The Hip: Labral Tears

Let’s talk about labral tears. Of the hip variety. Hip pain can come in many forms with many causes. This is because the hip joint has a huge range of motion with several layers of muscles performing a variety of actions. It can get pretty complex figuring out how or where your pain started. We’ll also put aside hip pain referred from the the lumbar spine for now–that’s a topic for another time. Labral tears of the hip are extremely common. However, knowing you have one can make you feel tentative and cautious. We hope to diffuse some of your fears and empower you to keep moving and stay active.

What is a Hip Labrum and what is Hip Impingement?

The labrum of the hip is the connective tissue that lines the hip socket to make it deeper and more stable. It can become torn or damaged. Hip impingement is abnormal bony contact between the ball and the socket. This can be caused by muscle imbalances, stiffness in your joint or joint capsule, bony deformities, or movement pattern problems. A labral tear can be caused by impingement or it can just happen without any known cause.

Symptoms of Hip Labral Tear

Labral tears of the hip can be difficult to diagnose and treat. In my experience, it may take months to years for patients to get a diagnosis or seek treatment. So what are symptoms of hip socket (aka. acetabular) labral tears? They include clicking, catching and pain around the hip. Pain can be located in the groin, lower back, sacroiliac joint, buttock, lateral hip, and thigh. Onset of symptoms tends to be non-traumatic with a gradual onset. For example, years of overuse with running and biking. These symptoms can seem nonspecific and, frankly, confusing.

Do You Need Imaging?

Imaging of your hip can lead to a diagnosis of a labral tear, but those results can be misleading. This is because sometimes they cause pain, and sometimes they don’t. For example, in a 2012 study, 69% of pain-free hips (average age 37.5 years) had labral tears. In another 2018 study, 54% of pain-free hips had labral tears, while just 62% of painful hips had them. We’re learning more and more about what happens to joints as we age. And we’re learning that imaging gives us findings that aren’t always clinically relevant.

When you see a physical therapist, you can expect us to evaluate your hip as a region, looking for muscle imbalances, joint dysfunction, and altered neuromuscular patterns to get a full picture of you and your hip. People with hip impingement/labral dysfunction tend to have deficits with gluteal and core muscle strength, which leads to more load on joints.

The good news is that labral tears, and hip impingement in general, can be treated conservatively. In a 2011 case study, patients showed meaningful improvement with physical therapy. We can address joint mobility, muscle imbalances, and neuromuscular control to normalize hip mechanics and help you get back to what you love doing.

If you have a hip and it hurts, please get it evaluated by a physical therapist. It’s never too late to get moving!

References:

Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study.

What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis.

Nonsurgical treatment of acetabular labrum tears: a case series.