Hip Labral Tear
About the Labrum
The hip joint is a ball and socket joint with the head of the femur (ball) fitting deep in the pelvis (socket). The labrum is a circular structure surrounding the hip socket and functions to seal the hip joint, distribute joint stress and enhance stability. That stability permits normal physical function like walking.
What causes labral tears?
Active athletes are at risk for labral tears because of the extremes of motion imposed by training and competition. The wear and tear of everyday movements like walking and bending can contribute to labral tears as well. Individuals with abnormally-shaped hips (e.g., hip dysplasia or femoroacetabular impingement) are at greater risk for labral tears.
Signs and Symptoms
Labral tears may cause a sharp catching pain, popping and/or a sensation of locking of the hip. Most people with this injury experience more subtle, dull pain that is described as a deep discomfort in the front of the groin or deep within the buttocks.
When surgery is not recommended for the treatment of a labral tear, physical therapists develop a rehabilitation plan, starting with a comprehensive examination to identify factors contributing to hip pain. This is followed by a customized treatment plan to address muscle imbalances, pelvic position, posture and movement patterns, which can put increased stress on the hip joint. Activity modification or rest from sports is common to decrease stress on the hip joint. Conservative treatment may include:
Gentle hip joint mobilizations for pain relief
Stretching and range-of-motion exercises
Exercises to increase strength
Although most labral tears are unlikely to heal fully due to a lack of blood supply, conservative treatment can reduce symptoms and pain, and progressive exercise programs may make returning to sports and other activities possible.
Treatment: Surgical (Hip Arthroscopy)
For hip labral tears that do not respond to non-operative treatment, hip arthroscopy may be required. This is a minimally invasive outpatient procedure performed under general anesthesia. The common course of the procedure includes:
Placing the hip in traction to open up the hip joint
Making a small incision into the hip joint to insert an arthroscope with a camera to display the inside of the hip on a television monitor
Performing two or three other incisions to insert the surgical instruments used for removing labral tears, loose bodies and bony prominences that contact the bones of the hip joint (impingement)
Treatment: Post-operative Rehabilitation
After arthroscopic hip surgery, rehabilitation with a physical therapist or athletic trainer focuses on regaining normal motion, strength and movement patterns at the hip. Rehabilitation also focuses on addressing any other factors that may be causing injury and identifying strategies to prevent future injury. General points about rehabilitation:
Crutches may be required for about two weeks (sometimes longer) after surgery
Exercises starts soon after surgery
Rehabilitation progresses as certain criteria is met with the goal to return to full activities, including sports
Return to high-impact sports usually takes eight to twelve weeks after surgery