Physical Therapy for Labral Tears
Feeling Hopeful About Hip Labral Tears
Hip pain in both the athletic and non-athlete population is a common complaint heard by orthopedic physicians and physical therapists. The hip joint is a ball-and-socket joint and is designed to move through a large range of motion. The labrum is a cartilaginous ring that lines the socket part of the joint also known as the acetabulum. The labrum acts almost like a suction cup holding the head of the femur in place while it moves in all directions. Injury to the labrum can be chronic or acute but when symptomatic, can cause pain and discomfort with both athletic and everyday activities. Physical therapy is considered to be the first line of treatment for labral tears and this article will describe this injury and as well as some of the exercises that are commonly used to manage symptoms of a labral tear.
WHAT DOES A LABRAL TEAR FEEL LIKE?
The symptoms of a labral tear can be mild or severe. They can come on suddenly and persist or present only during certain activities. In some cases, there are no symptoms at all. Oftentimes a labral tear causes a deep, aching sensation in the front of the groin where your underwear line is located. This pain is often worse upon standing and initiating walking after rest or prolonged sitting. You may experience this pain or even a pinching sensation in that area when you squat down or rotate the hip inward. Some people will notice a clicking or catching in the hip and stiffness in the joint. If the tear is severe or chronic, you may even notice some feelings of weakness or instability around the hip.
Because a number of conditions affecting the hip can present with similar symptoms, labral tears can be mistaken for other conditions or even misdiagnosed. In runners training at high volumes, for example, a femoral neck stress fracture should always be considered as these conditions may mimic one another but need to be treated differently. Other conditions that should be considered when these symptoms present are hip flexor strains, bursitis, osteoarthritis and even pelvic floor or pelvic pain syndromes.
WHO IS AT RISK FOR A LABRAL TEAR?
Labral tears are often considered to be a repetitive stress injury. This means that repetitive micro-stresses to the labrum results in the development of a tear over time. You may be able to pinpoint the exact moment that the tear worsened enough to become noticeable but there is a chance it was slowly developing and worsening over time. In many cases the presence of a labral tear is an incidental finding on hip imaging and may not cause any symptoms at all.
Repetitive performance of certain movements can place someone at higher risk for developing a labral tear. Running, deep squatting, twisting and cutting, for example, can put strain on the labrum and may cause it to tear. The presence of bony abnormalities on either side of the joint (hip impingement) may increase the likelihood that an activity like running or squatting will injure the labrum. Similarly, weakness or lack of motor control around the hip joint and even improper biomechanics with repetitive movements can increase the risk of tearing the labrum.
HOW IS A LABRAL TEAR TREATED
While surgery is recommended in some cases that don’t respond to conservative care, physical therapy is often the first line of treatment to address a torn labrum. Even if a surgical approach is eventually needed, a course of physical therapy to strengthen the hip and improve its mobility can make recovery from the surgery that much easier. When working with a physical therapist they may perform joint or soft tissue mobilization techniques to address pain and joint mobility but addressing strength and motor control around the hip and lower extremity is essential for long term improvement. While you may have to decrease or modify activities that are provoking symptoms in the beginning, the long term goal for labral tear rehab is to get you back to pain-free movement! With chronic labral tears symptoms may be aggravated intermittently but with a solid PT program you should feel confident that you can manage these symptoms.
An exercise program for labral tear rehabilitation should be individualized. The severity and irritability of your symptoms will dictate which exercises you start with but let’s take a look at some exercises that can be helpful in managing a labral tear long term. Note, these are more advanced exercises and you should talk with your physical therapist about where to start with your own recovery as they are not appropriate for everyone, especially those recovering from recent surgery!
Adductor Plank: This exercise is performed like a side plank but the top leg is resting on a bench while the lower leg rests underneath. By pressing the inside of the top leg into the bench, raise your hips and lower leg off the ground until your body is in a straight line. This exercise works the adductors or inner thigh muscles in both legs. To make this exercise easier, place the top knee on the bench so most of your lower leg is supported. To make this exercise harder, place only the ankle or foot on the bench.
Dead Bug with Resisted Hip Flexion: Tie a resistance band or loop around your feet. Lie on your back with your knees and hips bent to 90 degrees and arms parallel and pointed toward the sky. To begin the exercise extend one leg out away from your body and toward the ground while extending the opposite arm overhead. Bring the arm and leg back to the starting position and perform this movement with the other arm and leg. Continue to alternate sides until the desired number of repetitions is reached. Contract your abdominals to limit arching of your spine as you lower the leg. The resistance band on the ankle will challenge the hip flexors on the stationary leg to keep the hip flexed.
Standing Kettlebell Hip Flexor March: Standing on the edge of a step or box with one foot, slide the opposite foot into the handle of a light kettlebell. Flex this hip to raise the knee to hip height with the kettlebell hanging below your foot. Slowly lower the kettlebell back to the floor. Make sure to keep your pelvis level as you raise and lower the kettlebell. Hold on for balance if needed or challenge your balance by performing this activity without a hand hold.
Box Squats: Squatting may provoke symptoms early on in labral tear rehabilitation but there is still a great deal of benefit from performing a squat. Sit on a box or bench that is low enough to feel challenging but not provoke a pinching or painful sensation in the hip. Bend forward at the waist to rise to a standing position then slowly lower back to sit. Hold onto a dumbbell or kettlebell for added resistance and challenge.
We hope this article has helped you feel more knowledgeable about hip labral tears and reassured you that this condition can often be managed with a great physical therapy protocol. If you have a labral tear and are looking for ways to manage your symptoms and get back to pain-free activity, schedule an evaluation with one of our physical therapists to get started on your recovery today.
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