A Guide to Physical Therapy for Hip Labral Tear
Particularly in the sporting world, hip labral tears (also known as acetabular labrum tears) are relatively common hip injuries. Up to 50% of patients with groin or hip pain symptoms have a labral tear.1 Women, runners, professional athletes, and participants in sports that require frequent external rotation or hyperextension are most susceptible to a hip labral tear.
Working with a CityPT clinician can help you effectively manage your hip symptoms and prevent exacerbation.2 Physical therapy can result in less downtime and more participation in the activities you love. Read on to learn how.
- Understanding Hip Labral Disorders
- Symptoms of a Hip Labral Tear
- What are the Most Common Causes of a Hip Labrum Tear?
- Diagnosing a Hip Labral Tear
- What to Expect from Physical Therapy for a Hip Labral Tear
- What If Conservative Treatment Doesn't Work?
- Preventing Hip Labral Disorders
- Is It Time to Seek Treatment?
The hip is a large ball and socket joint designed to provide stability, lower body mobility, and weight transference. The labrum is a ring of cartilage that surrounds the outside of the socket (also known as the acetabulum) and deepens it.
The labrum acts as a sealant and increases the depth of the socket, helping to keep the ball (the femoral head) snugly in place within the socket. In addition, the labrum aids in lubrication and shock absorption.
The hip structure, surrounding joint capsule (including the labrum), and ligaments, all work together to reinforce the stability of this large and critical weight-bearing joint.
A hip labral tear occurs when the cartilage of the hip labrum becomes compromised due to (repetitive stress and/or repetitive motion) or trauma, typically resulting in hip or groin pain.
Hip Labral Tears: Classification
A hip labral tear is classified in a few different ways. First, the area of the hip that is affected:
- Anterior (front): most common
- Posterior (back)
- Superior/lateral (top or side): rare
Additionally, a hip labral tear is also classified by the type of tissue damage:
- Flap (disruption of the margin of the cartilage)
- Frayed flap
- Longitudinal tears (circular)
- A complete detachment from the hip socket bone1
The most common symptom is hip pain. Hip labral tear pain is typically felt in the groin or hip area and may radiate down the thigh or to the knee or buttocks. Hip pain may be worse with activity, such as running, squats, or lunges, and may be present at night or when lying down.
Other symptoms may include:1
- Clicking or locking
- Snapping or popping
- Limited hip mobility, including internal rotation, flexion, and extension
- A dull ache with weight-bearing activities, particularly when involving hip flexion — including brisk walking, running, twisting/pivoting, and stairs
There are a few different potential causes of hip labral tears. These include:3
- Trauma: Falls, a car accident, or any other sudden impact or direct trauma
- Sports: Repetitive motions, such as running or squatting, can put excessive strain on the labrum over time, eventually causing a tear
- Anatomical factors: Some people are born with shallow hip sockets or develop childhood complications like hip dysplasia, which can increase the risk of a hip labral tear
- FAI: The presence of femoroacetabular impingement, a condition in which the ball of the hip joint does not fit snugly into the socket
- Degenerative changes: As we age, changes in cartilage health and extensibility can increase the risk of a tear
Literature indicates that imaging is typically not a reliable way to diagnose issues within the hip joint. However, if needed, an MRI (magnetic resonance imaging) or MR arthrogram (a specific type of MRI that uses contrast dye to better visualize the joint) can help assess for a tear or rule out other suspected hip pathologies.4
Typically, an in-depth physical exam will be enough to determine the underlying cause of your hip pain. Your physician specialist or physical therapist will:
- Ask a series of questions
- Assess your strength, flexibility, and hip movements
- Complete a series of orthopedic special tests to determine what area of your hip is affected
The most reliable way to diagnose a hip labral tear is through arthroscopy, a minimally-invasive surgical procedure in which a small camera is inserted into the joint through a small incision. This allows the surgeon to visualize the joint and assess for any damage directly.5
Physical therapy is an effective treatment option if you are diagnosed with a hip labral tear. You should find a clinician specializing in sports physical therapy if you are an athlete. A comprehensive rehabilitation and exercise program will be designed by your CityPT clinician to focus on hip pain relief, restore range of motion and strength, and improve your ability to return to your previous activity level.2
Your specific treatment plan will be based on your tear's severity, symptoms, and goals. Treatment may include:
- Joint mobilization: Gentle movements of the hip joint to help restore range of motion, promote circulation, and reduce stiffness.
- Soft tissue mobilization: Techniques to release any tightness or adhesions in the muscles surrounding the hip and promote short-term pain relief. Common problem areas include the hip flexor muscles and gluteal muscles.
- Strengthening exercises: Hip labral tear exercises to improve the stability and function of the hip with daily activities with the use of body weight, a resistance band, and weights.
- Balance and proprioceptive exercises: Physical therapy exercises to help retrain your body to move optimally and prevent future hip injury. Examples include single-leg balance (standing on one leg), lunges, standing hip abduction, and stair training.
- Pain management: Modalities like ice, heat and dry needling can be utilized to address secondary pain and stiffness in the hip musculature
- Education: To learn about your injury, activity modification/ergonomics, and how to prevent future problems.
Conservative nonsurgical treatment, primarily physical therapy treatment, is always the first line of defense. However, you have other options if hip pain or dysfunction is persistent. These include:
- Injections: Of corticosteroids or other agents to help reduce pain and inflammation
- Hip Bracing: To offload weight-bearing joints and relieve hip pain6
- Surgery: Surgical intervention to repair or remove the damaged tissue
Following these procedures, it is still recommended that you complete (or continue) a modern physical therapy program to help optimize your joint function and smoothly return to your daily routine.
If you'd like to reduce your risk for a hip labral tear, optimizing your hip and overall tissue health throughout the body is best. You can do so by:
- Exercising regularly: With a combination of core and hip strength training (the body, weights, or a resistance band), cardio exercises, flexibility work, and proper warm-up/cool-down routines. If you need help deciding what activities to do, consider getting recommendations for specific physical therapy exercises that target the core and hips (hip adductors, hip abductors, back/stomach muscles, and quadriceps muscles).
- Modify high-risk activities and movements: If hip pain is experienced with particular movements, reduce or try to adjust your mechanics if possible (i.e. impact sports, deep squatting/lunging, prolonged sitting).
- Practicing optimal mechanics with high-risk movements: Such as pivoting and running.
- Wearing proper footwear: With appropriate arch support to help offload stress on the joints.
- Addressing any muscle imbalances: That may lead to joint instability and poor mechanics.
- Managing your weight: Within a healthy range to help minimize joint stress.
- Making healthy lifestyle choices: Such as adequate sleep, good nutrition, and stress management can all help promote optimal tissue health throughout the body
A hip labral tear can make it hard to participate in your life the way you'd like. If you're experiencing symptoms or are concerned about your risk of developing hip pain, it's time to get the help you need.
A CityPT clinician can assess your individual risk factors, symptoms, and movement patterns to determine your best course of action. With expert guidance, you can get out of pain and back to the things you love.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Philippon MJ, Martin RR, Kelly BT. A classification system for labral tears of the hip. Arthroscopy. 2005;21(suppl):e36.abstr. ↩
Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB et al Crossley KM. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med. 2018;52(9):581-593. ↩
Springer BA, Gill NW, Freedman BA, Ross AE, Javernick MA, Murphy KP. Acetabular labral tears: diagnostic accuracy of clinical examination by a physical therapist, orthopedic surgeon and orthopedic residents. N Am J Sports Phys Ther 2009;4(1):38-45. ↩
Eyles JP, Murphy NJ, Virk S, Spiers L, Molnar R, O'Donnell J, Singh P, Tran P, Randhawa S, O'Sullivan M, Hunter DJ. Clin J Sport Med. Publish online 8 Sep 2021.https://pubmed.ncbi.nlm.nih.gov/34516433/ ↩