Monday, February 19, 2024

Hip Labral Tear Physical Therapy

The Right Way To Choose Exercises To Improve Hip Labral Tear Pain

Hip Labral Tear Stretches & Exercises – Ask Doctor Jo

So if the hip pain is not because of the hip labral tear, why am I hip pain? you might ask. Well the answer is it doesnt really matter. The goal is to feel better right? Not to get rid of the hip labral tear. That is why you need to choose exercises that will help you move and feel better as opposed to treating your hip labral tear.

The best way to start analyzing proper exercise selection is by looking at the 6 main hip movements. The 6 movements include:

  • Hip Flexion
  • Hip Internal Rotation
  • Hip External Rotation
  • It’s ok if learning all of these seems overwhelming at the moment. But you want to eventually figure out which of these you’re weakest in. This will help you decide which exercises you should focus on.

    Ideally, youd assess each of these main hip movements to identify your individual weaknesses. I dont prescribe any corrective exercises to my clients before we do assessments first. If youre not assessing, youre just guessing.

    If youd like to assess your own hip movement, try my free hip assessments course here.

    Below, youll find some of my favorite exercises I give to clients in hip pain. To help you start getting familiar with the 6 movements, I’ll provide one example for each. Try them out and pay attention to the ones that give you the most trouble. Those are the ones you should add to your training!

    What Is The Acetabular Hip Labrum

    The acetabular labrum is ring of connective tissue in your hip that functions to increase the surface area of the socket of your joint.

    As a ball and socket joint, the labrum helps to connect the ball with the socket . The labrum serves to distribute forces in such a way that keeps the hip where it needs to be.

    The good news: even with a tear to this tissue, our hip labrum still works to perform this function.

    Rather than diving into the depths of anatomy, just have a look at the picture that shows a normal image of the anatomy deep within our hip.

    Symptoms Of An Inflamed Hip Labrum Or Hip Labral Tear

    First off, the labrum is a ring of cartilage that stabilizes the hip joint. It also helps distribute pressure, allows for more shock absorption, and improves joint articulation, says Cameron Yuen, D.P.T., C.S.C.S., a senior physical therapist at Bespoke Treatments in New York City.

    Like Rose mentioned, a labral tear isnt as obvious as youd think. You could have a labral tear and not even know it, Yuen says. But pain in the front of your hip, or deep in your groin, should clue you in. Its a fairly constant ache with clicking or clunking as you move your hip.

    The sensation and of course, the location, is similar if youre dealing with inflammation, not a full-fledged tear. Both create similar signs and symptoms, but labral tears dont heal on their own and often have mechanical symptomssuch as that clicking or clunking, Yuen says.

    So, if the pain subsides and you dont notice any strange sounds, its probably not a tear. If you want to be sure, youll need an MRA, or a magnetic resonance arthrogram, which is a type of MRI that can show blood vessels and blood.

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    Should I Choose Pt Or Surgery For My Hip Impingement Or Labral Tear

    The labrum is a dense connective and fibrocartilage tissue lining the socket of the hip joint. It functions to deepen the hip socket and improve stability and weight bearing during functional activities. The labrum is highly innervated on top and front portions of the joint and often refers to the front of the hip when symptomatic. Labral tear diagnosis is on the rise due to more surgeons being trained in hip arthroscopic surgery and increased utilization of MRI scans. Experts note caution is warranted when interpreting these findings because up to 68% of pain free individuals will have a labral tear after MRI testing.

    Hip labral tears and femoral acetabular impingement are common diagnoses among < 40 year old patients especially those involved in rotational sports such as hockey and tennis. As stated previously, many of the positive MRI findings are also present in pain free athletes. Researchers are still determining which of these findings indicate pathology vs. a natural adaptation to the sport similar to what we see in pitcher’s shoulders.

    What Is The Labrum

    Physical Therapy Management of Hip Labral Tears

    The Acetabular Labrum, commonly known as the Hip Labrum, is a fibrous ring of cartilage that encircles the hip socket. Its primary job is to hold the thighbone in place, providing stability for the entire lower body. When functioning properly, the labrum manages fluid within the joint, acting like a rubber seal, allowing ease of movement.

    The hip is a complex joint that allows the leg to move in multiple planes and directions. As a result, many factors can lead to malfunction or pain, the most common being a hip labral tear. A tear of the labrum can be very painful and if left untreated, can lead to debilitating instability of the hip.

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    How Long Does It Take To Recover From A Hip Labral Tear Surgery

    Every patient is unique in their specific injury and recovery.

    While most patients can expect to spend four months in one-on-one treatment with a physical therapist, it could take up to nine months to fully recover. Most patients should be able to return to normal activities by four to five months post-surgery.

    Hip Labral Tear Pain Down Leg

    A hip labral tear can cause pain down the leg. The hip labrum is a ring of cartilage around the hip socket. It helps to stabilize the hip joint and keep the ball of the thighbone in the socket. A tear in the hip labrum can cause pain in the hip and down the leg.

    It is an injury to the hip labrum, or the soft tissue covering the acetabulum of the hip. Fractures in the spine can be caused by an injury, a structural problem, or a degeneration. Hip labral tears are usually treated with nonsurgical methods rather than surgery in severe cases. Rest and other measures can be taken to reduce symptoms in the absence of a hip labral tear, but this is not always possible. If there is no improvement or if the tear becomes more severe, your doctor may advise you to have surgery. Outpatient surgery is frequently used to treat osteoarthritis, and the patient leaves the hospital the same day.

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    Recovery After Hip Labrum Repair

    Arthroscopic surgery is typically an outpatient procedure, which means you can go home the same day. After your hip labrum repair, you will be able to return to low-impact activities such as walking almost immediately. Your surgeon will refer you to a physical therapist to start exercising your hip to restore your range of motion and strengthen the joint.

    If your job is in a low-activity environment, such as an office job, you may be able to return to work in one to two weeks after your hip labral tear surgery. If your job puts significant stress on the hip, you can work with your physical therapists to determine a safe return date or discuss job modifications with your employer to allow you to ease back into work as you recover.

    How Do You Do Physical Therapy After Hip Labral Tear Surgery

    Hip Labrum Tear- How to Assess & Rehab at Home

    Physical therapy after hip labral tear surgery should be performed by a board-certified doctor of physical therapy.

    Its never recommended for patients to engage in physical therapy without the help of a professional. This can lead to improper healing and increase the risk of reinjury.

    The licensed physical therapists at PRO~PT have helped hundreds of patients recover from labrum arthroscopy. Let us help get you back on your feet and back to normal activities after your labral tear surgery.

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    Stop Stretching The Hip Flexors

    This is contrary to what EVERYONE else says, but the hip flexor muscles are crucial to improving the stability of the hip joint. We often find that by dropping hip flexor stretching and replacing it with the strengthening of the same muscles, we see rapid decreases in pain. The psoas march is one of the most effective exercises we prescribe to quickly improve symptoms.

    Choosing A Physical Therapist

    There are many ways to choose a physical therapist. Here are some helpful tips:

    • Ask your sports medicine doctor, friends, and family for any recommendations to start .
    • All physical therapists are adequately trained to address hip injuries so see what is covered by your medical insurance.
    • Consider cash pain clinics if you dont have insurance or it doesnt cover PT.
    • For a hip injury physical therapy will be administered in an outpatient clinic.
    • Find a PT specialized in orthopedics

    The bottom line is simple: its important to find a PT that you are comfortable working with and trust, which is more about personalities and philosophies than anything else.

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    Movements To Avoid With Hip Pain

    When recovering from a hip labrum tear, there are a few certain moves that may exacerbate your symptoms or even cause a bigger tear. Try to avoid these movements as much as possible while you are in the healing process to prevent any unnecessary setbacks. As you recover, talk to your doctor about clearance for higher level activities.

    • Any movement that elicits an increase in hip pain or any other abnormalities
    • Movement that requires a combination of internal rotation and flexion- as it will cause anterior hip impingement
    • Deep flexion activities such as end range squatting
    • End range hip extension
    • Jumping, running, or other high impact activities
    • Pivoting or cutting during sports activities
    • Heavy leg lifting

    Nonsurgical Treatments For Hip Labral Tears

    Rehab after Arthroscopic surgery

    Hip labral tears can sometimes be treated with nonsurgical treatments. Below are some of the most common.

    • Rest. Limited activity is advised to control discomfort, including the activities that bring on hip pain.
    • NSAIDs. Taking non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen, for a limited period may reduce inflammation and pain in the hip area.
    • Injections. A doctor may recommend local anesthetic fluid injections directly into the hip joint, called an intra-articular injection, if the pain is not alleviated from other measures. A corticosteroid may be added to the injection depending upon the level of hip pain and any other existing hip problems.
    • Physical Therapy. A licensed physical therapist can provide an individual treatment plan. The plan may focus on strengthening the buttocks, thigh, and back, while also improving hip stability. Physical therapy for hip labral tears is considered a safe but under-studied treatment.1 Individuals should consult their doctor before beginning any physical therapy regimen.3

    If these treatment options fail to relieve symptoms within 10 to 12 weeks, a doctor may recommend surgery.

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    Summary Of The Condition1

    A hip labral tear is a mechanically induced pathology that could predispose one to develop osteoarthritis at the joint. Joint abnormalities or excessive forces at the joint from sudden or repetitive twisting and pivoting motions are known to cause a labral tear. Patients often present with hip or groin pain but differential diagnosis is necessary to confirm the presence of a labral tear. Treatment for a labral tear is dependent on the severity of the symptoms. Conservative management can be beneficial for some patients while arthroscopic surgery might be indicated for others to repair or remove the torn labrum.

    Potential impairments seen in patients with a labral tear are as follows: Pain Knowledge deficit regarding condition, self-management, home program, prevention

    Is A Labral Tear Serious

    It runs in both directions around the joint, both anterior and posterior. If this area of the biceps tendon is injured, the labrum can also be injured. There may be a mild or severe injury in this area.

    The Pain Of A Hip Labral Tea

    It is common for hip labral tears to cause severe pain. Walking, pivoting, and sitting for an extended period of time are frequently exacerbates their condition. It is also possible to aggravate them by engaging in impact activities such as running. If left untreated, a hip labral tear can lead to arthritis in the hip joint. If a severe tear occurs, surgery may be required to replace the hip.

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    Hip Labral Tear Diagnosis

    Diagnosis begins with a physical exam where your doctor will instruct you to walk around and move your leg while gauging your level of pain.

    Imaging tests may also be necessary to diagnose a hip labral tear. These tests may include:

    • X-rays an x-ray will alert the doctor to possible problems with the bones in your hip.
    • MRI this test will show more detail in the soft tissue and highlight the severity of the labral tear.

    Hip Impingement: A Common Problem

    Labral Hip Tear – Home Exercise Rehabilitation And Strengthening Programme

    Pincer syndrome, or hip impingement, is a common condition that causes pain and stiffness in the hip. The repeated rubbing of the hip can cause pain and instability, in addition to tearing the labrum. A tear in the labrum can also cause osteoarthritis. MRI is more accurate than direct visualization for determining the presence of a tear in the labrum, but it is less accurate for determining pathology.

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    More Exersises You Can Try:

  • Kneeling Hip Flexor Stretch Helpful for opening up the front of the hip and creating more length in the hip flexors and quads for hip extension movements and arabesque. Caution if you have knee pain. Make sure to use a cushion, towel or rolled up yoga mat underneath the knee during the stretch. The stretch should be primarily felt along the front of the thigh and hip. If you experience any knee pain, stop.
  • Clamshells with Develope This exercise is meant to help strengthen the abdominals and the external rotators of the hip the muscles you should be using to turn out your legs and to help you balance on one leg in a turned out position. You want to keep your abdominals engaged when performing this exercise and make sure you can place a hand under your waist line when lying down on the mat. During the exercise, only the hip is rotating outwards and the work should be felt deep into the back of the hip. When performing the develope make sure you are not sinking into the mat and or hiking the hip up the get the leg higher keep the torso lifted and long and maintain space in the hip when reaching the leg up.
  • With the approval of your doctor, give these a go and see how they feel.

    When youre ready, seek out a physical therapist to help you get to the next level.

    Symptoms Of A Labral Tear

    Symptoms of a hip labral tear are easy to detect. Commonly, pain originates deep in the groin, accompanied by soreness in the hips, hamstrings, abdominals or lower back. Often, patients feel discomfort, even during simple, stress-free activities such as walking, twisting or sitting in a car or at a desk.

    Symptoms include:

    Phase 3 Advanced Exercise

    • Manual therapy should be performed as needed
    • Flexibility and passive ROM interventions should become slightly more aggressive if the limitations persist
    • Strengthening exercises: walking lunges, lunges with trunk rotations, resistent sportcord, walking forward/backwards, plyometric bounding in the water.
    • Exercises such as core ball stabilization, golf progression, lunges

    To progress to the forth phases it is important that there is symmetrical ROM and flexibility of the psoas and piriformis.

    What To Expect After A Hip Labral Tear Surgery

    Hip Labral Tear

    Hip surgery can be done in 3 ways typically :

    • Fixing the tear by stitching it back together

    • Reconstructing it by using healthy tissue from ones own body or from a donor

    • Debridement: removing a part of the labrum permanently

    Some things to expect after a hip labral tear surgery are:

    • Complications if not healed properly: infection, bleeding, and/or nerve injury

    • Usage of crutches after dischargement from the hospital for 2-6 weeks

    • Involvement in physical activity and exercises tailored for acetabular labral surgery

    • Can typically take up to 6 weeks before resuming previous physical activities/sports and/or full restoration

    • Avoiding pivoting and twisting activities near the beginning of recovery

    • Some may require hip labral surgery time off work

    Prioritize The Things You Love

    This cannot be stated loudly enough: PRIORITIZE THE THINGS YOU LOVE.

    The number one mistake I see athletes make is the complete elimination of the activities they enjoy. Unfortunately, many providers will tell you that you need to stop doing activity as well .

    The number one mistake I see athletes make is the complete elimination of the activities they enjoy.

    I have found there is almost always a way to work in the activity you love WHILE youre recovering from injury.

    For example: when I was in high school and recovering from an ACL reconstruction surgery, I just WENT to soccer practices. As I was cleared to do more, I did the activities I could do, such as passing a ball. This kept me engaged with my team, engaged with life and kept me motivated to keep going. Metaphorically speaking, it kept my eye on the ball .

    Here Is Everything You Need To Know About Hip Labral Tears What Causes It And The Best Way To Treat It

    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, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip.

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