Clicking in Hip

Hip labral tears occur when the labrum, a band of cartilage surrounding the hip joint, is injured. Labral injuries can be the result of trauma, such as a fall or a car accident, but are most commonly caused by repetitive trauma to the hip joint. Individuals who participate in sports that require extremes of motion, such as figure skating, repetitive twisting and “cutting,” like hockey or soccer, or long-distance running are most often diagnosed with labral tears. To treat the symptoms associated with a labral tear, physical therapists typically prescribe a combination of stretching and strengthening activities to decrease irritation in the hip.

What is a Hip Labral Tear?

A hip labral tear occurs where there is damage to the labrum within the hip joint. The hip joint is where the thigh bone (femur) meets the pelvis (Ilium). It is described as a ball-and-socket joint. This design allows the hip to move in several directions. The bony socket is surrounded by a ring of cartilage called the labrum. The labrum provides additional stability to the hip joint.A labral tear results when a part of the labrum separates or is pulled away from the socket. Most often, a labral tear is the result of repetitive trauma to the hip, either due to running or repeated twisting and cutting.The consequences of repetitive stress can be magnified in a hip with bony abnormalities. Hip impingement is a condition involving abnormal bony contact between the ball and socket. As the hip is moved into specific positions, this bony contact occurs, placing increased stress on the labrum. (See “A Physical Therapist’s Guide to Hip-Impingement.”)Hip labral tears may result from a combination of several different variables, including:

  • Bony abnormalities in the hip joint (hip impingement)
  • Hip muscle tightness
  • Hip muscle weakness
  • Improper technique with repetitive activities
  • Participation in sports that require distance running, or repetitive twisting and cutting

Once torn, the labral tissue in the hip does not have the ability to heal on its own. There are surgical procedures to remove or repair torn labral tissue; however, treatment for a labral tear often begins with a course of physical therapy.

Nonsurgical treatment efforts are focused on addressing symptoms by maximizing the strength and mobility of the hip to minimizing the stress placed on the injured area. In certain cases, patients are able to achieve a satisfactory level of activity without surgery.

Surgical interventions are available to clean out the hip joint, and repair or reconstruct the torn labral tissue. Following surgery, patients will complete several months of physical therapy to regain function of the hip.

How Does a Hip Labral Tear Feel?

Pain in the front of the hip or in the groin resulting from a hip labral tear, can cause an individual to have limited ability to stand, walk, climb stairs, squat, or participate in recreational activities. You may experience:

  • A deep ache in the front of your hip or groin, often described by the “C sign.” (People make a “C” with the thumb and hand, and place it on the fold at the front and side of the hip to locate their pain.)
  • Painful clicking or “catching” with hip movements. This creates the feeling of something painful stuck in the hip or blocking hip motion.
  • Pain that increases with prolonged sitting or walking.
  • A sharp pain in the hip or groin when squatting.
  • Pain that comes on gradually rather than with 1 specific episode.
  • Weakness in the muscles surrounding the hip.
  • Stiffness in the hip

How Is a Hip Labral Tear Diagnosed?

Your physical therapist will review your medical history and complete a thorough examination of your hip, and possibly your lower back and knee. The goals of the initial examination are to assess the degree of the injury, and determine the cause and contributing factors to it. A hip labral tear may be the result of a single injury, but most likely is a condition that develops as a consequence of repetitive irritation in the hip.Your physical therapist will assess the mobility and strength of your hip, and may watch you walk, step onto a stair, squat, or balance on 1 leg. Your physical therapist will also gently touch the front, side, and back of your hip to determine exactly where it is most painful.Your physical therapist may also ask questions regarding your daily activities—most importantly, activities that aggravate and relieve your symptoms. Your physical therapist will also ask about your exercise regimens and footwear, to identify other possible contributing factors to your pain.Your physical therapist may also refer you to an orthopedic physician who specializes in hip injuries for diagnostic imaging (i.e., x-ray, MRI). An x-ray helps to identify any bony abnormalities, such as hip impingement that may be contributing to your pain. An MRI helps to identify a labral tear.

How Can a Physical Therapist Help Treat a Hip Labral Tear?

When you have been diagnosed with a hip labral tear, your physical therapist will work with you to develop a plan to help achieve your specific goals. To do so, your physical therapist will select treatment strategies in any or all of the following areas:

  • Pain management. Many pain-relief strategies may be implemented; the most beneficial with hip pain is to apply ice to the area and decrease or eliminate specific activities for a certain length of time. Your physical therapist will help to identify specific movements or activities that continue to aggravate the inside of your hip joint. Your physical therapist then will design an individual treatment plan for you, beginning with a period of rest, and gradually adding a return to certain activities as appropriate.
  • Movement re-education. Your back and hip may be moving improperly, causing increased tension at the hip joint. Self-stretching techniques may be applied to the lower body to decrease tension and help restore normal motion in the back, hip, and leg. There are, however, certain hip motions to avoid following an injury to the hip labrum. Your physical therapist will carefully prescribe exercises that improve your range of motion, while protecting the area that has the labral tear.
  • Manual therapy. Your therapist may apply hands-on treatments to gently move your muscles and joints to decrease your pain and improve motion and strength. These techniques often address areas that are difficult to treat on your own.
  • Muscle strengthening. Muscular weaknesses or imbalances can be the cause or the result of hip pain. Based on your specific condition, your physical therapist will design a safe, individualized, progressive resistance program for you, likely including your core (midsection) and lower extremity. You may begin by performing strengthening exercises lying on a table, for example, lifting your leg up while lying in different positions. You then may advance to doing exercises in a standing position, for example, stepping on and off a raised platform. Your physical therapist will choose what exercises are right for you.
  • Functional training. Once your pain, strength, and motion improve, you will be able to safely transition back into more demanding activities. To minimize tension on the hip, it is important to teach your body safe, controlled movements. Based on your own unique movement assessment and goals, your physical therapist will create a series of activities to help you learn how to use and move your body correctly and safely. Your physical therapist will also discuss specific positions and activities that should be avoided or modified to protect your hip.
  • Education. Your physical therapist will work with you to identify and change any external factors causing your pain, such as exercise selection, footwear, or the amount of exercises you complete. Your physical therapist will develop a personal exercise program to help you return to your desired activities.

Can a Hip Labral Tear be Prevented?

Maintaining appropriate lower-extremity mobility and muscular strength are the best methods for preventing a hip labral tear.Unfortunately, the way the hip and pelvis bones of some individuals are structured, the risk of sustaining a labral injury can increase. It is imperative to be aware of any hip pain that you experience, particularly with sitting and squatting, as these are signs of a potential hip injury. Identifying and addressing these injuries early is helpful in their treatment.
References:
http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=fabdfb4e-5fb5-4077-b341-df5d04a93605#.VW841M_BzGc