A torn hip labrum is an injury to the cartilage around the hip joint socket. It can occur after a traumatic injury-like contact during a sport or a car accident, or it might occur over time from overuse due to repetitive movements. This hip injury could also be due to age-related degenerative changes. But why do female sports medicine patients experience different symptoms than male patients when it comes to a torn hip labrum? Will their labrum recovery be different?
"There are gender-specific differences in hip labral tears that are not often recognized," says Scott Martin, MD, Mass General Brigham Sports Medicine specialist and director of Joint Preservation Service at Massachusetts General Hospital.
In general, symptomatic hip labral tears tend to occur more frequently in women patients than in men. This may partly be due to the increased incidence of hip dysplasia in women, particularly in women who are between 15 and 41 years old.
"A lot of the differences in hip labrum tears are because women are built differently," says Dr. Martin. "They have much higher flexion arches of their hip because they have less muscle. They are able to get their knee up to their chest and can rotate a little more, which makes even smaller impingement lesions." Impingement lesions are lumps and bumps on the hip socket or femoral head (top of the thigh bone) that can damage the cartilage over time.
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Women tend to start out with symptoms that are worse than men, says Dr. Martin. "You might not find noticeable differences on imaging findings, but we've found that even small irregularities can cause big problems in women."
It's common for women to experience pelvic-floor pain in association with labral tears. Or, that pelvic pain could be linked to hip impingement, hip dysplasia and early or late-stage arthritis development.
Pincer impingements are a type of hip condition thought to be more common in middle-age women who played or currently play sports. This occurs when there is excessive coverage of the femoral head by the acetabulum (hip socket). When the hip flexion is in motion, the neck of the femur bone bumps against the rim of the deep hip socket, causing cartilage and labral damage. Alternatively, cam hip impingements (when the ball-shaped end of the femoral head is not perfectly round) are more common in young, athletic males.
Although women's hip labral tear symptoms are usually worse, if you operate on them, they do just as well as men with labrum recovery, Dr. Martin says. They recover just as quickly, but there are definitely gender-specific differences.
"We treat each patient as an individual. We aim to understand their particular lifestyle and goals, as well as the methods they're using for activities and sports. Every sports medicine patient is going to have a different profile depending on what they do, what their activity level is and their age."
If patients must receive arthroscopic surgery, a minimally invasive procedure, to heal a hip labral tear, they will first undergo prehab with a physical therapist.
"You need prehab, and then if you have surgery, it exponentially expedites your recovery if you had prehab," says Dr. Martin. "If you show up in my office with a lot of pain, you probably already have altered your gait. What do you think your gait is going to do post-op? It's going to take forever to turn around. Our treatment goal is to relieve patients' pain first and then straighten the muscles that are supposed to be working. It's important to correct their gait abnormalities before you operate, and we can usually do that within the first few months."
In general, it takes four to six weeks for most patients to allow the tissues to heal, says Dr. Wilk. "And then they'll go through physical therapy and rehab after that."
The physical therapy for labrum recovery isn't necessarily different for men and women, but it's tailored to each specific patient. "I tell every patient who has an arthroscopic procedure that it is a six-month rehab and recovery period before they may be ready for a full return to sports."
A lot of times, patients feel dramatic pain relief soon after this surgery, says Dr. Wilk. "On some level, that's good news because obviously their pain is gone and they've been suffering and they're happy with that. But then they might think they don't need their crutches and don't need to go slow.
"I often have to emphasize the need to slow it down to allow things to heal, to go through the rehab and to not try to do too much too soon," says Dr. Wilk. When patients feel good, they just want to get back to their normal lives. But if they do too much too soon, they can have a temporary setback.
"We treat each patient as an individual," says Dr. Wilk. "We aim to understand their particular lifestyle and goals, as well as the methods they're using for activities and sports. Every sports medicine patient is going to have a different profile depending on what they do, what their activity level is and their age."
All of those components are factored into the prehab and post-surgery labrum recovery.