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By Melbourne Sports Physiotherapy Team
Hip Labral Tears - What Are They and How You Can Recover?
You’re training for that big event, almost beating your personal record or you’re just enjoying your exercise regime as it is. Then you feel this deep nagging pain in your groin or hip area and a fear flashes before you - what could it be?
Don’t these things just always seem to happen at the worst times?
Well, a hip labral tear or hip impingement could be what’s causing your grief. No need to worry though because we’re going to unpack the what, why and how of it all, and spoiler alert - physiotherapy can help you get back on track with your goals.
What is the labrum and why does it matter?
Your hip joint is a ball and socket type joint - the acetabulum of the hip bone forms the socket part, with the head of the femur (thigh bone) fitting nicely into the socket to form the joint.
The labrum is a ring of cartilage that lines the acetabulum. It is strong, flexible and deepens the hip joint which increases its stability by keeping the head of the femur more securely in the acetabulum.
It also allows for nice smooth movement of the hip during sports and activities.
A labral tear is when there is a tear in this labral cartilage.
Causes of a labral tear:
Femoral Acetabular Impingement Syndrome (FAI) is the most common cause of a labral tear and is when there is a structural problem with the femur head (ball) or the acetabulum (socket) - usually including and excess of bone growth on either the femur head or acetabulum which causes an irregular contact between the two.
This results in the ball and socket not fitting together properly which can make movement painful and even contribute towards an early onset of osteoarthritis.
There are two types of hip impingements that have been acknowledged in the literature:
This is when there is an abnormality with the head of the femur (abnormal shape so that it’s not smooth and nicely circular), and can result in pain with certain movements where the femur head makes contact with the acetabulum that is not normal.
This is when the anterior part of the acetabulum has more bone than usual and so “cups” the femoral head more than it should, resulting in pain or discomfort in the groin area with movements.
Repetitive movements of hip flexion (especially large ranges of hip flexion) can affect the cartilage negatively and cause FAI, such as soccer, rugby, golf, gymnastics and long distance running.
Repetitive movements can also cause a labral tear, such as the various sports listed above, but also common movements of everyday life that put strain on the hip joint. Even sitting for long periods of time throughout the day can result in FAI which could lead to a labral tear.
Trauma such as sports injuries and car accidents can also result in a hip labral tear.
Structural problems that people may be born with can cause labral tears such as legg-calve-perthes disease and hip dysplasia.
Symptoms of a labral tear in the hip:
Pain that tends to feel deep and is usually located near the front of the hip or in the groin area that worsens with activity.
Pain that may sometimes be felt in the back, thigh or buttock area.
Locking, clicking or catching sensations.
A feeling of stiffness or decreased range of motion of the hip.
Feeling as if the hip is going to give way or collapse which is a sign of hip instability.
Not everyone will experience symptoms and many people don’t know that they have a labral tear until they develop symptoms that interfere with their daily activities.
Treatment for a hip labral tear:
Once a labral tear has been confirmed by a healthcare professional, a plan of action can be made to address the problem. Treatment strategies include:
Physiotherapy for a hip labral tear and hip impingement
Intra-articular and/or steroid injections
Oral analgesia or non-steroidal anti-inflammatory drugs
Surgery (arthroscopic or open)
Resting from the activity causing the problem
Physiotherapy for a labral tear of the hip:
Physiotherapy has been found to be effective in treating a labral tear and there are many studies that support this. A study conducted in 2019 found that out of 35 patients who received physiotherapy, 27 had successful results and were able to return to full activities. Link to the article here.
Your physiotherapist will do a thorough assessment of both of your hips. This will enable us to plan out a treatment program specifically for you. We will also have to make sure that there isn't something else in the hip or lumbosacral region that is causing the hip pain, which is done by doing various special tests.
Patient education on the diagnosis and on activity modification
Neuromuscular control and movement patterns
Coordination and balance training
Physiotherapy for a hip labral tear is very effective in reducing pain and improving function. In some individuals it even boosts performance as the physiotherapy will target deficits and weak areas that either contributed to the labral tear or happened after the tear.