What is a hip labral tear?

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 are common causes of 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.

Where does it hurt?

In most cases of hip labral tears, the patient will report groin or anterior hip pain. To be specific, they will point to the front of the hip area and report that it feels like something is pinching. Some may even report sharp groin and inner thigh pain. Because of this, it’s possible to feel pain of an injury in other parts of your body. This is called referred pain. Understanding the root cause of your pain is fundamental to treating your pain in the long run & will decrease your dependence on painkillers or treatment that only addresses the symptoms.

What are common symptoms of a hip labral tear?

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

Can a hip labral tear be treated?

Yes, hip labral tear pain can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries if you can address it early enough. If it’s a huge traumatic labral tear then maybe you need surgery, but most non-traumatic tears can resolve. The key to treatment is to solve the root cause of your pain so you can get the best results and a long-term outcome.

Some root causes of hip labral tear pain can be:

• Decreased hip range of motion
• Poor posture in sitting
• Hip arthritis
• Weak hip and glute muscles
• Poor lifting biomechanics
• Sports injury or trauma
• Hip flexor problems
• Leg length discrepancy
• Previous leg or hip injury
• Tight low back and hip joints
• Poor biomechanics at work
• Too much sitting

If you have failed multiple treatment approaches already, your clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. What do I mean by this? Say your fire alarm goes off in your house. Its purpose is to protect you and make you aware that something is wrong, i.e., that there is a fire in your house. The “alarm” is like your pain (your body’s way of telling you something is wrong) and the “fire” is the root cause. When the fire alarm goes off, you don’t run upstairs and just turn it off, right? You run through the house with the fire extinguisher, trying to find the room where the fire is at. You try to find out what caused the alarm to go off so you can put it out. Once the fire is out, then the fire alarm can go off. Solve the “root” cause of your pain, and then the pain (“the effect”) eventually goes away.

Additionally, there is a common root cause which many clinicians misdiagnose. They treat the hip pain with a cookie cutter approach, hoping it will work and treat it as a simple muscle problem. They tend to rely on stretching, ultrasound, massage and focus treatment directly on the hip joint. However, often the root cause is missed and the symptoms return. If you have failed multiple hip treatments and still have hip pain, then maybe it’s not just a hip problem? There is probably something else adjacent to the hips that is overloading or stressing the hip to cause your pain. So many healthcare clinicians treat pain like this and thus show poor treatment outcomes which results in the pain coming back. Why? They missed the root cause of your hip pain. This is also the case when patients turn to injections, nerve blocks and other surgeries which are still not effective because the actual problem still is not solved, their treatment was just chasing the pain.

The first step in treatment is to identify the root cause of your pain. A specific and individualized treatment approach for your type of pain can lead to a successful outcome for you and resolve your symptoms for the long term. This is why you can’t rely on a standard cookie cutter approach; you need a customized and individualized treatment approach specifically for your type of hip labral tear pain.

“I wish I could give 10 Stars! Let me tell you, they have exceeded my expectations and I felt better much sooner than I ever thought I would. In just one session she alleviated my hip pain. Now, two months later and I don’t have reoccurring hip pain anymore. I am walking, jumping, and back to my normal workout routine, PAIN FREE!“

Megan
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What happens if it goes untreated?

Minor case – If it is a minor case of pain from a hip labral tear, research shows that many acute cases of pain may spontaneously go away in 4-8 weeks. The key to prevent from becoming a more severe chronic case is to solve the root cause of the hip pain and determine what actually is causing it. The labral tear may be a false positive. Meaning, its a positive finding but not causing your hip pain. You may have had it before your hip pain started and it may not be the root cause. But who wants to wait 8 weeks to get pain free? Let’s try to solve the root cause of your pain in 2-3 weeks and address all of the risk factors present (so it never returns!) and get you back to your favorite activities faster! We still recommend that you get it checked out by a one of our board-certified physical therapists to ensure that it is just a minor case, to solve all risk factors, and to get the optimal outcome in the fewest visits needed. Most minor cases resolve on their own in time, or get better with some stretching and strengthening. But, the sooner you take action, the sooner you are pain free. (And research supports this!)

Severe case – If it’s more of a severe and chronic case of hip pain from a labral tear, your pain will probably start to worsen and increase because the root cause and underlying risk factors of the pain are not being treated. Many people turn to pain medication and injections at this time but this only blocks the pain for short term. You may not feel the pain when taking pain medications, but the underlying problem is still there. Many people say after the pain medication is stopped, then usually the pain returns and sometimes it returns even worse. This is when you may experience hip popping, groin pain, lateral hip pain, or buttock pain. Sitting, bending forward, lifting, and driving all increase your pain now. If the hip pain continues to worsen, you may start experiencing difficulty walking, be unable to run or golf, and you may get sitting groin pain now. A sharp front hip pain may be experienced when you move from sitting to standing. Once the root cause is addressed, then we can start decreasing your pain, regardless of how chronic and severe the pain is. This is the crucial first step. It just may take more time to recover from a chronic case. Usually with chronic and severe cases, the longer you have your pain and injury, the longer it takes to resolve. If you fail conservative treatment and all treatment approaches has been exhausted then you may need to consult an orthopedic surgeon for surgical options.

What outcome can you expect from treatment?

As we’ve discussed, the first step is to solve the root cause of your hip labral tear. This is the most essential step to plan a treatment specialized for you and your unique type of pain. Your root cause will guide your treatment and dictate what is the best way to treat your pain. This, along with identifying risk factors that may be predisposing you to have your pain and injury, will allow you to start getting pain free again. The next step is to start decreasing pain, modifying activities, and start addressing all of the impairments causing your pain which we discovered during your evaluation. With each session, pain should start to decrease and you should start to regain range of motion with less pain and symptoms. Any radicular and referred pain should resolve fast as well. At this point, we begin light and basic strengthening only if it does not increase pain. Treatment will consist of a lot of manual therapy and light exercises.

The next step is to achieve full range of motion, (which should correlate to being pain-free) and now we can start progressive strengthening. Strengthening the muscles is crucial and research shows that this gives you the best long-term outcome! As you start to get stronger and maintain your mobility, your pain will continue to decrease if it is not already gone. Your increased strength will allow you to perform more activities and prevent flare-ups. This usually does take up to 4 weeks. As you clear our goals, then we can start easing you back into sport, golf, running, and whatever your favorite activities are. This is when we start winding down treatments and getting you back into functional strengthening, sport specific training, return to run programs, golfing, and whatever your goals are. In the end, we reassess everything, making sure we achieved all of our goals, your goals, that all risk factors are gone, and finalize your long-term home exercise program. There are many factors which can influence your outcome, but 85-90% of our patients respond well to our treatment approach and achieve a successful outcome when completing their plan of care.

How is it 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.

Do you need an X-ray and MRI imaging for hip labral tear?

For most common orthopedic cases, imaging is not needed and the diagnosis can be made with a simple physical therapy evaluation. No need to waste thousands of dollars on unwarranted diagnostic imaging. We also have clinical tests which we can perform to help rule in and rule out pathologies that correlate to MRI findings (which is WAY cheaper than an MRI!). An expensive MRI may just tell us what we already know. Also, often times the positive findings found on x-rays, MRIs, and EMGs may not actually be the root cause of your pain. What does that mean? Many positive findings on an MRI are also found in asymptomatic (pain-free) individuals, so diagnostic imaging may not be able to tell us what is actually causing your pain. For example: many people have a herniated disc in their low back but do not have any low back pain. So if herniated discs can cause no pain, just because someone with low back pain has a herniated disc does not mean that is what’s causing their pain. The key is to find out if your clinical evaluation findings during your evaluation at Pursuit match the MRI findings. If so, then we can decide what is the best way to treat it.

How can a Physical Therapist treat it?

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.

“After at least three years of doctor-hopping […] looking for someone to alleviate my constant dizziness and neck pain, I finally found Dr. Miller. I have more energy and less pain, and have halved my dependence on painkillers. He shouldn’t be the last stop on your road to recovery, he should be the first.”

Lisa B.
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How long does it take for recovery?

Recovery time for hip labral tear depends on multiple factors:

• The severity and chronicity of your pain
• Whether your pain is an easy or complex case
• If the root cause of your pain was solved or if it was missed (this is the key to getting a great recovery!)
• How long you have been in pain for and when you need to be pain-free by
• Other therapies and treatments you have tried
• Which medical professional(s) you saw prior to seeing us
• How active you are in trying to resolve your pain
• Which treatment approach is chosen and if it is proven to work for your pain

There are many factors that influence your recovery time and every patient’s recovery time is different. If you do nothing and don’t pursue treatment, it could gradually get better on its own, you could continue to have the same pain persist, or it could continue to get worse. As stated earlier, most acute cases may or may not resolve in 4-8 weeks. If you get expert treatment that solves the root cause of your pain, some cases resolve in 1-3 weeks! Then you can get back to sports, exercise, and your favorite activities without flare-ups and recurrences. Some of our patients are pain-free in 1-3 visits and back to 100% in 2 weeks!

If it is a complex case with chronic pain, your recovery may take longer, but you can still get a good outcome. Some chronic cases can resolve as fast as 2 months but can take as long as 4-6 months. It varies with every patient because every case of hip labral tear is different. Every patient’s recovery varies depending on the factors listed above. After a thorough evaluation here at Pursuit Physical Therapy, you will know your exact timeline of recovery, your prognosis, and when you should reach your goals.

How much does it cost?

The average cost of care for a case of spine pain in the US is $1800-$6600. This high price is due to many factors: the over-inflated cost of healthcare, the over expensive cost of unwarranted imaging (x-rays, CT scans, and MRIs) that is not needed, over-utilization of care (which increases the number of visits needed to be treated, requiring multiple visits to different doctors and physical therapists for the same diagnosis), and getting billed for unnecessary and unproven treatments that you don’t even need. All of these factors increase cost and this is why healthcare is so expensive. We strive to end that unnecessary, expensive cycle. In fact, we are currently publishing our first-year data with the University of Central Florida that shows the cost-effectiveness of our treatment approach.

This year, the average cost of our care was shown to be $814-$1141. Some of our patients get even as low as $315 for the full treatment! So if you have a deductible of $3,000-$10,000 and you have to pay out of pocket for your treatment, we can save you lots of money.

Remember, every case of pain is different and not all pain from a hip labral tear is the same. It is hard to predict exactly how much your treatment is going to cost you. But after a thorough evaluation, we can tell you exactly what is causing your pain, how long it is going to take, what the best way to treat it will be, and exactly how much it is going to cost. We have no hidden fees, no co-pays, and no miscellaneous bills that you will be surprised by 3 months after you receive treatment. Your pain, your diagnosis, your goals, and what is best for you dictate your treatment and how much it will cost, and while it varies for every patient, treatment at Pursuit is still much more affordable than standard healthcare.

How long are sessions?

Our evaluations are always one-on-one with one of our board-certified specialists and 60-90 minutes long. We like to perform thorough evaluations so we can solve the root cause of your pain, identify all risk factors, and make sure that we do it right. After the evaluation, you will know your diagnosis, the root cause of why you have your pain and symptoms, your prognosis, an expected timeline of when you should see results, what the best way to treat your pain is, how much it will cost, and your expected recovery outcome. We want you to fully understand everything about your pain and injury. What is best for you and will get you the best outcome is what will dictate your care and treatment. There will be plenty of time for you to ask questions so we can make sure you fully understand why you have your pain and what the best way to treat it will be. After the evaluation is completed, all treatment sessions are 60 minutes going forward and still one-on-one with your physical therapist. You and your physical therapist will design a customized treatment plan that works for you and that will achieve your goals.

How can it 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.

What are the next steps?

Getting started is simple. The first step, and the key to getting you pain-free again is to solve the root cause or your case of pain. Remember, not all pain is the same. Your pain is different than someone else’s pain, even though it may be in the same area. If you’re ready to get pain free, give us a call at (407) 494-8835 or fill out the form below. The next step is to schedule your evaluation so we can solve the root cause for you. We’re happy to answer any questions you may have and we would love the opportunity to help you.