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If you’ve been diagnosed with a hip labral tear, you’re probably wondering your treatment options. Surgery is one option, but it’s not always necessary and should always be a last resort.
You can do many things to treat a hip labral tear without resorting to surgery. Oftentimes the diagnosis of a labral tear will cause people to pause their normal activities for fear of injuring it further; however, this is the opposite of what you should do. Getting back to normal activities and improving the strength around the hip are key to avoiding hip surgery.
In this blog post, we’ll explore some nonsurgical treatment tips for those with hip labral tears. We’ll also provide some tips on specific exercises on how you can potentially return to normal without going under the knife.
It can Take Months for the Hip to Improve.
Patience is key in the healing process of a hip labral tear. It can take months for the tear to improve and heal, so don’t expect any overnight results. We often find patients undergo surgery way too early in the healing process.
This decision is often financial as people meet their deductibles and have to decide before the end of the year.
It’s also true that the Labrum won’t actually “heal” or “repair” itself. The labrum has a poor blood supply, and there doesn’t heal like other soft tissue. However, that doesn’t mean that symptoms won’t improve and that you can’t get back to normal.
In fact, there is some argument that labral tears are normal and expected.
Yes, you read that correctly. In this study, the MRIs of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears identified in 69% of the joints. Yet all of these patients were asymptomatic, meaning they had no pain and no idea that they had labral tears.
Even though this was a small study, the results are consistent with other published results. What this indicates is that labral tears are normal and that a percentage of the population can live happily and return back to normal activities even with a labral tear.
In this study, comparing physical therapy and conservative treatment against surgical intervention, only 56% percent went on to have surgery after a year of conservative treatment. This means that nearly half of the people with diagnoses of labral dysfunction chose to have surgery after a year’s time.
What’s even more impressive is that the people only received an average of 6 physical therapy treatments. That’s it, and that’s not near enough to make a change in most people. Imagine if you found an excellent physical therapist and spent more focused time on your symptoms.
It can be done. You have to be patient.
In most people, it takes nearly 9 months for a patient with torn hip labrum to get back to their prior level of function. Yet, most people are having surgery much sooner than that. We have even seen it take up to 2 years before people get back to their normal strength..
Waiting to determine if your hip is going to recover or not is a mental challenge, as it can take forever. However, the goal of this article is to compile some helpful tips that you can do as you proceed through the healing process.
Stay as Active as Possible
Staying active with your normal exercise routine is potentially the most important recommendation for people with a labral tear. Regular exercise helps to keep us fit and strong and can even improve mental health, which is important after a labral tear diagnosis.
If you stop performing your normal exercise routine, then you risk losing critical muscle mass and strength. This loss of strength will actually make the symptoms worse in the long run. Studies have shown that the more someone can work out and stay active after an injury, the lower their pain levels are over time.
Worried that you’ll make the labral tear worse? Don’t be.
Your body will tell you if you are doing something harmful to the labrum. If you feel sharp pain, locking, or pinching with specific activities, try backing off or modifying. However, don’t quit your activities entirely. Try as many modifications as you can until you find a way that works to get back to biking, running, or lifting weights.
Be mindful of deep squatting, cutting, quick changes in direction, and other activities, such as sprinting, that may cause an increase in pain. For these activities, you may have to modify them and not go as deep or as hard.
Activities like biking, yoga, pilates, or swimming are also great ways to stay active while taking safety precautions into account. Most strength and resistance training is also safe to perform without the risk of further injury. So get back in the gym and get those legs as strong as you can.
One of the best activities for a labral tear is biking. This can be on the stationary, peloton, or normal cycling outside.. This is a great way to improve muscular endurance without pressure on the labrum. You can also resume regular hiking and walking as long as you take it slow to build it back up.
In reality, the worst thing you could do is do nothing at all.
Imagine how much happier and more robust your hip will be once you resume your regular exercise routine.
Conversely, if you are not an exerciser and recently suffered a labral tear, now is a great time to start a light exercise routine. Its the best way to help your hip recover.
Strengthen the Hip Muscles, Especially the Glutes
Glute strengthening is essential to overall fitness but especially important after a labral tear. The glute muscles stabilize and reduce pressure on the anterior hip. This is the location where the labrum is most commonly torn. The stronger the glute muscles are, the less pressure on the anterior hip and, in theory, less pain in the front of the hip.
Weakness in the posterior hip and glute muscles is a risk factor for sustaining a labral tear. Therefore if glute strengthening isn’t part of your routine yet, it should be now.
Our favorite Glute-centric exercises for a labral tear include:
- bridges
- squats
- clamshells
- lateral step-downs
- Single-leg RDLs.
The best part about these exercises is that you don’t need fancy equipment. You can do all of these in the comfort of your living room if needed.
Just be aware of any pain or pinching in the front of the hip, and you must modify the exercises based on symptoms. For example, if you have discomfort with squatting, don’t go as deep into the squat or try against a wall.
You can add resistance to any of these exercises to make them more challenging. We recommend progressing the resistance slowly, as the most common mistake we see are patients trying to lift with too much resistance too quickly.
As you progress, there are more advanced exercises that you can and should perform, but the list above is a great start to getting you back to your previous activity levels.
Strengthening these vital glute muscles increases core stability, knee stabilization, improved range of motion, and helps with posture — to name a few. You don’t have to be an athlete or have an injury to benefit from increased Glute strength – Glutes impact our ability to move effectively in many aspects of life.
Try Physical Therapy To Address Deficits
Physical therapy can be a viable solution for those struggling to address hip and groin pain. With a physical therapist experienced with hip and labral injuries, patients can get back to normal functioning with customized treatments designed for their needs.
Not only do physical therapists provide therapeutic exercises and stretching techniques, but they are experts in the performance and movement of the body. They can help find those exact positions and activities that cause aggravation to your labral injury and help find modifications. Not only that, they can help you resume your normal activities much quicker than by yourself.
Importantly, the physical therapist will help you find weakness and strength deficits in muscles you never knew were there. By finding those areas of weakness, you can strengthen the right muscles and create symmetry at the hip joint, reducing stress on the labrum.
Not only can physical therapists help with strengthening and stretching exercises, but they can help break the pain cycle and resulting muscle guarding. Performing specific manual therapy and soft tissue work can help reduce the tightness around the injury to create more natural movement and mechanics at the joint.
We love to have people try specific pain-relieving activities such as:
- Dry needling
- Blood Flow Restriction Therapy
Perhaps most importantly, physical therapists can work with each patient to develop a tailored plan for managing pain and regaining mobility over time, supporting realistic and achievable goals. This tailored program is much more effective than guessing which exercises to do and when.
Modify Activities that Aggravate the Hip
To avoid aggravating the hip further, it is important to modify certain activities.
Deep squats should be performed cautiously, as this puts excessive pressure on the hip joint, but they are not entirely avoided because of how beneficial squats are as an exercise.
You might squat down to a bench or chair to stop you from going deep and into pain. You may also have to play with the angle of your feet and have a wider stance or squat with a slightly toe-out position like in a sumo squat.
Likewise, sitting in an incorrect position can cause discomfort to the hip. Being aware of specific sitting modifications to relieve pain in the front of the hip is key. Certain chairs can go a long way in preventing the hip from getting angry and sore throughout the day. Try tilting the seat slightly forward and using a footrest to help with tension. You may also find sitting on a cushion elevates the hips and reduces discomfort in the labrum area.
If you must stand for long periods, take regular breaks and avoid straining the hip region. You might try standing on a mat to help cushion the joints. Take regular breaks and change positions or simply walk for 2 minutes to give the hip a break from that position.
Try sleeping with a pillow between your knee to take the strain off your hips. This keeps the hips in a natural alignment and reduces aggravation on the labrum.
Try Injections to Rule in or Out the Source of Pain
Finally, as a last resort, we recommend trying steroids or other types of injections to accurately rule in or rule out a correct diagnosis.
As we touched on earlier in the post, labral tears are expected and normal in a certain percentage of the population. Just because it shows up on the MRI does not mean the labral tear is the actual cause of pain.
There are other potential causes of anterior such as hip adductor pain, hip flexor tendon issues, and inguinal hernia.
By going through a series of injections and assessing the improvement or lack thereof, you can feel more confident in the source of pain.
During an injection, a special numbing agent is injected directly into the source of your pain, allowing doctors to diagnose what’s causing your discomfort immediately. Once the origin of the pain is ruled in or out, further steps can be taken if necessary.
An injection may take the pain away, allowing for more advanced physical therapy and full recovery. Or it can provide the surgeon with an accurate diagnosis to make the best possible decision about surgical technique and intervention.
Some of the possible types of injections include:
- Corticosteroids
- PRP – Platelet Rich Plasma
- Stem Cell Injections
Most insurance companies deem stem cell injections as experimental and will not cover the cost of stem cell injections. Some insurances are beginning to cover PRP injections, depending on your carrier and plan.
Wait Longer and Get Stronger… Still
Even when you believe that you waited long enough and that you’ve gotten your affected leg and hip stronger enough… you haven’t. If you can’t perform the same single-leg squats as your other leg in 60 seconds, you need to get stronger.
If you haven’t tried modifying to biking, swimming, or rowing at near your VO2 max, then you haven’t waited long enough.
Our internal checklist for people to undergo surgery for a labral tear includes the following:
- Being able to perform the same number of single-leg squats in 60 seconds
- Being able to maintain a single-leg balance without wobbling for 60 seconds
- Hitting zone 4 in heart rate multiple times in an activity that doesn’t cause pain, such as swimming or bike
- Being able to perform the same amount of weight on a single-leg leg press machine
If you are able to do all 4 of those exercises and the hip is still bothering you, and you’ve tried the various types of injections, then it’s time to consider surgery.
Conclusion
A labral tear can be a debilitating injury, but there are options for treatment that don’t involve surgery.
If you’re dealing with a labral tear, stay as active as possible and strengthen the muscles around the hip, especially the glutes.
Physical therapy can also help address any deficits you may have. It’s also essential to modify activities that aggravate the hip and to try injections to rule in or out the source of pain.
Surgery should always be a last resort.
Have you had success treating a labral tear without surgery? Let us know in the comments below.
