

Hip labral tears may result from a combination of several different variables, including:

  • Bony abnormalities in the hip joint (hip impingement)
  • Hip muscle tightness
  • Hip muscle weakness
  • An unstable hip joint
  • Improper technique when performing repetitive activities
  • Participation in sports that require distance running, or repetitive twisting and cutting
  • Typical wear-and-tear over time

Once torn, the labral tissue in the hip cannot heal on its own. There are surgical procedures to remove or repair torn labral tissue; however, treatment for a labral tear often begins with a course of physical therapy.

Nonsurgical treatment efforts are focused on addressing symptoms by maximizing the strength and mobility of the hip to minimize the stress placed on the injured area. In some cases, patients can achieve a satisfactory level of activity without surgery.

Surgical interventions are available to clean out the hip joint, and repair or reconstruct the torn labral tissue. Following surgery, patients will complete several months of physical therapy to regain function of the hip.

How Does It Feel?

Many people have labral tears in the hip and do not experience symptoms; however, some labral tears can result in significant pain or limitations. Pain in the front of the hip or groin resulting from a hip labral tear can cause an individual to have limited ability to stand, walk, climb stairs, squat, or participate in recreational activities.

With a labral tear, you may experience:

  • A deep ache in the front of your hip or groin.
  • Painful clicking or “catching” with hip movements; the feeling of something unpleasant stuck in the hip or blocking hip motion.
  • Pain that increases with prolonged sitting or walking.
  • Sharp pain in the hip or groin when squatting.
  • Pain that comes on gradually rather than with one specific episode.
  • Weakness in the muscles surrounding the hip, or a feeling of the bone “giving way.”
  • Stiffness in the hip.

How Is It Diagnosed?

Your physical therapist will begin your evaluation by gathering information about your condition and medical history. Although a hip labral tear may be the result of a single injury, it most likely is a condition that develops as a consequence of repetitive irritation in the hip. Your physical therapist may ask you to describe:

  • Your current symptoms and how they affect your activities in a typical day
  • Any pain you are experiencing, its intensity and location, and how it may vary during the day
  • What actions you may be unable to do or have difficulty completing
  • What activities aggravate your symptoms, and how you reduce the level of your discomfort
  • Prior injury occurrences before your symptoms began
  • Other health care professional visits and any tests received

 

Your physical examination will focus on the region where your symptoms are occurring, but also include other areas that may have been affected as your body adjusted to the pain. Your physical therapist may watch you walk, step onto a stair, squat, or balance on one leg.

Your physical therapist will gently but skillfully palpate (touch) the front, side, and back of your hip to determine exactly where it is most painful. The therapist will assess the mobility and strength of your hip and other regions of the body to identify the areas that require treatment.

Following the interview and physical examination, your physical therapist will discuss the findings with you and, through mutual collaboration, develop an individualized treatment program to begin your recovery.

Your physical therapist also may refer you to an orthopedic physician who specializes in hip injuries for diagnostic imaging (i.e., X-ray, MRI). An X-ray helps to identify any bony abnormalities, such as those that occur with hip impingement, which may be contributing to your pain. An MRI helps to identify a labral tear.

How Can a Physical Therapist Help?

When you have been diagnosed with a hip labral tear, your physical therapist will work with you to develop a plan to help achieve your specific goals. To do so, your therapist will select treatment strategies in any or all of the following areas:

Education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, footwear, or the number of exercises you perform.

Pain management. Apply ice to the area and decrease or eliminate specific activities causing your symptoms. Your physical therapist will identify particular movements that aggravate the inside of your hip joint, and design an individualized treatment plan for you, beginning with a period of rest, and gradually adding a return to specific activities as appropriate. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medication, including opioids.

Manual therapy. Your physical therapist may apply hands-on treatments to gently move your muscles and joints to decrease your pain and improve motion and strength. These techniques often address areas that are difficult to treat on your own.

Movement reeducation. Your back and hip may be moving improperly, causing increased tension at the hip joint. Your physical therapist may teach you self-stretching techniques for the lower body to decrease pressure and help restore normal motion in the back, hip, and leg. There are, however, certain hip motions to avoid following an injury to the hip labrum. Your physical therapist will carefully prescribe exercises that improve your range of motion while protecting the area that has the labral tear.

Muscle strengthening. Muscle weaknesses or imbalances can be the cause or the result of hip pain. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises while lying down and advance to performing exercises in a standing position. Your physical therapist will choose what exercises are right for you.

Functional training. Once your pain, strength, and motion improve, you will be able to transition back into more demanding activities safely. To minimize tension on the hip, it is essential to teach your body safe, controlled movements. Based on your movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely. Your therapist also will discuss specific positions and movements that you should avoid or modify to protect your hip.

Can This Injury or Condition Be Prevented?

Repetitive motion, such as sports or long-distance running, can create the risk of sustaining a labral injury. It is imperative to be aware of any hip pain that you experience, particularly with sitting and squatting, as these are signs of a potential hip injury. Identifying and addressing these injuries early is helpful in their treatment. A physical therapist can help an active individual learn proper body movements to lessen the possibility of injury.

After recovering from a hip labral tear, it is important to continue the lower-extremity mobility and muscle strengthening practices taught to you by your physical therapist, to help reduce the risk of further irritation or injury. In some cases, complete avoidance of the activity that contributed to the symptoms may be recommended.

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