Best Exercises For Hip Labral Tear
What is a labral tear in the hip?
Some anatomy about the hip, the hip is a ball and socket joint (Hospital for Special Surgery, 2021; Cleveland Clinic, 2018). The socket is the acetabulum, which is part of the pelvic bone (the largest indented part on the bone), and the ball is the head of the femur (thigh bone; Hospital for Special Surgery, 2021; Cleveland Clinic, 2018). A labral tear in the hip is when the labrum, which resides on the acetabulum, is torn. There are different labra for different structures, and this labrum is called the acetabular labrum as it resides on the acetabulum (Hospital for Special Surgery, 2021).
A labrum is cartilaginous and is shaped like a moon or horseshoe, as it underlies and surrounds the edge of the socket, the acetabulum (Washington University Physicians, 2017; Mayo Clinic Staff, 2019). The purpose of the labrum is to help reduce the friction between the 2 bones, the acetabulum (which is part of the pelvic bone) and the head of the femur. It is also there to act as a cushion, shock absorber, pressure distributor, and helps to keep the 2 bones secure and stable (Cleveland Clinic, 2018; Mayo Clinic Staff, 2019; Hospital for Special Surgery, 2021).
What does a hip labral tear feel like?
Some hip labral tear symptoms may include hip labral tear pain down the leg, pain in the buttocks, groin or deep groin region, and the front and/or side of one’s hip (Hospital for Special Surgery, 2021; Washington University Physicians, 2017; Cleveland Clinic, 2018). One may also feel pain and/or stiffness while in motion (Hospital for Special Surgery, 2021; Cleveland Clinic, 2018; Mayo Clinic Staff, 2019). Additionally, many may feel their hips locking and/or catching and/or hear a clicking and/or popping sound when moving (Hospital for Special Surgery, 2021; Washington University Physicians, 2017; Cleveland Clinic, 2018; Mayo Clinic Staff, 2019). It is also normal to “feel unsteady on the feet” with a labral tear (Cleveland Clinic, 2018) and demonstrate “limited range of motion in the hip joint” (Mayo Clinic Staff, 2019).
What causes a labral tear in the hip?
There are many things that can cause a labral tear. The most common being: (Hospital for Special Surgery, 2021; Cleveland Clinic, 2018; Mayo Clinic Staff, 2019)
Repetitive motions through “wear and tear”
Injuries such as high and/or sudden impacts, sport injuries, motor vehicle accidents, etc.
Other conditions such as osteoarthritis, impingement, structural ailment, etc.
What does a hip labral tear look like on an MRI?
MRIs (magnetic resonance imaging) are imaging technology used to produce detailed images of the body’s soft tissue, in which dyes can also be injected to enhance those images (Cleveland Clinic, 2018; Mayo Clinic Staff, 2019). Although using dye may enhance images, not all come back accurate and hence, doctors will need to use their best clinical judgement (Washington University Physicians, 2017). On the other hand, accurate MRIs are able to show how severe the labral tears are, and thus used often (Cleveland Clinic, 2018).
Labral tears of the hip look as though a part of the labrum is missing or detached from the rest of it. Using an analogy, in an MRI, the labrum looks like a wrench that encapsulates the ball (the head of the femur). At the ends of the circular part of the wrench/labrum, from a sagittal view (viewing the body separated from the front and back), it typically looks like a triangle. With a tear in the labrum, typically this triangular section of the labrum is detached or sectioned off from the rest of the labrum.
How to treat/fix a labral tear in the hip?
Labral tears in the hip typically do not fully heal on their own, that would usually require surgery for full structural recovery (Cleveland Clinic, 2018). However, most people are comfortable with rehabilitating to the point where it does not cause discomfort. People can typically improve their symptoms by: (Hospital for Special Surgery, 2021; Cleveland Clinic, 2018; Washington University Physicians, 2017; Mayo Clinic Staff, 2019)
Taking medication such as nonsteroidal anti-inflammatory drugs (NSAIDs)
Visiting a physiotherapist (strengthening and/or flexibility exercises may be prescribed)
Getting steroidal injections
Rest
Surgery as a last resort
What to expect after a hip labral tear surgery?
Hip surgery can be done in 3 ways typically (Cleveland Clinic, 2018; Mayo Clinic Staff, 2019; Washington University Physicians, 2017; Hospital for Special Surgery, 2021):
Fixing the tear by stitching it back together
Reconstructing it by using healthy tissue from one’s 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 (Mayo Clinic Staff, 2019)
Usage of crutches after dischargement from the hospital for 2-6 weeks (Hospital for Special Surgery, 2021)
Involvement in physical activity and exercises tailored for acetabular labral surgery (i.e., graded return to work or sport; Hospital for Special Surgery, 2021; Washington University Physicians, 2017)
Can typically take up to 6 weeks before resuming previous physical activities/sports and/or full restoration (Hospital for Special Surgery, 2021; Cleveland Clinic, 2018; Washington University Physicians, 2017)
Avoiding pivoting and twisting activities near the beginning of recovery (Washington University Physicians, 2017)
Some may require hip labral surgery time off work
Hip labral tear exercises
Squats: standing with feet shoulder width apart, bend at both knees to make a 90⁰ (as though one is going to sit down on a chair) by sticking out one’s buttocks while keeping the back/spine as straight as possible
o Feet should be flat on the floor. Try to distribute the body weight over the entire feet rather than just the toes or heels.
o 10-12 repetitions, 2-3 sets
Squat walks: performing a squat with a resistance band tied around the thighs or ankles. When performing the squat, take a step to the side and then squat. Next, take a step and squat in the opposite direction (basically, squatting side to side).
o 5-7 repetitions per side, 2-3 sets
Balancing on one leg: while standing on both feet, try to raise one foot off the floor without falling over and/or losing balance (swaying from side to side, falling forward, and/or backwards)
o Depending on how stable one feels, they can hold onto a chair, table/counter, and/or a wall for support. Progression: From using both hands to only one hand. One hand to one finger and one finger to holding nothing. From nothing to eyes closed.
o Try to maintain balance for 30 seconds to 1 minute before progressing.
o Perform the exercise on both legs.
o 3 repetitions per leg, 2-3 times per day
Lunges: standing upright, take one step forward (lowering the body) by bending at the knee and keeping that leg bent at 90⁰. While doing so, the other leg will also be bending (the angle does not matter for this leg) at the knees (towards the floor) to balance.
o Try to keep the front leg’s knee behind the toes of the foot
o Alternate between each leg
o 10 repetitions per leg, 2-3 sets
Resistance band exercises: using a resistance band tied to something sturdy, tie the other end around one’s ankle. Keeping the leg straight, moving the legs at the hip joint, bring the legs forward, backwards, and to the sides.
o Can hold onto a chair to maintain one’s balance
o Examples of some sturdy objects: bed frame, legs of an elliptical machine, a table leg, etc.
o Perform each exercise per leg (forwards, backwards, and sides) 10-15 times, 1-2 times per day. Progression: after having increased the number of repetitions to 20 and it still feels easy, one can increase the resistance of the band
Summary
A labral hip tear is when there is a tear in the acetabular labrum. Labral tears of the hip may cause discomfort to individuals when performing minimal tasks and hence should get treated. People may develop tears as a result of injury, repetitive motions, and/or other health conditions. Most often, acetabular labral tears cause pain in the hip or groin region. When there is severe pain, it is advised that one seeks professional medical help. It is common to see drugs prescribed to help reduce the pain as well as booking an appointment with a physiotherapist. They may prescribe strengthening and/or flexibility exercises to help one cope with the symptoms. However, when the pain is persistent regardless of the treatment methods, surgery is the last resort. Although labral hip tears may be debilitating, one can recover optimally from them in approximately 6 months with the help of a trained practitioner.
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References
AskDoctorJo. (July 11, 2016). Hip Labral Tear Stretches & Exercises – Ask Doctor Jo [Video].
Youtube. https://www.youtube.com/watch?v=yZLMCAzKZz8
Cleveland Clinic. (2018, March 8). Hip Labral Tear. 100 Years Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17756-hip-labral-tear
Hospital for Special Surgery. (2021). Labral Tears of the Hip. HSS.
https://www.hss.edu/condition-list_labral-tears-hip.asp
Mayo Clinic Staff. (2019, December 20). Hip labral tear. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/hip-labral-tear/diagnosis-treatment/drc-20354878
Mayo Clinic Staff. (2019, December 20). Hip labral tear. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/hip-labral-tear/symptoms-causes/syc-20354873
Washington University Physicians. (2017).Hip Labral Tear FAQ’s. Washington University Physicians.