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Labral Tears and Hip Dysfunction Therapy

At Garner Pelvic Health in North Carolina, we aim to provide pelvic health education to our patients in addition to therapies that can help them. Here is a look at the difference between labral tears, hip arthroscopy, and hip arthroplasty, and how physical therapy can help heal after these procedures.

What Is The Acetabular Labrum? 

The labrum is the cartilage that provides shock absorbency and stability to the hip. It provides a 170-degree rim around the hip socket, increasing surface area and creating a “seal.” Research posits that loss of that seal leads to early joint degeneration and a high rate of joint replacement at the hip. The jury is still out on whether or not hip arthroscopy decreases the rate of hip replacements worldwide. 

Hip arthroscopy is the gold standard for hip preservation and for identifying and diagnosing labral tears. Diagnostic testing such as high-resolution MRI and MRA are the best technologies for diagnosing hip labral tears. X-rays are no help in diagnosing a labral tear. However, they can provide insight into joint space and integrity (the presence of potential osteoarthritis and early joint degeneration). 

How Can A Pelvic Physical Therapist Help? 

The first line of defense when people have hip pain, is often to go and see an orthopaedic surgeon. While that can be a good idea, a surgeon is looking for surgical candidates. A physical therapist is your best choice if you aren’t a surgical candidate. A physical therapist will diagnose and treat musculoskeletal “soft tissue issues” that occur with hip impingement and a labral tear. 

Hip arthroscopy is a much more involved surgery than a hip replacement (arthroplasty), so you want to ensure that you get to a pelvic PT trained in the orthopedic treatment of the hip. The pelvic girdle includes the hip, but not all pelvic PTs specialize in managing hip labral tears, impingement, and hip arthroscopy rehab, so it’s important to ask. 

We recommend seeing a skilled pelvic/hip PT specialist first, who can direct you to the top surgeons in the US, known for their expertise in hip arthroscopy. We do not recommend seeing a general orthopedic surgeon. Hip arthroscopy is an exclusive field, and surgeons trained in hip arthroscopy are the only surgeons we refer to for this procedure.

Medical Therapeutic Yoga in Greensboro, NC

What Are The Symptoms Of A Labral Tear?

Research cites mechanical complaints as the most common symptom of an acetabular labral tear, especially when standing after being seated. These symptoms can include: 

  • Snapping, popping, clicking, catching, and even giving way.

Other less reliable symptoms include: 

  • Groin pain
  • Buttock, back, sacroiliac joint, or knee pain 
  • Pain with prolonged activity such as sitting, standing, walking, or running 

How Does A Labral Tear Occur?

There are many causes for labral tears, including age and general degeneration, but it is generally accepted that those at higher risk for labral tears include: 

  • Pregnant women
  • People with hip dysplasia 
  • Those who participate in high-risk sports such as dance, gymnastics, hockey, football, soccer, and yoga 
  • And singular events like auto or skiing accidents where the hip is loaded, torsion is applied, or the hip is pushed past its normal range of motion.

What Is Hip Impingement?

Hip impingement can occur in CAM, Pincer, AIIS impingement, and ischiofemoral (IF) impingement. This post describes the typical CAM and Pincer types. The most common presentation is to have both types. See this post for more information about the less common and lesser-known AIIS and IF impingement types. 

How A Physical Therapist Can Help

A physical therapist may do various orthopedic tests. These tests will check the hip joint integrity and look for signs of a labral tear, impingement, pelvic floor issues, and low back and sacroiliac joint connections. There is also a neural and fascial connection between the vocal and respiratory diaphragms to the pelvic floor – so a pelvic PT should also be trained in evaluating the orofacial link to hip pain. 

Specialty clinics like Garner Pelvic Health will also have advanced therapy techniques such as Lumbopelvic Rehab Ultrasound Imaging to visualize the muscles and structures around the core, hip, and pelvic floor. These advanced techniques will help take the guesswork out of therapy prescriptions and accelerate rehab. 

They may also include or recommend treatments such as: 

  • Manual therapy
  • Dry needling 
  • Visceral mobilization 
  • Myofascial release
  • Therapeutic movements
  • Movement adaptations 
  • Prescriptive fitness for return to your chosen activities 
  • Pelvic floor therapy, because often sexual dysfunction and bowel and bladder issues can make hip pain worse 

Labral Tears Versus Other Types Of Hip Dysfunction?

Pain and anti-inflammatory medications (a diagnostic injection) will sometimes be injected into the hip (intra-articular injection). This may reduce symptoms temporarily, which helps determine if the problem is inside the hip joint. A 3D CT scan with pelvic reconstruction is also sometimes used to determine if there is dysplasia or impingement. However, it is essential to note that it can still be inconclusive or produce a false negative (meaning you do have it, but it didn’t pick it up). 

MRI (Magnetic resonance imaging), with an arthrogram. Contrast material will be injected into the joint space to see the tear more readily. Still, it can also yield false positives, especially if the labral tear is posterior (in the back of the joint. 

How Long Is The Recovery And Rehab Period For Hip Arthroscopy? 

Recovery and rehab times for hip arthroscopy can be as short as four months. If there are other conditions, such as a mother who just gave birth, recovery can take up to 18 months because there are multiple diagnoses to tackle. However, with good pelvic and hip physical therapy, there is no reason that you cannot completely recover and return to normal activities! 

What Is Hip Arthroplasty? 

Hip arthroplasty is a hip replacement. Recovery from replacement generally lasts for about six weeks, compared to arthroscopy, which is at least four months. The surgical techniques involved with hip arthroplasty have become more sophisticated over time. These advanced surgical techniques include:

  • Robotics for greater precision in the placement of the joint components 
  • The use of virtual reality in training new surgeons
  • 3D printing of patient-specific components 
  • And the development of dual mobility bearings (used in hip joint revisions due to instability). 

What Signs And Symptoms Lead Up To The Need For A Hip Replacement?

  • A marked decrease in your ability to move your hip
  • Pain and stiffness in the hip or immediate other areas, like the back or knee
  • Increased weakness in the hip joint and surrounding areas, and you may notice more limping over the sore hip and leaning to the side (Trendelenberg) when walking. 
  • Other leg deformities such as knock knees, bow legs, flat feet, or high arches can occur as the hip becomes more impacted.

How Can You Prevent Osteoarthritis In The Hips And Elsewhere In The Body?

Research well supports that chronic inflammation in the bloodstream can contribute to early joint degeneration. How do you prevent chronic inflammation? 

  • Eat an anti-inflammatory diet 
  • Stay at a BMI between 18-24 
  • Manage stress 
  • Prevent diabetes 
  • Move. Get at least 150 minutes of aerobic activity weekly, which equates to an easy 30-minute walk five days a week at a pace where you can talk but not sing. 
  • Lifting weights. This includes doing yoga (lifting your body weight) and Pilates, not just weight lifting. 
  • Minimize lifestyle factors that lead to chronic disease and pain
  • Keep hormones balanced 
  • Get good sleep

Contact Us Today For An Assessment

The staff at Garner Pelvic Health in NC are experts at helping you accomplish the goals above for minimizing your risk of osteoarthritis. Contact us today and we will be happy to provide you with an evaluation on your condition and help you reach your health goals.