Have you ever experienced a deep pain in the front of the hip or groin region? You may also experience a locking, clicking or catching sensation when you move your leg. Whether this is from a fall, a sporting injury, if it has been going on for a while, you may end up getting a scan, often an MRI - a magnetic resonance imaging scan. If you look through the scan report, you may see the words “labral tear”. This blog is going to take you through what a hip labral tear is, its signs and symptoms, causes and contributing factors, and the recent evidence on effective management.
Let’s have a look at the anatomy first!
What is a hip labral tear?
A labral tear of the hip joint is an injury to the labrum. The labrum is a tough, fibrous cartilage that lines the rim of the hip socket (called the acetabulum). The hip joint is a ball-and-socket joint, where the ball of the thigh bone (femur) inserts into a socket in the pelvis. The labrum acts as a suction seal for stability of the hip joint, as well as a shock absorber for distributing pressure during movements.
What are the symptoms of a hip labral tear?
More than 90% of people diagnosed with labral tears report pain at the front of the hip and groin.1 In some cases, the pain may radiate to the knee.2 People with labral tears are less likely to experience pain over the side of the hip or in the buttock.3 Clicking of the painful hip is another possible sign of a hip labral tear, but there are many other reasons why a hip might click. Other symptoms such as locking, catching or giving way may also be noticed by those with a labral tear.
For the majority of people with hip labral tears, their symptoms start to become noticeable slowly over time.1 Patients seeking help from a health professional commonly report a constant dull ache with episodes of sharp hip or groin pain. Activities like walking, stair climbing, pivoting, sitting for long periods of time (more than 30 minutes) and running often bring on the sharp pain. In addition, patients with hip labral tears may find themselves limping when walking. Their ability to walk longer distances on inclines or uneven surfaces may also be reduced.
Is a hip labral tear always painful?
Hip labral tears are common in both people with and without hip pain. One review reported that on average, 62% of those with hip pain have labral tears present on imaging, while 54% of those without hip pain also had hip labral tears.4 What this means is that it is possible to have a hip labral tear but no hip pain. It also means that although a labral tear may cause pain, just because a hip labral tear is reported on scans, it does not necessarily mean it is the source of pain. Information provided by the patient and a physical examination are required to determine if the imaging results are likely to be related to the current pain. It has been reported that it takes on average more than 2 years to obtain an accurate diagnosis of a hip labral tear. So it’s important to ensure you have a thorough clinical examination by a health professional experienced with hip conditions.
What causes hip labral tears?
Traumatic hip labral tears
Injury to the labrum is frequently observed if trauma to the hip is experienced, such as during a motor-vehicle accident, falls and sudden impact to the hip during contact sports. These types of labral tears can occur with other injuries, like hip joint dislocation.1 Although a tear sounds like it would always be associated with some form of trauma, in fact most labral tears develop over time secondary to natural bony shape or flexibility and/or repetitive activities.
Hip labral tears and Femoroacetabular Impingement
It is very common to have a variation of bony anatomy of the hip in healthy populations. The natural formation and alignment of the hip joint may increase the likelihood for some people to have a hip labral tear. It could be the bone structure of the thigh bone (femur) or the socket (acetabulum) that creates natural restriction in hip flexibility, called femoracetabular impingement or FAI. This kind of restriction may result in compression and shearing of the hip labrum. The labrum is more prone to injury during extremes of movement, particularly bringing the knee to the chest and with full rotation of the hip. In some people with this bony anatomy, pain related to a hip labral tear may develop – this condition is then called Femoroacetabular Impingement Syndrome (FAIS).5
Hip labral tears and acetabular dysplasia or hip dysplasia
The bony shape of the socket or acetabulum can also increase the risk of hip labral tears. People who have a shallow socket or a change in the natural orientation of the hip socket are also more likely to develop hip labral tears. Up to 90% of people with hip dysplasia and a painful hip will have a labral tear.6 This is due to less bone in the socket available to absorb forces and therefore a greater amount of force is absorbed by the labrum that lines the edges of the socket.
Hip labral tears and hyper-mobility
People who are naturally very flexible in their early years, may be at higher risk of sustaining hip labral tears. Instead of reduced hip motion like in people with hip FAI, these patients usually have greater than normal hip flexibility due to more relaxed capsule and ligaments around the hip. In this situation, the labrum may again need to absorb larger forces, increasing risk of injury.
Hip labral tears, repetitive motion and age
Repetitive and forceful motion into the extremes of hip joint range may over time cause changes in the labrum. Court and field sports involving lots of hip rotation and sports involving large ranges of motion such as dance and gymnastics may cause increased stress at the hip joint and the acetabular labrum. These stresses are normal, but high repetition of strong forces may eventually result in a labral tear and in some people the tear may become symptomatic. This does not mean these sports are necessarily dangerous for your hips – it depends on many factors like your bony shape and natural flexibility as mentioned above, how much of certain activities you do, how you do them, and your age. Over the years, our body is naturally exposed to more repetitive forces and so it is not surprising that age is also related to development of labral tears.
What is the treatment for hip labral tears?
Activity modification and exercise for hip labral tears
The first line of treatment is education and exercise, and physiotherapy plays a significant role in this management approach. A physiotherapist may advise how to appropriately minimise aggravation of the hip. A graduated exercise program is developed to address any weakness around the hip and improve the ability of muscles to absorb the forces travelling through the hip joint. This can help reduce forces placed on the labrum.
Corticosteroid injections for hip labral tears
Corticosteroid injections into the hip joint can help reduce pain in the short term but do little to help the condition in the longer term. There are also concerns about adverse effects that cortisone may have on the hip cartilage, particularly in younger individuals. For this reason, trying at least 3-6 months of activity modification and rehabilitation is usually recommended prior to undertaking more invasive procedures such as injections or surgical interventions.
Surgery for hip labral tears
Surgical treatment for hip labral tears is most commonly performed through keyhole surgery (hip arthroscopy). The surgeon generally ‘debrides’ - trims up - any flaps or rough areas at the site of the labral tear. It is important to be aware that such treatment does not ‘fix’ the labrum or restore its normal function. Sometimes a surgeon may attempt to repair the labrum but this is less common as the labrum naturally has poor blood supply and is not so easy to repair.
Surgery can help with reducing pain and improving ability to perform normal activities and sport, but many people do not return to sport or to their previous level of sporting activity. Some can be no better or even worse after surgery – this is more likely to occur in those who already have some osteoarthritis within the hip joint.
Scientific research has not yet determined which people will have the best outcomes from surgery, so it is always wise to try an extended period of physiotherapy treatment prior to opting for surgery. If surgery is then required, you will be much better placed for a quicker recovery if you have done a good period of ‘pre-habilitation’ before surgery. Rehabilitation after surgery is recommended for a minimum of 3 months, but this may be longer depending on what activities you need to return to.
Getting help for your hip labral tear?
If you have a hip labral tear or think you may have a tear, please book a consultation with one of our physiotherapists at Physiotec. All of our Physiotec staff have higher level experience in the treatment of hip pain and injuries. We will provide a thorough examination and an evidence-informed treatment program to give you the best chance of returning to the things you need to do and the things you love to do! We can also assist you with modifying activities to keep your hip as happy and healthy as possible for the longer term, and if surgery is required, we can assist you through this process to ensure the best result.
4. Heerey, J., Kemp, J., Mosler, A., Jones, D., Pizzari, T., Souza, R. and Crossley, K., 2018. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. British Journal of Sports Medicine, 52(9), pp.581-593.
5. Griffin, D., Dickenson, E., O'Donnell, J., Agricola, R., Awan, T., Beck, M., Clohisy, J., Dijkstra, H., Falvey, E., Gimpel, M., Hinman, R., Hölmich, P., Kassarjian, A., Martin, H., Martin, R., Mather, R., Philippon, M., Reiman, M., Takla, A., Thorborg, K., Walker, S., Weir, A. and Bennell, K., 2016. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal of Sports Medicine, 50(19), pp.1169-1176.