Not long ago, I found myself discussing hip labral pathology with a dear friend. She had recently been diagnosed with an acetabular labral tear of her hip.

 

Her symptoms were pain in her hip with running and strength training exercises.

 

When I asked her if she thought she could get better with conservative treatment strategies (like physical therapy), her answer was a devastating: “no.”

 

Unfortunately, the belief that hip labral tears are unrecoverable, is all too common. Once we’ve obtained the diagnosis of acetabular hip labral tear via MRI imaging, it can be very difficult for an athlete (or an active person) to manage on their own [1].

 

Before we go on, it is important to understand that you can recover from this injury via conservative treatments. It is even more likely you will recover if you BELIEVE can recover. And it is a major bonus if you have the right people in your corner coaching you in that direction [1]. 

 

Let’s dive in and learn a bit more about hip labral tears.

 

How common are hip labral tears?

 

Hip labral tears are pretty darn common. Several studies have demonstrated that if we just plop a group of pain-free (known as ‘asymptomatic’ in the research) people from society under an MRI, roughly 60-70% of them will have an acetabular labral tear [2,3]. 

 

When you start to look at this prevalence in highly active or sporting individuals, that number jumps to an impressive 80% [2]. That’s roughly 80% of symptom-free athletic folks walking around with changes to the tissues in their hips.

 

It appears that some folks in society can have an acetabular labral tear and have no idea it exists (how wonderful! Ignorance is ‘sometimes’ bliss when it comes to the body).

 

What is the acetabular hip labrum?

 

The acetabular labrum is ring of connective tissue in your hip that functions to increase the surface area of the “socket” of your joint.

 

As a “ball and socket” joint, the labrum helps to connect the “ball” (head of the femur) with the “socket” (acetabulum). The labrum serves to distribute forces in such a way that keeps the hip where it needs to be.

 

The good news: even with a tear to this tissue, our hip labrum still works to perform this function.

 

Rather than diving into the depths of anatomy, just have a look at the picture that shows a normal image of the anatomy deep within our hip.

 

Will you ever get better?

 

The burning question on anyone’s mind with this tissue issue is: “will I ever get better?” or in the case of my friend, “will I ever be able to run again?” and “will lifting ever be pain-free again?”

 

The unbearably confident physical therapist in me says a resounding “YES!” to those questions.

 

Sisu Side Bar: Many physical therapists (myself included) will attest that we cannot, with confidence, tell folks not to have surgery. Why is it acceptable for a surgeon to confidently suggest to a person to have surgery (that may not even help by the way!), but it’s unacceptable for me (a physical therapist), to confidently suggest conservative treatment as the best option? I’m tired of the dance.

I’m a physical therapist and my bias is strong and proud: conservative treatment is INVALUABLE (If folks would just believe me!). This is not to say that surgeon’s don’t have value. Truly, I know that they do. This is just to say that I am allowed to confidently proclaim conservative treatment is a useful, nay an EXCELLENT, option for folks with tissue issues. I digress…

 

What are the best treatments for a hip labral tear?

 

Activity modification

 

Honestly, this one can be a bit tricky. My thoughts are this: if you want to push through some of your pain, that’s totally fine by me and, typically, won’t be harmful to you or your hip.

 

If you want to push through some of your pain, that is ok and (typically) won’t be harmful to you or your hip

 

However, this is a personal decision. Therefore, I typically use a pain and suffering scale (learn more by downloading the Sisu Pain Guidelines ebook here). I’m ok with a little bit of pain, it’s when suffering starts to enter the equation that we may want to take a step-back. And suffering is very personal, and individual.

 

For example: If someone has hip pain during deep back squats we might have them perform a box squat/bench squat instead. This helps to control the range of motion and potentially reduce pain during a movement. By limiting the range of motion for a while, you may begin to build tolerance to the squat itself. At which point you can start to gradually increase the depth of the squat over time (as seen).

 

 

For runners, it may mean adjustments to your training. Most of the time, I wouldn’t encourage a complete cessation of running (although it truly depends on the person).

 

We would aim to meet you where you are, or somewhere in between. If you’re having trouble with something specific, like sprints, maybe we back it off a bit and work with strides for a few weeks.

 

Build hip strength and range of motion

 

As you work to calm things down in your hip, you may need to work to build up your hip strength and comfortable range of motion in a targeted fashion. 

 

Here are several examples of exercises that are useful in programs designed to help runners (or anyone) with acetabular labral tears.

Supine hip switch

With hip labral tear, aggressive stretching is not usually something I recommend, as it can be irritating to you and your hip. Some gentle hip mobility helps to increase range of motion and feels pretty good for most folks. Repeat a few times before your exercises to gentle mobilize your hips.

 

 

Copenhagen Planks (short lever)

This is a great plank for strengthening of the hip adductors. An all too often neglected region of the hip that plays a role in rehab for hip injuries and hip pain. Start with holding 15-30s, do 3 sets and repeat 2-3x/week. Progress by increasing the hold time or adding more sets.

 

Banded lateral toe taps

This is a great exercise for hip strengthening and stabilization.

 

Prioritize the things you love

 

This cannot be stated loudly enough: PRIORITIZE THE THINGS YOU LOVE.

 

The number one mistake I see athletes make is the complete elimination of the activities they enjoy. Unfortunately, many providers will tell you that you need to stop doing activity as well (*insert an eye roll).

The number one mistake I see athletes make is the complete elimination of the activities they enjoy.

 

I have found there is almost always (I don’t use this word lightly, definitive words can be problematic, but truly, there is USUALLY, always a way) a way to work in the activity you love WHILE you’re recovering from injury.

 

For example: when I was in high school and recovering from an ACL reconstruction surgery, I just WENT to soccer practices. As I was cleared to do more, I did the activities I could do, such as passing a ball. This kept me engaged with my team, engaged with life and kept me motivated to keep going. Metaphorically speaking, it kept my eye on the ball (recovery). 

 

See a physical therapist

 

Yes, this is a shameless plug. Seeing a physical therapist is about far more than just the exercises they prescribe.

 

A physical therapist can be an objective observer, a hard listener, a motivational speaker, a skilled supporter, a partner through your darkness. Physical therapy is so much more than just exercise or manual therapy. If you need some help, schedule a virtual consultation with Sisu using our online scheduling software and kickstart your way back to your activities. 

 

Conclusion

 

After chatting with my friend about her labral tear, her burning question was still “will I ever run again?”

 

Oftentimes, these decisions come down to personal priorities, desires and/or the severity of the injury or trauma.

 

My belief is this: if you have a hip labral tear, you don’t want surgery and you want to run again, I truly believe that you CAN and I have had many patients who have done just that.

 

I hope that simply reading that, affords you a little bit of light shining through the darkness.

 

For more information on hip labral pathology, I would encourage you to listen to our podcast episode about hip labral tears on Two Women Running Their Mouths podcast.

 

 

1. Rajasekaran S, Dilip Chand Raja S, Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of “clinical reporting”: results from an RCT and blinded trials. Eur Spine J. 2021. doi:10.1007/s00586-021-06809-0
2. Schmitz MR, Campbell SE, Fajardo RS, Kadrmas WR. Identification of acetabular labral pathological changes in asymptomatic volunteers using optimized, noncontrast 1.5-T magnetic resonance imaging. Am J Sports Med. 2012;40: 1337–1341.
3. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of Abnormal Hip Findings in Asymptomatic Participants. The American Journal of Sports Medicine. 2012. pp. 2720–2724. doi:10.1177/0363546512462124