Hip Labral Tears Cause Pain in Athletes and Young Adults.  New York Yankees A-Rod, New York Jets Quarterback, Mark Sanchez and Canadian tennis superstar Milos Raonic all know too well the impact that hip injuries can have on their body.  In young athletes hip labral tears are estimated to cause 22% of pain felt in the groin and hip areas.

The labrum is a piece of tough gristle like cartilage that runs along the rim of the hip socket. It can get torn through injury such as a heavy fall when skiing or twisting injury when playing soccer or football.  It can also undergo  wear and tear from repetitive movements or activities such as squatting or twisting. When this tissue gets damaged it can produce pain and stiffness in the hip or groin area.

What are the symptoms of a torn labrum?

  • You may feel pain in the hip area particularly the groin but also around the side of the hip and buttock.
  • You may experience a sensation of clicking, catching or a feeling of your hip getting stuck.
  • You may have stiffness or a loss of movement of the joint.

What does the labrum do?

The labrum deepens the hip socket.  This gives a better fit for the ball part of the hip joint. The increased depth helps to make the joint more stable which is particularly important in functional activities. When the labrum is torn the support in the hip joint is reduced.

How is a labral tear diagnosed? 

A diagnosis is based  on:

  1. History – we consider the location of the pain, which movements cause pain as well as when and how it started
  2. Examination tests – which movements and muscles of the hip joint cause pain and stiffness
  3. Xray  – to look at the bone and joint space
  4. MRI – may be used to look more closely at the soft tissues

When should I see a Physiotherapist? Consider seeing your physiotherapist if you have pain and stiffness in the hip that persists for more than a couple of weeks.  Or if you have hip symptoms which prevent your normal daily activities, sports or recreation.

Treatment

Treatment is based on your assessment findings.  It also depends on your stage of recovery.  In my experience you should experience improvement with 6-12 weeks of treatment.  There are three distinct phases to recovery and your treatment is determined by whether you are in the early phase, where pain is more of a factor, further along where you can engage in a full rehabilitation program or ready to return to full function and sports.

Early phase treatment typically consists of strategies to promote healing and reduce pain (1) such as: • Advice on avoiding movements or postures which increase your pain. • Restricting extreme  movements such as deep squats, lunges or twisting. • Taking time off from activities and sports that aggravate. • Medication may be helpful such as an anti-inflammatory.

Rehabilitation phase treatment consists of therapy to help you to restore basic movements and strength using: • Exercises and manual therapy to regain hip mobility • Strategies to regain muscle strength and flexibility. • Balance training to start re-training hip muscle control. • Core strengthening.

Functional phase treatment consists of therapy to help you to return to full activity such as: • Exercise progression based on specific sport or activity. • Monitoring symptoms as you increase your activity level to ensure you avoid re-injury. • Guidance on a graduated return to sports or recreational activities.

Surgery for hip labral tears

If your symptoms do not improve with a 6-12 week period of therapy you should follow up with your Doctor. Further imaging such as X-rays or MRI may be needed.  A referral to an orthopaedic surgeon with expertise in hip labral tears may be indicated. The goals of surgery are to relieve pain and restore function through repairing/reattaching the labrum to the bone or if this is not possible, to remove the torn piece. After surgery, a rehab protocol is typically provided by the surgeon. This usually involves a period of protected weight bearing where you may be using crutches or canes to allow the repair to heal.  This is followed by a supervised rehab program under the careful guidance of a physiotherapist. Post-operative treatment goals include:

  • Regaining joint movement
  • Restoring muscle strength
  • Preparing you for a gradual return to sports and recreational activities

The recovery after this surgery usually takes about six months before being allowed to resume normal activities. If you are experiencing hip pain or recovering from hip surgery and would like more information or to book an assessment please contact Gareth Sneath at 416-925-4687 or email at gsneath@orthophysio.com   (1) Narveson J.R et al (2016) Management of a Patient with Acute Acetabular Labral Tear and Femoral Acetabular Impingement with Intra-articular Steroid Injection and a Neuromotor Training Program http://www.jospt.org/doi/abs/10.2519/jospt.2016.6573