Understanding the anatomy of the hip and the labrum can help shed light on why these injuries occur and how physical therapy can be beneficial in addressing them. The hip joint is a ball and socket joint. The head of the femur is the ball and the acetabulum of the pelvis is the socket. The structure of a ball and socket joint allows for multiplanar movement of the hip. Hips can flex forward and extend backwards, rotate inwards and outwards and swing out to the side and in toward the middle along with any combination of these movements. The high degree of mobility in the hip joint allows you to perform all of the different movements you do with your legs throughout the day.

The labrum is a cartilaginous ring that lines the outer rim of the acetabulum. The labrum not only creates a seal around the joint but provides stability and shock absorption and assists in creating smooth movement between the head of the femur and the acetabulum. In some instances, the labrum can tear away from the bony structure underneath. Sometimes this tear goes unnoticed and remains asymptomatic, only to be discovered incidentally on imaging for an unrelated issue. Other times, however, stress applied across the area of the tear can result in the classic symptoms of a labral tear.

WHAT CAUSES THE LABRUM TO TEAR?

In many cases labral tears are considered a repetitive stress injury. This means stress applied repeatedly over time has weakened the structure of the labrum which eventually leads to the tear. Some examples of repetitive movements that may lead to a labral tear are as follows:

• Running.
• Cutting.
• Twisting.
• Deep squatting.

Additionally, there are other many other factors that may contribute to the development of a labral tear in the hip such as these:

• Bony abnormalities on either side of the joint (hip impingement).
• Hip muscle weakness.
• Decreased coordination and motor control around the hip joint.
• Improper biomechanics with repetitive movements.

If you decide to work with a physical therapist to help correct your labral tear issues, your entire treatment plan could consist of around 8-20+ different physical therapy for back pain sessions that will each last 60-90 minutes. Once you complete your customized back pain physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your back pain PT sessions yet in the comfort of your own home.

WHAT ARE THE COMMON SYMPTOMS OF A LABRAL TEAR?

Signs and symptoms that are suggestive of a labral tear are as follows:

• A deep ache in the front of the groin, often worse upon standing and initiating walking
• Painful pinching or ache with deep squatting
• Pain with end range flexion and internal rotation of the hip
• Painful clicking or catching in the hip
• Stiffness in the hip
• Feelings of weakness or instability around the hip

A person with a labral tear may experience symptoms:

• Never
• Only with certain movements or activities
• In recurrent bouts with resolution of symptoms in between
• Constantly

The frequency and intensity of symptoms often plays a role in whether someone chooses to seek care. A tear that is rarely symptomatic or only during activities that are easily avoidable may not warrant treatment, however, if symptoms are impacting daily life and function it is time to seek out help from your local physical therapist.

PHYSICAL THERAPY AS A TREATMENT FOR LABRAL TEAR

It is important to acknowledge that physical therapy cannot repair the tear in the labrum. In fact the labrum does not heal itself. In cases of large tears, very symptomatic tears and those that have not responded to physical therapy, surgical intervention to either trim or repair the labrum may be indicated. Following this kind of surgery there is often a period of modified weight bearing followed by several months of physical therapy to help the tissues heal and facilitate a return to full activity.

• Improve strength, motor control and coordination in the muscles surrounding the hip joint to decrease stress across the tear.
• Optimize mobility in the hip joint and adjacent joints to decrease stress and loading across the tear.
• Address errors in biomechanics or discuss modifications to movement patterns to decrease load across the injury site.
• Discuss training type and schedule to decrease symptom intensity and frequency.
• Advise you on how to gradually return to activities that were previously problematic.