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 trauma to the hip joint. Individuals who participate in sports that require extremes of motion, such as figure skating, repetitive twisting and “cutting,” like hockey or soccer, or long-distance running are most often diagnosed with labral tears. To treat the symptoms associated with a labral tear, our physical therapists at Progressive Physical Therapy 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 where there is damage to the labrum 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 socket is surrounded by a ring of cartilage called the labrum. The labrum provides additional stability to the hip joint.
A labral tear results when a part of the labrum separates or is pulled away from the socket. Most often, a labral tear is the result of repetitive trauma to the hip, either due to running or repeated twisting and cutting.
The consequences of repetitive stress can be magnified in a hip with bony abnormalities. Hip impingement is a condition involving abnormal bony contact between the ball and socket. As the hip is moved into specific positions, this bony contact occurs, placing increased 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
- Improper technique with repetitive activities
- Participation in sports that require distance running, or repetitive twisting and cutting
Once torn, the labral tissue in the hip does not have the ability to 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 minimizing the stress placed on the injured area. In certain cases, patients are able to 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 can a physical therapist help?
When you have been diagnosed with a hip labral tear, your physical therapist at Progressive Physical Therapy will work with you to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:
- Pain management. Many pain-relief strategies may be implemented; the most beneficial with hip pain is to apply ice to the area and decrease or eliminate specific activities for a certain length of time. Your physical therapist will help to identify specific movements or activities that continue to aggravate the inside of your hip joint. Your physical therapist then will design an individual treatment plan for you, beginning with a period of rest, and gradually adding a return to certain activities as appropriate.
- Movement re-education. Your back and hip may be moving improperly, causing increased tension at the hip joint. Self-stretching techniques may be applied to the lower body to decrease tension 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.
- Manual therapy. Your 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.
- Muscle strengthening. Muscular 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 lying on a table, for example, lifting your leg up while lying in different positions. You then may advance to doing exercises in a standing position, for example, stepping on and off a raised platform. 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 safely transition back into more demanding activities. To minimize tension on the hip, it is important to teach your body safe, controlled movements. Based on your own unique 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 physical therapist will also discuss specific positions and activities that should be avoided or modified to protect your hip.
- 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 amount of exercises you complete. Your physical therapist will develop a personal exercise program to help you return to your desired activities.