Do I have a Hip Labral Tear?
What is a hip labral tear?
One diagnosis of anterior hip pain is a hip labral tear. The hip is a ball and socket joint at the top of the thigh bone (femoral head), and the socket a part of the pelvis (acetabulum). The labrum is a cartilage ring that lines the socket, allowing optimal hip alignment with smooth joint movement.
Hip Labral tears can occur either in the front (anterior, more common) or back (posterior) of the hip joint and have two distinct causes. One is during any acute trauma, particularly athletes involved in high-impact sports and repetitive twisting (ballet, golf, football, hockey, etc.), car accidents, falls from a height/onto unstable surfaces, etc. Alternatively, they occur gradually over time or because of other conditions like impingement, hip dysplasia, or osteoarthritis.
What are the symptoms of a Hip labral tear?
The signs and symptoms of a hip labral tear can include pain in the hip, groin, buttocks, pain during walking or pain running and pain at night when lying down and trying to sleep. Furthermore, stiffness or inability to move the hip joint, especially after being inactive for a period such as sitting down for an hour or so. Clicking or locking in the hip joint which is specific to that hip and hasn’t been there before. Finally, some hip labral tears may be asymptomatic.
Do I have a labral tear?
A thorough hip assessment will give clarity into three critical aspects:
1) The mechanism or how it occurred. This is detailed during what we call a subjective assessment, where you can talk through your experience of what you were doing when you either felt the injury occur or any pain/stiffness emerge frequently during an activity.
2) The symptoms or characteristics around the pain: Location of pain, whether it’s sharp or dull, what it refers to, what activities/movements bring it on, whether it’s worse in the morning vs. at night, does it responds to pain medications, application of cool or heat, etc.
3) Specific tests carried out by a physio will give insight into measures that need further exploration. For example, joint range, strength, functional movement (squat), special tests that aim to replicate the same pain/discomfort, and rule in/out the likelihood of other injuries with similar symptoms. These will always be compared to your other side as a baseline idea of your ‘normal’ function. Following this, it may determine whether you need to have an MRI and what the treatment pathway would be.
Do I need an MRI if I have a suspected hip labral tear?
Scanning is the only way to confirm the extent of a suspected hip labral tear injury. Generally, there are two main reasons why a physiotherapist might send you for a scan, and that comes down to how bad your symptoms and function are at the time of your initial assessment (keeping your history in mind) and whether the additional information from the scan would change the pathway of your treatment. The other time MRI scanning for a hip labral tear is useful is if you have been undergoing treatment for a couple of months without much improvement or are getting worse.
What is the treatment for a hip labral tear?
Anti-inflammatory medications can help reduce symptoms (pain, swelling, inflammation) quicker in the early phases of recovery so that other aspects of treatment are more effective. Manual therapy (massage, dry needling, cupping, taping) and advice around recovery will likely form a large part of your treatment, with exercise prescription being phased in over time.
Appropriate rest and activity modification. This determines how your injury responds to a controlled amount of load. This might look like a week or so of not doing an activity or being limited to light activities/different exercises that protect the injury and prevent the effects of detraining as much as possible.
As your symptoms and testing measures improve, more demanding loads are phased back in until you reach your total capacity. The time frame of injury severity around this is different for everyone and will depend on the injury severity, fitness level, function, and response to load.
Are there specific exercises for hip labral tears?
The role of exercise in treating labral tears aims to restore full mobility, strength/power of muscles that control hip movement in all directions, and the ability to respond to unpredictable loads – usually in this order.
Specifically, exercises will focus on surrounding muscle groups and help improve the strength and stability around the hip joint. This includes the glutes, deep hip rotators, hamstrings, quadriceps, inner thigh, and core). Depending on the stage of recovery and between therapists, types of exercises might differ, but ultimately, all aim to regain optimal function for returning to sport/activity.
Strengthening the hip flexors may need to be progressed slower than other muscle groups, for example, by holding certain positions against resistance (isometric) instead of exercising through range (concentric and eccentric).
Will I need surgery if I have a hip labral tear?
Arthroscopic surgery is recommended if you have a severe labral tear or not responding to conservative treatment. It involves either repairing it with stitches, removing pieces of damaged labrum or replacing missing parts with tissues from other body areas.
What is the recovery process after hip labral tear surgery
Arthroscopic repair is the most common surgery for fixing a labral tear. You will be admitted and released on the same day and can return to low-grade walking almost immediately. Following arthroscopy, you may need 1-2 weeks off work, depending on the nature of your role.
Something that isn’t always highlighted well before the procedure is that a rehabilitative exercise plan is essential after surgery. This will set you up for a faster recovery with better long-term outcomes. You may be given a few exercises by a physio at the hospital, but this should be progressed within the first couple of weeks following the surgery. Seeking a physiotherapist’s guidance will cover all bases, including a return to work/life strategy.
