What Is a Hip Labral Tear?
A hip labrum tear is a tear of the labrum in the hip joint. The labrum is a type of fibrocartilage that surrounds the rim of the socket or hip socket. These soft tissues in the hip joint work to deepen the hip socket joint and stabilize the hip. Hip labral tear symptoms lower back pain is a common symptom of labral tears.
The hip socket is composed of the head of the thigh bone, also known as the femur and the acetabulum of the pelvis. An acetabular labral tear is more common than you may think. Approximately 22-55% of people with groin pain have underlying tears of the acetabular labrum. This post outlines the best physical therapy exercises to perform after a labrum tear.
Pathologies of Hip Labral Tear
It is important to note that many labral tears are due to other pathologies such as femoroacetabular impingement and hip dysplasia.
Femoroacetabular impingement or FAI is characterized as a bony overgrowth in the hip joint. This bony overgrowth can occur in the femoral head or the acetabular rim. An overgrowth in the femoral head is called Cam impingement. An overgrowth in the acetabular rim is called Pincher impingement.
Hip impingement is associated with very similar symptoms to symptoms of a hip labral tear. These include pain/stiffness in the groin area or front of the hip. This pain is worsened when a combination of hip flexion and hip internal rotation is performed. This “pinches” the hip and causes pain.
Hip flexion is the action of bending the hip forward. Internal rotation is the action of rotating the hip inward towards your body. Conservative treatment of femoroacetabular impingement is treated very similarly to that of labral tears.
This conservative treatment involves physical therapy and a licensed physical therapist performing an evaluation.
Hip Dysplasia
This occurs when the hip socket is essentially too small or shallow for the head of the femur. This causes the hip to not be aligned properly. This causes the hip joint to frequently become dislocated. Hip dysplasia is typically diagnosed at birth.
Hip dysplasia can cause hip labral tears. When hip dyplasia causes a labral tear, they are usually treated by addressing both pathologies. Nonsurgical treatment is usually the first course of treatment. This includes physical therapy focused on improving the stability of the hip socket.
What Causes a Hip Labral Tear?
A torn labrum is typically caused by repetitive stress or repetitive motion of the hip joint. This is most common in runners. Another way hip labral tears can occur is due to structural issues such as femoracatebular impingement and dysplasia.
The third way a hip labral tear occurs is due to trauma such as a car accident or a contact sport, such as football or ice hockey. A hip labral tear can lead to hip arthritis later in life.
Symptoms of a Hip Labral Tear
Symptoms of labral tear can be very uncomfortable. The most commons symptoms of a labrum tear are:
- Sharp pain in the groin
- The pain may feel like a groin strain
- Hip, butt, or low back pain.
- The groin pain is typically exacerbated when walking or running.
- hip stiffness and a decrease in range of motion
- The hip also may begin to click or catch when the hip moves with a labrum tear
- It is important to note that sometimes a hip labral tear has no symptoms at all.
Hip Labral Tear Symptoms Lower Back Pain
People with labral tears typically have tight hip flexors. These tight hip flexors can pull the pelvis forward. You body may attempt to compensate by overusing the low back muscles. This can cause lower back pain and tightness.
The best way to conservatively treat this lower back pain is through core stability and lower extremity strengthening exercises. You can find 7 Miraculous Exercises For Lower Back And Hamstring Pain here.
Difference Between Hip Bursitis and Labral Tear
Hip bursitis is when the bursa in the hip becomes inflamed and painful, while a labral tear is an injury to the labrum or cartilage that lines the hip joint. Although both of these conditions are painful, they do present in different ways.
In hip bursitis you will have pain mostly localized to the lateral or side of the hip. The pain is typically worsened with with prolonged walking, climbing stairs, standing up from a chair and lying on the affected side.
In a labral tear you will have pain in the groin and hip region. The hip may lock or catch when you try to move and you will most likely have a lack of range of motion or mobility in the hip.
Hip Labral Tear Exercises To Avoid
Any aggressive exercises or activities that will place excessive force on the hip joint should be avoided in the early stages of recovery. This includes:
- Jumping
- Pivoting
- Running
- Excessive hip extension especially with resistance
Hip Labral Tear Recovery Without Surgery
Although hip labral tears do not heal on their own, it is possible to recover after a hip labral tear without surgery. People with smaller labral tears who do not have large decreases in range of motion and symptoms of catching in the hip typically are able to recovery without surgery.
The timeline for hip labral tear recovery without surgery will vary depending on your symptoms.
How To Treat Hip Labral Tear Symptoms Lower Back Pain
There are a few treatment options of a labral tear. The first option is to treat it with nonsurgical treatment. This includes rest, anti-inflammatory medications, a hip injection and physical therapy.
The other option is to treat the labrum tear with surgical interventions. Any type of surgical procedure will include a physical examination by an orthopedic surgeon prior to surgery. This will allow the orthopedic surgeon to evaluate the patient and determine which treatment option is best. Most orthoepdic surgeons will recommend to try nonsurgical treatment first.
If the labrum tear is too severe for conservative treatment such as physical therapy, the orthopedic surgeon will suggest a hip arthroscopy. During this arthroscopic surgery, the surgeon will make a series of small incisions to the hip. The surgeon will then repair the joint capsule removing frayed pieces of the labrum and stitching the tear back together.
Exercises For Hip Labral Tear
The types of exercises that you are able to perform will depend on the severity of your labrum tear and the precautions, if any that your doctor gave you. Your physical level will also impact the exercises that you are able to perform. Some of these exercises involve balance.
If your balance is poor it is important to stand near a sturdy surface or physical therapist or trained medical professional for safety. Listen to your body. Muscle fatigue is ok but if your hip begins to hurt stop or modify the exercise.
Physical Therapy Exercises
Standing Strengthening Exercises
- Standing Hip Extension With Resistance Band
- Stand with your feet hip width apart. Place a resistance band around your ankles. Now balance on one foot and slowly kick your opposite leg back while keeping your leg straight. Now slowly bring your leg back to starting position.
- Try not to let the resistance band “snap” you back to the starting place. Instead use your muscles to slowly control bringing your foot down.
- If this is too hard or painful then perform this without the resistance band. If it is still too difficult then hold onto a sturdy surface as needed and perform exercise.
- Standing Hip Abduction With Resistance Band
- Start in the same position as the previous exercise with your feet hip width apart and a resistance band around your ankles. Now balance on one foot and slowly kick your opposite leg out to the side. Now slowly bring leg back to starting position.
- Mini Squats
- Stand with feet hip width apart and slowly bend your knees and hips back. Do not allow your knees to translate forward. Perform mini squat to comfortable depth and then stand back up to starting position.
- Be sure to evenly apply weight to both legs. This exercise is most beneficial to perform in front of the mirror so that you are able to see if you are leaning to one side and not bearing weight evenly on both legs.
- Lateral Lunge
- Stand with your feet hip width apart. Now lift up your left leg and perform a lunge to your left. Keep your toes pointing forward throughout the entire lunge. After you perform the lunge. Push off hard on your left leg and return the left foot to starting position. Perform this on each leg.
- This exercise strengthens your hip abductors or gluteus medius and minimus. If this exercise is too difficult or painful it is ok to perform a “mini lunge” to a smaller depth. You are still strengthening the muscles of the hip joint with a smaller range of motion!
- Side Steps
- Stand with your feet facing forward and a slight bend in both of your knees. Maintain this bend in your knees and perform side steps to one side. Your trunk should not be moving from side to side with this exercise. All of the motion is coming from the hips.
- If this exercise is too easy place a resistance band around your ankles or knees and perform the exercise. A resistance band around the knees will be slightly easier than a resistance band around the ankles.
- If this exercise is too hard, or balance is an issue you can perform this near a support surface and hold on as needed.
Stability/ Balance Exercises
- Single Leg Balance
- Stand on affected hip and balance for 30 seconds. You should feel your hip and your ankle making small movements to work to maintain your balance.
- If this is too hard you can perform a modified single leg stance with one leg on the ground and the other leg on a step higher than the ground. This will force your lower leg to bear more weight. Make sure that if you perform this modification you do not shift all of your weight forward to your front, higher leg.
- If single leg balance is too easy for you then stand on an airex pad, foam pad or dynadisk to create more instability. If it is still too easy then perform this exercise while closing your eyes. You can find 11 Creative Dynamic Balance Exercises To Improve Stability In Seniors here.
- Single Leg Deadlift
- Stand with your feet hip width apart. Now slowly lean forward, shifting your weight to one leg. This will cause your back leg to slowly extend behind you. Keep your back leg straight.
- It is important to keep your back in a straight line throughout this entire exercise. Do not just bend down and fold your back.
- In the ideal situation your back and back leg should be almost parallel to the ground at the end position. Obviously you are performing this exercise after a hip injury. You may not have the range of motion, strength or stability to perform this exercise perfectly. That is ok!
- The important thing is to perform this exercise within you tolerable range and focus on good form within that range.
- Bird Dog
- Start on your hands and knees. Make sure your hands are directly below your shoulders and your knees are directly below your knees. Tighten your abdominal muscles and reach forward with one arm and kick your opposite leg back. Bring your leg and hand back to starting position. Now perform with your other arm and opposite leg.
- It is important to avoid rotating your hips with this exercise. Your hip should be facing straight down throughout the entire exercise. The hips should also be flat, so if someone were to place a plate on your back it should theoretically stay balanced on your back.
- This exercise is great because it strengthens the core, stabilizes the hips and strengthens the hip all at the same time. Since you may be performing this exercise after a hip labral tear it is important to not force the back leg back too far. This motion is called hip extension.
- Although hip extension is ok to perform after a labrum tear, you do not want to perform excessive or forced hip extension. If you feel pain, simply perform this exercise in a smaller range.
Mat Exercises
- Clamshells
- Lie on your side with your hips stacked on top of each other and your feet on top of each other. Now lift your top leg up without lifting your feet. Make sure that you do not rotate your hips as you move with this exercise. Now slowly bring your top leg back to beginning position. This exercise strengthens your hip external rotators and helps to stabilize your hips.
- Single Leg Bridge
- Start by lying on your back with the affected leg bent and your other leg straight. Now squeeze your butt and abdominal muscles and lift your butt off of the mat while keeping your “good” leg straight. Pause at the top and then slowly lower yourself back down to the mat.
Summary of Hip Labral Tear Symptoms Lower Back Pain
The good news is that hip labral tear symptoms lower back pain is treatable. All symptoms of a labral tear are treatable. It is possible to achieve full pain relief after a labrum tear. It is important to see your doctor and have a proper physical examination in order to diagnose you if you are having hip labral tear symptoms.
If you do in fact have a hip labral tear and your doctor recommends a nonsurgical treatment, make sure to listen to your physical therapist. The goal is to strengthen and stabilize your hip muscles so that you can live a pain free life and get back to the activities that you love!