How To Address Hip Labral Tears Without Surgery
Physical therapists are trained to assess hip function with tests and measures to help differentiate the origin of hip pain. They are able to differentiate which area of the hip is involved by:
- Listening to your symptoms.
- Examining any mobility and strength deficits.
- Performing a cluster of tests.
- Determining pain patterns and relief factors.
Imaging isnt immediately necessary to treat this type of injury, but if symptoms persist despite conservative treatment, an MRI may be appropriate to determine more information about the suspected labral tear.
Once a physical therapist identifies pain patterns and body limitations, they can assist in recovery of function with various strengthening and mobility exercises. Common physical therapy interventions include:
- Soft tissue mobilization
- Hip strengthening
- Core stabilization
Exercises most commonly address the trunk and hips, but could also involve the knee and ankle if they impact your ability to use the hip properly. The goal is to decrease pain as you perform your normal activities throughout the day.
Physical therapy intervention does not heal the actual tear in the labrum, but addressing body limitations can provide the stability required to function pain-free in the presence of a tear.
The rehabilitation process for this type of injury may take a few months without surgery. However, these timelines can vary based on the goal of each individual. Advanced goals like return to sport may take longer.
How Are Hip Labral Tears Treated
Treatment for hip labral tears falls into two broad categories: nonsurgical and surgical.
Nonsurgical treatment. In most cases, the initial treatment for labral tears is nonsurgical. These treatments, which are usually used in combination with one another, may include:
- Activity modification. If you stop doing the things that make your hip hurt, symptoms may improve. Without additional treatment, however, the pain may return when you resume these activities.
- Nonsteroidal anti-inflammatory drugs . Drugs like ibuprofen and naproxen help reduce inflammation and pain.
- Physical therapy. Following an individually tailored exercise and stretching program helps strengthen muscles in the core, pelvis, and around the hip. Physical therapy, which may last three months or longer, improves hip stability, gait, and range of motion with the aim of helping you return to your previous activities without pain or other symptoms.
- Steroid injections. Corticosteroid injections in the hip are used to reduce inflammation and pain.
- Biologic injections. Injections of platelet rich plasma or PRP may be considered. These are cells from the patients own blood that can be injected into the hip, with the goal of helping to incite a healing response.
In general, three surgical techniques are used to treat hip labral tears:
After surgery, patients will need to follow a rehabilitative physical therapy program to rebuild strength, stability, and flexibility of the hip joint.
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.
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Hip Labral Tear Or Strain Prevention
Often, hip labral tears and strains are associated with athletes and participating in sports, so some precautions you can take include:
- Improve the strength and flexibility in your hips with exercises
- Avoid placing your full body weight on your hips when your legs and hips are at their extreme ends.
What Kind Of Physical Therapist Do I Need
All physical therapists are prepared through education and experience to treat a labral injury in the hip. However, you may want to consider:
- A physical therapist who is experienced in treating people with hip labral injuries or tears, and hip impingement. Some physical therapists have a practice with an orthopedic or musculoskeletal focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you’re looking for a physical therapist :
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people who have hip labral injury or hip impingement.
- Be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.
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What Does A Hip Labral Tear Feel Like
Having a torn labrum can feel different for each person, depending on the type and the severity of the tear, but it is usually uncomfortable or painful. Pain from a labral tear is most often at the front of the hip, near the groin, but could also extend into your thigh or buttocks.
You might experience pain when rotating your leg, squatting, climbing stairs, or sitting for long periods of time. Many patients with labral tears describe feeling unsteady when putting weight on their hip, or a clicking or catching feeling when standing or participating in physical activities.
What Causes Hip Pain
Hip pain can be caused by a number of different factors. In some cases, the cause is unknown, while in other cases, the source of hip pain can be traced to an underlying condition or injury. It is important to recognize what causes hip pain and to seek appropriate treatment when necessary.
Hip pain can be caused by certain injuries or medical conditions. Some of the most common causes include arthritis, bursitis, tendonitis, strained muscles and ligaments, inflammation of the joint capsule or labrum , contusions , fractures, and dislocations. Injuries such as excessive physical activity may also increase the risk for hip pain although usually, this type of injury does not result in long-term disability.
Certain medical conditions including diabetes, obesity, and lupus may also increase the risk for the development of hip pain although this is typically not an immediate concern after diagnosis with the condition itself. Rheumatoid arthritis may also contribute to discomfort due to inflammation and increased stiffness which can damage surrounding tissues leading to bone degeneration and more severe damage over time if not managed properly.
Finally but certainly not least, infection in or around tissue surrounding a joint is another common cause of persistent chronic hip pain which should always be considered if initial treatments do not yield relief from discomfort.
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Hip Labral Tear Recovery Without Surgery Torn Labrum Hip Exercises And More
Many patients inquire about hip labral tear recovery without surgery. Simply put, a hip labral tear will not heal without surgical treatment. However, many less severe hip labral tears can be managed for years, sometimes even indefinitely, with nonsurgical treatment. When beginning a nonsurgical treatment plan, your physician may start by recommending small lifestyle adjustments to minimize the pain and discomfort related to hip labral tears.
For some, this may include a weight loss regimen to minimize the amount of weight and stress on the hip joint during activity. Other patients may be encouraged to tweak their activities and fitness routines, reducing the frequency or intensity of activities known to cause hip labral tear symptom flare-ups. Nonsteroidal anti-inflammatory drugs may be used to relieve minor aches and labrum hip pain symptoms. The RICE method may also be recommended to help alleviate torn hip labrum symptoms such as swelling and inflammation. RICE stands for rest, ice, compression, elevation, and its a popular home treatment for inflamed injuries, as well as for pain and discomfort following rigorous activity. Ice and heat therapy can also relax the surrounding tissues and minimize hip stiffness. In a recent blog post, we detailed a comprehensive guide on when to use ice or heat therapy for a range of conditions.
RELATED: Feel free to read more about appropriate ice or heat therapy here.
Hip Pain Locking And Instability
Primary symptoms of a hip labral tear may include:
- Hip pain. The pain is often described as a constant, deep, dull ache when at rest and occasional, sharp, stinging pain that gets worse during activities, such as turning, walking, and running.1Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009 2:105-17. When asked to locate the pain, patients often make a C shape by cupping their hand around the side of the hip. Pain can be experienced in the buttocks and thigh, as well as through the knee.
- Hip clicking, locking, or catching. It may feel like the rounded top of the thighbone is caught within its socket during movement. The hip joints overall range of motion may decrease.
- Hip instability. The hip and leg may feel like they are about to give way, especially when walking, running, or standing for long periods of time.
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Identifying Labral Tear Hip Pain At Night
Knowing torn hip labrum symptoms, in general, can help you to identify labral tear hip pain at night. Keep in mind that the way torn hip labrum symptoms present can vary if the tear is an anterior or posterior one.
An anterior tear is located on the front of your hip, which is easier to injure due to the lack of blood vessels in that area. Posterior labral tears are located on the back of your hip. Since there is less motion in the back of your hip joint, the labrum cartilage does not experience as much contact as it does in the front.
So, although I did state that most labral hip tears will cause pain in the groin area, that is more specific to anterior labral tears. If you have a posterior labral tear, you are likely to have more pain in the back of your hip when performing a motion like squatting or sitting.
Pain is not the only symptom of a labrum tear though. Other symptoms of a labrum tear may include:
- A clicking, locking, or catching sensation when moving the hip joint
- Limitations when it comes to hip mobility and general range of motion
So, how do you know if you are experiencing labral tear hip pain at night?
First, identify if you have any of the symptoms above throughout your day. Do you only have hip pain when you are in one position for an extended period of time? That could be a sign of a labral tear, and part of the reason why you have labral tear hip pain at night.
Will Cortisone Injection Help Hip Labral Tear
Cortisone will NOT repair a torn labrum. Some patients receive several months of relief, but others do not receive more than a few days of relief. It is not advisable to resume high impact activities if the cortisone injection decreases pain from the hip because of concerns of further damage to the torn labrum.
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What Is The Outlook For Someone Who Has A Hip Labral Tear
How well a person heals from a hip labral tear depends on the specific injury and how it is treated:
- Conservative therapies: Treatments such as anti-inflammatory medications and physical therapy do not fix the tear itself. They can decrease pain and offer a workable option for some minor tears. Some people will need additional treatment later.
- Surgery: In many cases, hip arthroscopy can relieve pain from a labral tear and return hip function. Many people recover fully from surgery within 4 to 6 months, and can often return to previous athletic pursuits and physical activity.
- Osteoarthritis: Chronic conditions such as osteoarthritis must be managed by a doctor to prevent more severe symptoms.
Hip Labral Tear Symptoms
Hip labral tears cause similar symptoms regardless of the type of tear. But where you feel the symptoms may change depending on whether the tear is in the front or the back of the hip labrum.
Hip labral tear symptoms include:
- Pain in the hip, groin or buttocks, especially as you walk or run, and sometimes at night when you sleep.
- Hip stiffness or limited range of motion
- A clicking or locking sensation in the hip joint when you move
Some labral tears of the hip may cause no symptoms, and can go unnoticed for years.
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Hip Labral Tear Treatment Options
Treatment for a hip labral tear will depend on the severity of the tear and other information about the patient, like age, activity level, and more. There are non-surgical and surgical options for patients who are struggling with a hip labral tear:
- Nonsurgical A labral tear in the hip wont heal on its own, but rest and other things can help with the pain and other symptoms of a small tear. Some nonsurgical treatments include:
- Anti-inflammatory drugs You can buy pain relievers like ibuprofen without a prescription that can help reduce swelling.
- Medication injections Steroids and other drugs can be injected by a doctor into the hip joint to help ease the pain.
- Physical therapy Certain exercises that stretch and strengthen the hip muscles may help ease hip pain. Most of the time, a doctors order is needed to begin physical therapy.
- Surgical If the symptoms dont go away or the tear is bad, your doctor may suggest surgery. Most of the time, hip labrum tears are fixed with arthroscopy, which is a minimally invasive surgery where the doctor only makes minor cuts in the hip and uses small tools to do the following:
- Refixation or repair Sewing back together the torn tissue
- Reconstruction Reconfiguring damaged tissue using healthy tissue from elsewhere in your body or from a donor
- Debridement Removing a small piece of labral tissue.
- If FAI is also present, it will be removed at the same time to help keep the labrum from tearing again.
Signs Of A Labral Tear
Hip pain is a common medical complaint for both women and men, affecting up to 40% of athletes and active adults and about 15% of all people over age 60. Various conditions can cause hip pain, including tears of the labrum, the cartilage ring that helps your hips move smoothly.
As a leading orthopedic surgeon in Houston, Texas, Joshua D. Harris, MD, uses advanced diagnostic techniques to diagnose and evaluate labral tears, so he can provide customized, patient-centered treatment aimed at resolving symptoms and restoring normal joint function. Heres how to tell if your labrum might be causing your hip symptoms.
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Diagnosing A Labral Tear
Your doctor can do a physical exam to check your hips range of motion and determine where the pain is occurring, but you might need to have other tests done to be sure that the pain is being caused by a labral tear.
- Diagnostic injectionYour doctor can inject an anesthetic into your joint to help diagnose the cause of your hip pain. If your pain is completely gone after receiving the injection, it confirms that a problem in your joint is the source of the pain. If you still feel pain after the injection, it could mean that something else is causing it.
- X-rayAn X-ray can help your doctor get a better look at the bones in your joint. He or she will check the X-ray images for conditions that might be causing your hip pain, like FAI or dysplasia.
- MRI scanAn MRI scan provides more detailed images of tissues in and around your hip joint. This will help your doctor determine the location and severity of the tear. An MRI can show labral tears even if you dont have any symptoms.
- ArthroscopyAn arthroscopy is a surgical procedure that can be used both to diagnose and to treat certain hip conditions, including labral tears. Your doctor will insert a small camera into your joint to look for damage.
After determining what is causing your symptoms, your specialist will make a recommendation for treatment.
Investigations For Labral Tears
A well trained doctor can diagnose a labral tear from your symptoms and an examination of your hip.
A number of investigations can help in the diagnosis of a labral tear:
- Xray. Specialised Xrays can help look at the shape of your hips
- CT scan. Helps shows the 3D anatomy of your hip and helps the surgeon plan the operation.
- MRI scan. Is a good test to show a labral tear. Sometimes, an MRI can miss a tear, which only becomes evident during the hip arthroscopy.
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Phase 4 Sport Specific Training
- In this phase, it is important to return safely and effectively back to competition or previous activity level.
- Manual therapy, flexibility, and ROM exercises can continue as appropriate.
- It is important the the patient has good muscular endurance, good eccentric muscle control, and the ability to generate power.
- The patient can be given sport specific exercises and has to have the ability to demonstrate a good neuromuscular control of the lower extremity during the activities.
- Exercises such as: sport specific drills, functional testing
The goal during physical therapy of an acetabular labral tear is to optimize the alignment of the hip joint and the precision of joint motion . This can be done by:
So far there has been no research on the efficacy of hip mobilization or manipulation in the treatment of labral disorders. Although it is suggested that the therapy should focus on optimizing the alignment of the hip joint and the precision of joint motion, avoiding pivoting motions and correcting gait patterns.