Sports Medicine
Sports Injury Prevention & Rehabilitation

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Labral Tear (Hip)

(Also known as a Hip Labral Tear, Labral Tear of the Hip)
What is a labral tear?
A labral tear is a condition characterized by tearing of the connective tissue within the hip joint known as the labrum.
The hip joint is a ball and socket joint - the ball arising from the top of the femur (thigh bone) and the pelvis giving rise to the socket. The depth of the socket of the hip joint is increased by strong cartilage known as the labrum which attaches to the rim of the hip joint.
The labrum is responsible for increasing the depth and stability of the hip joint. It also aids shock absorption, cushioning the impact of the femur on the pelvis during weight bearing. Normally the surface of the labrum is very smooth allowing easy movement of the femur on the pelvis. Occasionally the labrum can be torn or damaged so that the surface is no longer smooth. When this occurs, the condition is known as a labral tear.

Causes of a labral tear
A labral tear often occurs traumatically in sports that require sudden changes of direction and twisting movements. These sports may include running, football, soccer, basketball, tennis and snow skiing. They may also occur during running or due to direct trauma such as a fall, heavy landing or motor vehicle accident.
Occasionally, patients may develop this condition over time through gradual wear and tear associated with overuse. This may be due to excessive twisting or weight bearing activity over time (e.g. long distance running). In older patients, degenerative changes to the hip joint may also be present. In these instances, injury to the labrum may occur with a relatively trivial movement.

Signs and symptoms of a labral tear

Patients with this condition may report that they heard an audible sound at the time of injury or experienced a tearing sensation. Pain is usually felt in the groin, hip and / or lower back. Symptoms typically increase with weight bearing activity and twisting movements of the hip. Patients may also experience pain when climbing stairs or when squatting. The hip may also feel weak or unstable and may click or lock during certain movements.
In minor cases of this condition there may be little or no immediate symptoms. In these cases, symptoms may develop gradually over the coming days, typically with an increase in weight bearing or twisting activity. In more severe cases there may be severe pain and significant restriction in hip range of movement. Intermittent locking, clicking sensations, and episodes of giving way or collapsing may be present. The patient may also walk with a limp or, be unable to weight bear due to pain.

Diagnosis of a labral tear
A thorough subjective and objective examination from a doctor is usually sufficient to diagnose a labral tear. Investigations such as X-ray and MRI are often used to confirm diagnosis, assess the severity and exclude the presence of other injuries in the hip. In rare cases, where an MRI has proven inconclusive, an investigative arthroscope may be performed to assist diagnosis.

Treatment for a labral tear
Some minor tears to the labrum heal well with appropriate therapy although generally surgery is required. The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests sufficiently from twisting and weight bearing activities (such as standing, sitting, walking, lifting, squatting, and running) until they are pain-free. This may entail the use of crutches for a period of time. Once the patient is pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Anti-inflammatory medication may be beneficial in the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with rest). Anti-inflammatories can significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with a labral tear should also perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation for all labral tears the therapist can devise an appropriate return to sport or activity plan. Returning to activity too soon or without adequate rehabilitation will often lead to further injury and inflammation of the labrum.

Surgery for a labral tear
Generally, most labral tears will require surgery to ensure an optimal outcome and reduce the risk of the patient developing hip osteoarthritis. Surgery for labral tears is generally minimally invasive and typically involves a hip arthroscope. During this procedure, the surgeon removes the torn tissue enabling the hip joint to move freely once again. In cases of a large labral tear with bony damage, surgical fixation of the bony fragment and labrum may be indicated. The treating therapist and doctor will refer to a specialist if surgery is indicated. Physical therapy and rehabilitation is then required following surgery to ensure an optimal outcome and enable a safe return to sport or activity.

Prognosis of a labral tear
Those patients with minor labral tears that respond well to conservative management can usually return to sport or activity in approximately 2 - 6 weeks.
For minor tears that are managed surgically, patients can sometimes return to sport or activity within 4 – 8 weeks, although most patients (especially when the tear is moderate to severe) will require a significantly longer rehabilitation period.
It is important that labral injuries are managed appropriately, as inappropriate treatment may lead to the development of early hip osteoarthritis.

Therapy for a labral tear

Therapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients with a labral tear regardless of whether they have surgery. Treatment may comprise:
  • soft tissue massage
  • electrotherapy
  • joint mobilization
  • stretches
  • dry needling
  • hydrotherapy
  • the use of crutches
  • ice or heat treatment
  • biomechanical correction
  • activity modification advice
  • anti-inflammatory advice
  • weight loss advice where appropriate
  • education
  • progressive exercises to improve flexibility, balance and strength
  • clinical Pilates
  • a gradual return to activity program
For those patients who are undergoing surgery for their condition, physical therapy and rehabilitation should commence prior to surgery. This may include treatment to reduce pain and swelling, electrotherapy, flexibility and strengthening exercises, hydrotherapy and the use of crutches. Following surgery, physiotherapy and rehabilitation is essential to assist the healing process and ensure an optimal outcome.

Other intervention for a labral tear

Despite appropriate therapy management, some patients with this condition fail to improve either conservatively or following surgery. When this occurs the treating therapist or doctor can advise on the best course of management. This may include further investigations such as X-rays, MRI or CT scan, pharmaceutical intervention, corticosteroid injection, or further surgery.