Whether you're a recreational athlete participating in adult hockey, football or soccer, a weekend warrior or a professional athlete, you could be at risk of a torn hip labrum.
"A lot of times patients aren't sure if they have a labral tear because it can masquerade as other things. Your gastrointestinal tract, endometriosis, groin pain or pelvic pain to name a few," says Scott Martin, MD, Mass General Brigham Sports Medicine specialist and director of Joint Preservation Service at Massachusetts General Hospital. "A hip labral tear is probably the most common thing that we see in our office."
This injury refers to a ring of cartilage—called the labrum—that surrounds the hip joint socket. The labrum helps keep the hips in alignment and protects the hip joint where the ball of your thigh connects with the hip socket. When you have a hip labral tear, that soft elastic tissue tears or detaches from the joint. This can be very painful but some patients don't experience symptoms.
"The average time the pain has been going on before we see an athlete tends to be 18 months to two years. They often are misdiagnosed as a hip flexor strain, an abductor strain, sports hernia, lower back or a sacroiliac (SI) joint injury for a few months. They can often play with the injury or pain."
When the hip's labrum tears, it's called a hip labral tear. Here are some symptoms of a torn hip labrum:
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Certain athletes are at a higher risk of hip labral tear, like soccer, football, hockey and golf players, as well as ballerinas. They might have an injury from a hard hit with another player, or it could be due to repetitive motion.
"The average time the pain has been going on before we see an athlete tends to be 18 months to two years," says Dr. Martin. "They often are misdiagnosed as a hip flexor strain, an abductor strain, sports hernia, lower back or a sacroiliac (SI) joint injury for a few months. They can often play with the injury or pain."
Age plays a part in the degeneration of the labrum, too. If you suffer from hip arthritis, that could lead to a hip labrum tear.
"When you start to get degeneration of your hip, especially with an impingement hip where you get lumps and bumps that shouldn't be there, you can get a breakdown of that area," says Dr. Martin. "We really feel that's a significant injury that begins with arthritis, in addition to labral tears."
Mass General Brigham Sports Medicine patients will be evaluated for conservative treatment options and then a mutual decision will be made on whether surgery is needed. If a patient has a symptomatic hip labral tear, they may notice improvement with nonsurgical treatment. Patients might get a low-dose steroid injection to reduce or alleviate pain followed by physical therapy a few weeks later.
"Physical therapists work with the muscles of your lower back, your core, your pelvic floor, your hip itself, your IT band and your knee to stabilize your gait," says Dr. Martin. "It's to get you out of this walking pattern that causes a lot of the pain."
In The American Journal of Sports Medicine, doctors describe a just-completed five-year randomized study led by Dr. Martin of patients with a hip labral tear where some received surgery and others received conservative treatments. The patients either received conservative treatment for 14 weeks or underwent surgery and were followed for the same duration and then completed follow-up questionnaires a year later.
"We found that with proper selection, the surgical group did extremely well," says Dr. Martin. "The other finding was that if you are doing well with conservative treatment—and you have limited femoroacetabular impingement, a condition where the bones of your hip joint can come too close and cause friction—you will continue to do well."
Over 70% of the study participants who followed nonsurgical treatment procedures were satisfied. Some of those patients who received nonsurgical treatment and had a more significant hip injury still reported residual hip pain, were limited in their activities and were considering hip surgery.
If conservative treatments aren't working, your doctor might suggest surgery, which is usually done as a minimally invasive arthroscopic surgery.
"It's important to prehab the patient first by reducing the pain and improving the gait before surgery," says Dr. Martin. This can make their post-op recovery with a physical therapist less painful and more efficient. Choosing a skilled orthopaedic surgeon who has a lot of experience at arthroscopic hip surgery greatly improves your chances of full recovery after surgery and returning to activities you love without pain.