The Truth About Hip Labrum Tears

Plus: How to Strengthen Your Hips for Treatment and Prevention

Runner With Hip Labrum Tear

Surprisingly, there’s not much knowledge in the general public about hip labrum tears – what causes them and how they can best be managed. I’d venture to say most people don’t even know what a labrum is. Maybe this lack of awareness exists because labral tears aren’t that common – this is what I used to think. Then I looked into it and what I found shocked me. I learned that they are, in fact, incredibly common in people with hip or groin pain.

Because they’re so common, it’s important to understand the difference between what’s normal, and what needs treatment.  We will also look at how to best treat hip labrum tears and also how to potentially prevent them…

What Is The Hip Labrum?

The labrum in your hip is a structure made of fibrocartilage. It has several important roles:

  1. To deepen the hip socket1
  2. To buffer the forces acting on the hip2,3
  3. To create a negative-pressure seal inside the hip joint4
  4. To help with proprioception (your joint position sense)5

Just How Common Are Hip Labrum Tears?

Hip labrum tears are more common in people with hip pain than you might think.

I was shocked to find out a recent review of research found that the prevalence of labral tears in people with hip or groin pain is between 22% and 55% 6. Some studies even report prevalence as high as 90% for people with mechanical hip pain7,8,9.

What Causes Hip Labrum Tears?

Hip labrum tears can be caused by an acute trauma. Oftentimes, the precipitating activity involves a quick twist, pivot, or falling motion10,11. In athletes, a common mechanism of injury is a forceful rotation while the hip is hyperextended12.

Certain populations are more prone to labral tears than others – especially in those who perform activities that place specific repetitive stresses on the hip joint.

For athletes who complain of groin pain, 20% have hip labrum tears 13. Which sports? Distance running, ballet, golf, ice hockey, and soccer are most associated with labral tears 14. Rotational stresses15, hyperextension16, and hyperflexion17 are the motions likely to contribute.

Although they can affect people of all ages18,19, hip labrum tears seem to affect the older population more – even up to 96% of older people by some reports20,21.

Interestingly, 74% of labral tears occur insidiously 22, meaning they aren’t associated with any single event.

When we look at what is actually going on inside the hip joint, we find that people with labral tears, 87% of them, present with some kind of structural abnormality23, like dysplasia or impingement24.

These statistics were shocking for me to learn.  One reason I was so shocked is because I don’t see this in the clinic as frequently as these statistics might dictate.  Why is this?  Why do so many older people have labral tears and don’t even have pain?

The shocking truth is: maybe minor tears in the labrum are are a normal part of the aging processMaybe 96% of older people have tears because thats what happens when we get older.  Certainly all of these people don’t present with hip pain.

How To Know If You Have a Hip Labrum Tear

The gold standard for detecting a labral tear is through arthroscopic inspection. Next in line would be an MRA which is similar to an MRI but with contrast injected into the hip joint to allow better visualization of the labrum25.

Common symptoms with hip labrum tears 26 :

  • Anterior (front) groin pain
  • Generalized hip joint pain
  • Popping, locking, or snapping of the hip
  • Feeling of instability

Treatment Options for Hip Labrum Tears

Activity Modification:

If you have a labral tear, it’s recommended that you modify activities that could put the labrum at risk for further injury. Activities that place repetitive stress on the hip should be limited – in particular, hip motions of forced extension or rotational loading27.

Also, if you have hypermobility in your hip or structural instability due to a labral tear, you should not be stretching or mobilizing the hips – these two techniques are contraindicated28.

I know that stretching may feel good, but if you think about it, it makes sense that we shouldn’t stretch or mobilize a joint that already moves too much.

Cardiovascular Exercise:

Because of a reduction in activity due to a hip labrum tear, it’s important for you to maintain your health and fitness levels. For this, I’d recommend you participate in activities that place limited stress on the hip and promote aerobic conditioning such as:

  • Swimming
  • Stationary bike
  • Elliptical

Strengthening:

Labral tears can lead to excessive range of motion in the hip. Research shows that too much motion in one direction leads to weakness in the other direction, and vice versa29. Therefore, in order to stabilize and control the hip, strengthening is crucial.

Of course, any specific muscle weaknesses identified by your Physical Therapist should be addressed. In general, I’d recommend strengthening the hip abductors and rotators.

If you don’t currently have a hip labrum tear and are looking for ways to prevent the injury – maybe you participate in a sport or activity that is associated with labral tears – strengthening is your best bet

Here’s a couple of exercises to strengthen the hips:

1. Hip Extensions Leaning Over a Table

 

2. Hip Abductor Strengthening

 

Surgery:

For fraying or peripheral tears of the labrum, labral resection is an arthroscopic procedure that has the best outcomes30,31. Deeper (intrasubstance) tears may need to be surgically repaired.

Question: What Other Treatments Have You Found to be Helpful in Treating Hip Labrum Tears? You can leave a comment by clicking here.


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  10. Neumann G, Mendicuti AD, Zou KH, et al. Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthritis Cartilage. 2007;15:909–917. http://dx.doi.org/10.1016/j.joca.2007.02.002.  ↩
  11. Fitzgerald RH, Jr. Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res. 1995:60–68.  ↩
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  14. Guanche CA, Sikka RS. Acetabular labral tears with underlying chondromalacia: a possible association with high-level running. Arthroscopy. 2005;21:580–585. http://dx.doi.org/10.1016/j.arthro.2005.02.016  ↩
  15. Klaue K, Durnin CW, Ganz R. The acetabular rim syndrome. A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br. 1991;73:423–429.  ↩
  16. Guanche CA, Sikka RS. Acetabular labral tears with underlying chondromalacia: a possible association with high-level running. Arthroscopy. 2005;21:580–585. http://dx.doi.org/10.1016/j.arthro.2005.02.016  ↩
  17. Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004:262–271.  ↩
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  22. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2:105–117. http://dx.doi.org/10.1007/ s12178–009–9052–9  ↩
  23. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448–1457. http://dx.doi.org/10/2106/JBJS.D.02806.  ↩
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