Hip labral tears and femoroacetabular impingement (FAI) can be a source of pain and discomfort in the hip joint, and the expected outcome depends on the severity of the tear or bony impingement and the individual’s overall health and treatment.
In many cases, conservative treatment options such as rest, physical therapy, and anti-inflammatory medication may be sufficient to manage the symptoms of a hip labral tear and FAI. In more severe cases, surgery may be necessary to repair or remove the damaged tissue.
After surgery or conservative treatment, most people can expect to experience a reduction in pain and an improvement in hip function. However, recovery time can vary, and it may take several months to fully recover. In some cases, ongoing physical therapy or rehabilitation exercises may be recommended to help maintain hip strength and flexibility.
Causes:
Hip labral tears can be caused by a variety of factors, including:
Trauma: A direct blow to the hip or a fall on the hip can cause a labral tear.
Repetitive stress: Repetitive motions that put stress on the hip joint, such as twisting or pivoting, can cause labral tears over time.
Structural abnormalities: Structural abnormalities in the hip joint, such as femoroacetabular impingement (FAI), can cause labral tears. FAI occurs when the ball of the hip joint (the femoral head) does not fit properly into the socket (the acetabulum).
Degenerative changes: Age-related degenerative changes, such as osteoarthritis or degeneration of the labrum itself, can also cause labral tears.
Joint hypermobility: Individuals with joint hypermobility or laxity may be more prone to labral tears due to increased mobility and instability in the hip joint.
Sports: Certain sports that involve repetitive motions or high-impact activities, such as soccer, hockey, and ballet, have been associated with a higher risk of hip labral tears.
Symptoms:
The symptoms of a hip labral tear can vary depending on the severity of the tear but may include:
Pain in the hip or groin: The most common symptom of a labral tear is a pain in the hip joint or groin area. The pain may be sharp, dull, or aching and may worsen with certain movements or activities.
Clicking or locking sensation: Some people with labral tears may experience a clicking or locking sensation in the hip joint when they move their leg.
Stiffness: Stiffness in the hip joint, especially after prolonged sitting or lying down, is another common symptom of a labral tear.
Limited range of motion: A labral tear can cause a limited range of motion in the hip joint, making it difficult to move the leg freely.
Instability: Some people with labral tears may feel as though their hip joint is unstable or weak.
Structural Changes- focused look:
Femoroacetabular impingement (FAI) which can be a source of hip pain and lead to labral tears is a condition in which there is abnormal contact between the femoral head (the ball-shaped part of the thigh bone) and the acetabulum (the cup-shaped part of the pelvis) in the hip joint. This can cause pain, stiffness, and a limited range of motion in the hip.
Femoroacetabular impingement (FAI) is caused by an abnormal shape of the hip joint that leads to friction between the ball (femoral head) and socket (acetabulum) of the hip joint. There are three main types of FAI, each with a different underlying cause:
- Cam-type FAI: This type of FAI occurs when there is an abnormal shape of the femoral head (ball), usually with a bump or protrusion. This can cause the femoral head to rub against the acetabulum, leading to damage to the labrum or cartilage.
- Pincer-type FAI: Pincer-type FAI occurs when there is an overgrowth of bone around the rim of the acetabulum (socket), which can cause the labrum to become pinched or trapped between the femoral head and the acetabulum.
- Mixed-type FAI: Mixed-type FAI occurs when there is both a bump on the femoral head and an overgrowth of bone on the rim of the acetabulum, leading to both types of impingement.
The exact cause of FAI is not always clear, but it is believed to be related to genetic factors, abnormal hip development during childhood, and/or repetitive stress on the hip joint from certain activities such as high-impact sports or dance. Factors such as age, gender, and anatomy may also play a role in the development of FAI.
FAI can be diagnosed with a combination of physical examination, imaging tests such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.
Symptoms:
The symptoms of femoroacetabular impingement (FAI) can vary depending on the severity of the condition but may include:
Hip or groin pain: The most common symptom of FAI is a pain in the hip joint or groin area. The pain may be sharp, dull, or aching and may worsen with certain movements or activities.
Stiffness: Stiffness in the hip joint, especially after prolonged sitting or lying down, is another common symptom of FAI.
Limited range of motion: FAI can cause a limited range of motion in the hip joint, making it difficult to move the leg freely.
Clicking or locking sensation: Some people with FAI may experience a clicking or locking sensation in the hip joint when they move their leg.
Instability: FAI can also cause a feeling of instability or weakness in the hip joint.
Pain in the buttocks or thigh: In some cases, pain from FAI may radiate to the buttocks or thigh.
Treatment:
Most often labral tears and/or FAI can be managed with physical therapy. In some cases, surgery may be necessary to correct the anatomic abnormalities and repair any associated damage to the hip joint.
In addition to physical therapy, anti-inflammatory medications, and modifying activities that aggravate the hip joint will be needed to reduce symptoms.
What to expect in physical therapy and at home to have a full recovery:
Range of motion exercises: In the early stages of recovery, the focus is on regaining range of motion in the hip joint. Your physical therapist will guide you through gentle exercises that aim to increase the flexibility of the hip joint.
Strengthening exercises: As your hip range of motion improves, your physical therapist will gradually introduce strengthening exercises to rebuild the muscles around the hip joint. These exercises may include leg lifts, squats, lunges, and hip bridges.
Core strengthening exercises: Strong core muscles can help to improve your hip stability and reduce the risk of future injuries. Your physical therapist may recommend exercises such as planks, side planks, and bridges to strengthen your core muscles. A personalized program will be developed for your individualized needs.
Gait training: Walking and standing are essential daily activities that can be challenging after a hip labral tear. Your physical therapist will help you to regain proper walking mechanics, balance, and posture.
Neuromuscular re-education: Hip labral tears can disrupt the normal communication between the brain and the hip muscles. Neuromuscular re-education exercises aim to restore this communication and improve your hip joint function.
Manual therapy: Joint and soft tissue mobilizations to help regain ROM and reduce pain
Return to activity: A graded return to your activity or sport will help you achieve your goals!
The duration of physical therapy will depend on the severity of your injury, your surgery type, and your overall health status.
At Carolina Pelvic Health Center, Inc. we can diagnose your hip pain and get you the therapy you need to get you back to your activities!
Call today 919.571.9912 to schedule an appointment!
Resources:
American Academy of Orthopaedic Surgeons
American Physical Therapy Association
References:
Byrd, J. W. (2016). Hip arthroscopy: the basics. Elsevier.
Johnson, A. C., & Guanche, C. A. (2016). Hip labral tears: a review of diagnosis and management. World Journal of Orthopedics, 7(10), 644–651. https://doi.org/10.5312/wjo.v7.i10.644
Kahlenberg, C. A., Patel, R. M., & Knesek, M. (2019). Hip labral tears: evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 27(12), e556–e566. https://doi.org/10.5435/JAAOS-D-18-00114
Matsuda, D. K. (2015). Hip Arthroscopy for Labral Tears. In AANA Advanced Arthroscopy: The Wrist and Elbow (pp. 425–438). Springer International Publishing.
Philippon, M. J., & Devitt, B. M. (2019). Hip Labral Tears: Evaluation, Management, and Outcomes. Sports Medicine and Arthroscopy Review, 27(1), 17–25. https://doi.org/10.1097/JSA.0000000000000226
Safran, M. R. (2015). Hip labral tears: diagnosis, management, and outcomes. Journal of the American Academy of Orthopaedic Surgeons, 23(4), 231–238. https://doi.org/10.5435/JAAOS-D-14-00032
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2018). Hip Impingement (FAI). https://www.niams.nih.gov/health-topics/hip-impingement-fai
Mayo Clinic. (2021). Femoroacetabular Impingement (FAI). https://www.mayoclinic.org/diseases-conditions/femoroacetabular-impingement/symptoms-causes/syc-20354795
American Academy of Orthopaedic Surgeons. (2014). Femoroacetabular Impingement (FAI). https://orthoinfo.aaos.org/en/diseases–conditions/femoroacetabular-impingement-fai/
Byrd, J. W., & Jones, K. S. (2014). Hip arthroscopy in athletes. Clinics in sports medicine, 33(3), 441-468. https://doi.org/10.1016/j.csm.2014.02.006
Kassarjian, A., & Fritz, B. (2014). Hip MR arthrography and femoroacetabular impingement: a primer for radiologists. Clinical radiology, 69(5), e202-e208. https://doi.org/10.1016/j.crad.2013.12.011