Physical Therapy After Hip Labral Tear

Benefits of Physical Therapy

There are two primary causes of a hip labral tear: high impact hip trauma or overuse. Regardless of the cause, a tear of the labral ring of cartilage can significantly affect the stability and function of the hip. Thus, working with a movement specialist and musculoskeletal expert like a physical therapist can be highly effective by:

• Identifying any imbalances or poor movement patterns that are contributing your symptoms. 
• Designing a program that will give you the best possible results for recovery and getting back to your normal daily activities. 
• Guiding you through recovery if it’s determined that arthroscopic hip surgery is necessary.

Physical Therapy for a Hip Labral Tear: What to Expect

While working with a physical therapist (PT), you can expect personalized recommendations and progressions over time. The process will include 4 steps: diagnosing, identifying the cause, managing pain, and treatment.

Diagnosing a Hip Labral Tear

Firstly, your PT will assess your history, symptoms, and movement mechanics and if you are experiencing groin, buttocks, or anterior hip pain. Then, they will proceed with special tests to assess what type of underlying articular hip pathology is causing your symptoms. Most often using a handful of tests that involve passive movement of the hip and femur while assessing for pain. This might include hip extension (McCarthy test), a figure four position (FABER test), and other various combination moves involving hip rotation and hip flexion (hip impingement test, Fitzgerald test, etc.).

Your PT will be able to determine an accurate diagnosis, but if unsure or suspect of a more sinister underlying cause, you’ll be referred to an orthopedic doctor for further diagnostic imaging tests.

Identifying the Cause

With sensitive tests available for diagnosis, a confirmation of a hip labral tear is fairly straightforward. However, the underlying cause that led to hip damage in the first place can be a bit more complicated. This is especially true since a joint injury isn’t usually caused by a singular issue but rather a culmination of problems. Here are the most common underlying causes, one or all of the following may be present:

• The presence of Femoroacetabular Impingement (FAI)- characterized by a pinching of the hip tissues with end range of motion (like the labrum) caused by anatomical or bony abnormalities, poor healing femoral neck fractures, and other potential factors
• Trauma to the acetabulum from falling, misstepping, twisting, or repetitive end range hip motion
• Degeneration and/or overuse of the hip joint
• Excessive laxity of the hip joint itself that strains the acetabular cartilage 
• A PT will also look at any hip or core weakness, range of motion limitations, and poor movement mechanics that may be contributing to your injury and symptoms as well

Managing the Pain

What will be appropriate for managing your hip pain will be dependent on your symptoms and preferences. Your doctor may discuss the option of anti-inflammatory medications or cortisone injections for short term relief. However, your PT can recommend less invasive pain management modalities that don’t come with the risks or side effects of medication. They are a great short term solution for getting you on track and tolerating your treatment program. These options for pain relief might include:

• Electrical stimulation (TENS)- shown to reduce sensitivity to pain. Your PT can show you the best placement of the electrodes for your pain symptoms. 
• Ultrasound- deep sound waves to the superficial tissues of the hip joint can help promote healing when your PT finds it necessary. 
• Self-massage- use of your hands or massage tools can help give you muscle tension relief that may be contributing to your pain. Your PT can recommend specific techniques.
• Low impact movement to promote blood flow- such as swimming, walking, and stationary biking.
• Gentle hip stretches (only indicated when hip range of motion limitations or stiffness is present).
• Temperature based modalities- including ice packs or a heating pad.

Other Helpful Home Treatments

Treatment

Initially, your treatment will primarily focus on pain management and gentle hip strengthening to restore balance. With time, as you can tolerate more, you will progress to more functional hip movements for optimizing biomechanics with daily activities. Ultimately, the goal is for you to have a home exercise program that you are comfortable continuing independently once you have fully returned to your normal routine.

• Massage Techniques

  Manual therapy is a common part of the initial stages of physical therapy. Some techniques might include lower extremity soft tissue massage, deep tissue massage, joint mobilization, muscle energy techniques, trigger point massage, myofascial release, and more. The goal with these techniques is to decrease pain, restore hip range of motion and joint mobility, and reduce stiffness in surrounding muscles and connective tissue.

• Exercises

  Your exercise program will primarily consist of hip and core strengthening exercises. When pain is higher initially, you will start with more basic pain free movements, such as isometrics with resistance bands and exercises that focus on one major muscle group at a time. As symptoms resolve and your coordination improves, you can progress to more dynamic hip and core moves that will prepare you for your normal daily activities, such as lunges, single leg balance, and squats. Common target areas will include the abdominals, glutes, hamstrings, quads, hip flexors, and deep hip rotator muscles.

  For specific instructions on hip exercises for a labrum tear, see our full guide here.

• Correcting Movements

  The final stage of PT will focus on optimizing your movement patterns. Proper form and biomechanics with daily activities like sitting, walking, sleep and more dynamic movements (with exercise or sport) is essential for hip recovery. This will allow proper healing and reduce the potential for future hip problems.

Choosing a Physical Therapist

There are many ways to choose a physical therapist. Here are some helpful tips:

• Ask your sports medicine doctor, friends, and family for any recommendations to start (although most clinics don’t need a referral from your doctor anymore unless your insurance requires it).
• All physical therapists are adequately trained to address hip injuries so see what is covered by your medical insurance.
• Consider cash pain clinics if you don’t have insurance or it doesn’t cover PT.  
• For a hip injury physical therapy will be administered in an outpatient clinic. 
• Find a PT specialized in orthopedics

The bottom line is simple: it’s important to find a PT that you are comfortable working with and trust, which is more about personalities and philosophies than anything else.

Make Your First Appointment

You are one phone call away from better hip recovery outcomes with the right treatment plan. Get that first visit with a PT scheduled so that you can get a full assessment and discuss with them what the best course of action is moving forward. With the guidance of a professional, it is often much easier to stay accountable with your home program. You will never have to wonder what your next step is in the recovery process and will feel confident in your hip as you get back to your routine. What are you waiting for? Call a local clinic today to get started.