A hip labral tear is a painful malady that can limit your ability to participate in any activity that involves twisting or pivoting (think golf, tennis, and softball). While typically there isn’t one notable cause, studies indicate that identifying specific repetitive activities or movements that place unnecessary pressure on the hips, and replacing them with alternative activities or movements, and keeping your muscles loose and strong, may help prevent hip labral tears.
The hip labrum, or acetabular labrum, is a structure made of cartilage on the outside rim of the hip socket. The hip labrum is designed to keep the hip joint intact, and keep the ball of the femur (thighbone) congruent with the socket (acetabulum) of the pelvis. In essence, it acts as a seal to hold the ball of the femur (your large leg bone) in the hip socket.
The hip labral tear occurs more often in women and athletes. Generally, women experience this malady more often than men due to an increased incidence of pelvic abnormalities in women. These abnormalities may accelerate wear and tear on the joint and, over time, cause tearing of the labrum. Also, the constant repetitive movements of athletes who participate in sports like golf or softball, experience wear and tear on the hip joint which can result in a labrum tear.
While there may be no signs or symptoms, patients with labral tears may complain of pain in the hip and groin area with hip motion (especially squatting and bending), stiffness or limited range of motion in the hip joint, or a locking or clicking sensation in the hip joint. Pain may also be experienced with running or jumping, and in severe cases, with walking. Generally, movement causes the pain; however, low-grade tears can be pain-free with many activities. In contrast, large tears cause inflammation in the joint that can result in pain during activity and even at rest.
A labral tear can be the fraying of a piece of the labrum, or when the labrum is completely ripped off the joint. Blood flow is essential in healing injuries. Thus, the naturally decreased amount of circulation in this area, as compared to other parts of the body, results in a particularly long healing process. Some low-level tears can be treated with exercise, but many require surgical intervention.
Most labral tear injuries do not have an easily identifiable cause. There are three possible causes: (1) structural abnormalities that result in increased wear and tear of the cartilage; (2) prolonged exposure to stresses, such as repeated twisting and pivoting (e.g., from golf or softball) or weight-bearing forces (e.g., from excessive jumping and running, especially on hard surfaces); and (3) traumatic injury to the area due to a car accident or a contact sport accident. Weak gluteal muscles and weak deep abdominal muscles (transverse abdominals) may also lead to an increased incidence in tears. Both the gluteal and deep abdominal muscles are designed to take pressure off the joint during activity. When they are weakened, the hip joint experiences added pressure that, over time, can result in injury.
- Maintain a healthy weight. Obesity is directly correlated to hip injuries. The hips are designed to support a specific body weight that allows for proportional support throughout the body. When the body carries more weight than designed, the hips are forced to take on a more difficult role, essentially working overtime to keep an unbalanced body in balance. This extra weight specifically puts excess pressure on the hip joints. Over time, this excessive pressure will wear down the joint and likely lead to injury.
- Stay in shape. Maintaining a good level of overall fitness and conditioning keeps the body strong and more resistant to injury. Many injuries occur in “weekend warrior” athletes—those who are not in good shape and do not work out consistently, but play sports on weekends. When we become fatigued, our form and technique can begin to break down. By staying in shape during the week through a combination of resistance training and cardio, we can gain the strength and endurance to avoid injury on weekends. Remember to warm up your body prior to any physical activity and stretch at the end.
- Stand tall. Wear and tear injuries can be exacerbated by a lack of proportion in the general region of the injury. Practice standing tall to help bring the body back into proportion, potentially helping to prevent injury. To stand tall, ground the feet by pushing the bases of toes and heels into the ground, engage your abdominals by drawing the belly in toward your back and up toward your ribs, and lengthen your side body by creating as much space as possible between your ribs and hips.
- Ground the feet. To prevent injury in the hips requires attention to not only the hip region, but also the body parts above and below. The feet are the base of your body. By grounding the feet you are setting your body up for proportional success. Ground the feet by pressing the bases of the toes and the heels into the floor and equalizing the weight distribution on each individual foot. Now, equalize the weight between the right foot and the left foot. Feel the earth supporting you. Choose three activities you do every day when you can practice grounding your feet. For example, practice grounding the feet while brushing your teeth, making coffee, and washing your face.
- Stabilize the hips. Imagine your sit bones—the bones protruding from the middle of each butt cheek—opening wide. At the same time, engage the abdominals by pulling the lower belly in toward the lower back and up toward to the ribs. Now, lengthen the side body by creating as much space as possible between the hips and the ribs. Simply practicing this technique while seated a few times a day will strengthen the hips.
- Organize the shoulders. You will be amazed by how aligning your shoulder girdle adjusts your posture and thus brings your entire body into better alignment. To organize the shoulders, open the collarbones wide by reaching them east and west. Now, plug the tips of your shoulder blades down your back. Practice organizing your shoulders while seated for long periods of time, whether at a dinner table, office desk, or in the car.
Consult a physician for an affirmative diagnosis. A low-level tear in the labrum may be addressed with exercise, but more severe tears often require surgery.
- Start supine with knees bent and feet grounded. Take hands to triangle mudra by touching the sides of the index fingers and tips of the thumbs to make a triangle.
- Place triangle mudra on the lower belly with thumbs underlining the navel and fingertips pointed to the pubic bone.
- Lift lower back off the mat and angle pubic bone toward the mat. This is tilt.
- Press lower back into the mat and angle pubic bone slightly toward the ceiling. This is tuck.
- Inhale; tilt. Exhale; tuck. Continue for eight cycles of breath.
- Start supine with knees bent and feet flat.
- Raise legs—one at a time—to a 90-degree angle. Position knees over hips and toes visible above knees. Kiss together the sides of big toes, inner anklebones and inner knees to centerline your legs. This is centerline tabletop.
- Inhale; lengthen the side body by creating as much space as possible between the ribs and the hips. Exhale; empty by drawing the lower belly in toward the back and up toward the ribs.
- Continue for 8 breath cycles.
- Start supine with knees bent, feet grounded and arms extended at the sides with palms facing down.
- Tuck pelvis and roll up – vertebra by vertebra – to the spine of the scapula. Roll down – vertebra by vertebra – back to start position.
- Inhale; roll up and ground the feet by pressing the base of the toes and the heels into the floor. Exhale; roll down and empty by drawing the belly in toward the back and up toward the ribs.
- Continue for 8 breath cycles.
- Lie on the side of the body with the bottom arm stretched upward long and flat on the mat. Bend bottom knee to 90 degrees, place top hand in front of the chest and rest the side of the head on the outstretched arm. Lift and reach long through the top leg and strongly press the hands into the floor. This is start position.
- Lift top leg to hip level and reach long through the toes. Lower the leg to start position.
- Inhale; lengthen right side body and lift top leg to hip level. Exhale; empty by drawing the lower belly in toward the lower back and up toward the ribs and lower the leg to start position.
- Continue for 12 breath cycles and follow with the alternate side.