Finding out that you have a hip labral tear may be scary at first, but the diagnosis is not as grim as it sounds. This musculoskeletal issue is more common than you'd think, especially among more active individuals. In fact, in many cases, it's treatable without surgery. A clear understanding of labral tears and hip labral tear symptoms can help get you back on your feet after this type of injury.
Exercises that strengthen the muscles on the outside and back of your hip can help to lessen the pain associated with a labral tear.
What Is a Labral Tear?
The labrum is a layer of cartilage that lines the outer rim of the hip joint socket, called the acetabulum. The purpose of this tissue is twofold. First, the labrum helps absorb the forces to which the hip joint is exposed when you walk, run or just move about during the day. In addition, this ring of cartilage helps create a seal or suction that keeps the ball portion of the hip joint, called the femoral head, secure in the socket.
Occasionally, tearing or degeneration in the labrum can occur. When this happens, a portion of the cartilage pulls away from the bony socket of the hip. Surprisingly, this does not always cause pain.
In fact, a 2015 study published in The Bone & Joint Journal found labral tears in more than 38 percent of young adult volunteer participants, with none of them reporting any pain. Paying attention to your symptoms can help you determine if a tear in the labrum is the source of your issues.
Hip Labral Tear Symptoms
While not always painful, labral tears can definitely cause a variety of symptoms. If you have a tear, you may experience deep, achy pain in the front of the hip or groin. Frequently, the pain comes on gradually and is accompanied by stiffness or clicking in the hip joint.
Movements like hip flexion (bringing your knee in toward your chest) or hip adduction (bringing your leg closer to the body's midline) can make your symptoms worse. As a result, activities like sitting or crossing your legs can be irritating. Movements like standing and walking might actually feel better when you have a torn labrum, depending on the location of the tear.
What Causes a Labral Tear?
Tears in the hip labrum can occur for a number of reasons. Sometimes, bony irregularities in the ball (femoral head) or socket (acetabulum) portion of the hip joint can cause higher amounts of contact and strain on the labrum. This is called femoral acetabular impingement, or FAI, and can lead to the labrum ultimately tearing.
According to the Cleveland Clinic, repetitive or high-impact activities can also be the cause. If you regularly experience this type of force, whether at work or while playing sports or exercising, you might be more susceptible to tears due to the increased stress on the labrum.
Finally, some labral tears can be attributed to simple degeneration or wear and tear. Osteoarthritis of the hip, which causes the cartilage to break down, can make the labrum more susceptible to fraying and tearing. This is worse in obese individuals as the extra weight already increases the stress on the joints in the legs.
How Are Labral Tears Diagnosed?
While your symptoms can help your doctor diagnose a labral tear, imaging is the only way to be sure. The most accurate way to determine whether you have this issue is to get a magnetic resonance angiography (MRA), a version of an MRI that uses dye to visualize your blood vessels.
X-rays can also be helpful in diagnosing FAI or osteoarthritis, which can cause the tearing to happen in the first place. CT scans are usually not effective at visualizing a hip labral tear and aren't frequently used.
Hip Labral Tear Exercises
Early on in your recovery from a labral tear, it's best to start with gentle, pain-free exercises. Initially, these movements should focus on strengthening the muscles in the back and outside of the hip. Activating these areas helps minimize the strain on labrum on the front portion of the joint. Exercises that incorporate twisting or those that strain the hip flexor muscles in the front of the hip should be avoided.
To maximize strength early on in your recovery, try three sets of 15 repetitions of these hip labral tear exercises: bridges, clam shells, fire hydrants, resisted side-stepping and donkey kicks. You can do these once per day.
Do the Bridge
This exercise is an easy way to activate the gluteus maximus, a large muscle in the back of your hip.
Lie on your back with your knees bent to a 90-degree angle and your feet on the floor. Begin by squeezing your stomach muscles and then lift your butt in the air until your spine is relatively straight. Hold this position for five to 10 seconds before lowering back down to the floor again.
Include Clamshells in Your Routine
The clamshell exercise exercise targets your gluteus medius, a muscle on the outside of the thigh that supports the pelvis and hip joint.
Lie on your good side with your knees bent and your legs stacked on top of each other. Keeping your feet together, lift your top knee up in the air as high as you can without allowing your body to roll backward. Hold it here for a second or two before slowly lowering the leg back down again.
You can add a resistance band around your knees to increase the intensity of the exercise.
Try the Fire Hydrant Exercise
This unique exercise activates multiple muscles, including the abdominals and the hip external rotators.
Get on your hands and knees and begin by squeezing your stomach muscles. Then, raise the affected leg out to the side and slightly behind you without allowing your pelvis to move. After holding this position for one to two seconds, lower the leg to the starting position again.
Stand with your feet shoulder-width apart and tie a resistance band around your legs just above the knees. Squeeze your stomach muscles and take a large step to your right. Then, slowly bring your left leg back toward the right again without allowing your body to lean.
After taking 10 steps to the right, reverse directions and lead with the left leg. If this is too easy, try lowering the level of the resistance band to your ankles.
Try Donkey Kicks
This distinctively named exercise helps increase the strength in your glutes and support the back of your hip joints.
Stand facing a counter and lean your arms against it. Bend your knee on the affected leg and move the leg backwards while keeping the knee flexed.
As you do this, clench your stomach muscles to avoid letting your low back arch. After holding this position for one to two seconds, lower the leg back to the initial position.
Perform Side Planks Regularly
Lie on your side with your forearm on the floor underneath you and your legs stacked on top of each other. Keeping your knees straight, push up through your forearm as you lift your hip off the floor.
After a second or two, lower your hip back down again. If this is too challenging, try the same movement with your knees bent.
Do You Need Surgery?
While arthroscopic hip labral repair surgery may be required in some cases, not everyone with a torn labrum needs it.
According to a 2018 review published in the Journal of Sport Rehabilitation, there is evidence to suggest that patients who were diagnosed with hip joint disorders, like a labral tear, improved with conservative treatment, such as activity modification, strengthening exercises and the use of pain medication.
Although a labral tear will not physically heal itself, improving your flexibility and strength while avoiding aggravating movements may allow you to resume your normal activities without surgery.
Torn Labrum Recovery
For labral tears that do not require surgery, two to four months of physical therapy may be needed before you can fully return to your previous activity levels. This time frame is significantly extended if arthroscopic hip labral repair surgery is required.
Following surgery, the hip labral tear treatment is typically divided into four phases, according to a 2016 clinical review published in Sports Health. Phase 1 lasts about three weeks and focuses primarily on diminishing your pain, protecting the area that was operated on and preventing your muscles from getting weaker. Phase 2 is spent slowly restoring your strength and range of motion, while also correcting any lingering abnormalities in your walking pattern.
Phase 3, which can last four more weeks, continues to emphasize strength, while also working on your balance and overall endurance. Finally, the last phase of rehabilitation reintroduces running and other impact activities after about 12 weeks. While every surgeon has her own protocol, it is not unusual for the entire rehabilitation process to take five to six months.
Warnings and Precautions
If you have questions about the pain in your hip or if it's failing to improve with exercise, be sure to speak to your doctor. She will be able to properly diagnose your condition and help you feel your best again.
- Mayo Clinic: Hip Labral Tear
- The Bone & Joint Journal: The Prevalence of Acetabular Labral Tears and Associated Pathology in a Young Asymptomatic Population
- American Physical Therapy Association: Physical Therapist’s Guide to Hip Labral Tears
- Current Reviews in Musculoskeletal Medicine: A Comprehensive Review of Hip Labral Tears
- International Journal of Sports Physical Therapy: Electromyographic Analysis of Gluteus Medius and Gluteus Maximus During Rehabilitation Exercises
- PM&R: Clinical Outcomes Analysis of Conservative and Surgical Treatment of Patients With Clinical Indications of Prearthritic, Intra-articular Hip Disorders
- Sports Health: A Multidisciplinary Approach: Physical Therapy Protocol After Hip Arthroscopy: Clinical Guidelines Supported by 2-Year Outcomes
- Cleveland Clinic: Hip Labral Tear
- Journal of Sport Rehabilitation: Nonsurgical Treatment of Acetabular Labral Tears
- Journal of Sport Rehabilitation: A Systematic Review of Rehabilitation Exercises to Progressively Load the Gluteus Medius