Understanding Hip Labral Tears
by Dr. Kerry McMahon, PT, DPT from MOTI PT
Do you have anterior hip pain? Does your hip have sharp pain intermittently or do you feel clicking in your groin? Is it painful to walk or sit for prolonged periods?
These are common symptoms of hip labral tears. The labrum is considered the “vacuum seal” of the hip joint. It is a cartilage ring that helps hold the head of the femur securely within the hip socket. If the labrum is torn, the congruency of the hip joint is compromised. Labral tears may be caused by trauma as in a motor vehicle accident, or by anatomical abnormalities where the structure of the hip may accelerate wear on the labrum. For dancers, labral tears may result from a traumatic injury resulting from a fall or sudden pivoting motion; but more commonly, labral tears result from repetitive motions in dance that wear on the labrum over time. Repetitive damage the hip labrum is commonly exacerbated by practices like over-stretching (in splits and/or turnout positions).
Pain is usually reproduced if you flex your hip, abduct, and fully externally rotate….a common movement pattern in many dance styles (for example, a développé or grands battement a la seconde). Or you can also cause impingement with hip flexion, adduction, and internal rotation.
If you or a dancer you know are experiencing these symptoms, it is a good idea to seek medical intervention early on. This is why having an ongoing relationship with a good dance physical therapist can really serve you and/or the dancers you teach. You want to have that person you can call at the onset of these types of symptoms, so that you have a better chance at success with conservative treatment. PT’s are a great medical first point of contact because they can help direct you to the best care, whether it’s conservative treatment with physical therapy or referral to an orthopedic physician. Often times, a good dance or sports PT will have close relationships with many orthopedic physicians in your area and can help refer you to an appropriate specialist. Labral tears should be diagnosed by an orthopedist, though they are not always treated surgically and can be treated conservatively with physical therapy.
J Dance Med Sci. 2011;15(4):149-56. Review of acetabular labral tears in dancers. Kern-Scott R1, Peterson JR, Morgan P.
Here are some exercises that may be used in non-surgical treatment for hip labral tears. Strengthening the muscles of the legs and hips with these exercises can help reduce the amount of impact on the labrum.
Lie on your back with your feet planted hip-width apart and parallel. Extend one leg up. Tighten your abdominals and press your hips up into a bridge…and then lower back down. Keep your trunk stiff, so that you are pressing your hips up and then down (rolling up and down through the spine). Be careful to keep your pelvis level…one hip should not dip lower than the other. Perform 10-20 reps on each leg.
Side Plank with Hip Abduction
Place a resistance band around your legs, just above your knees. Take a side plank on your forearm. Make sure hips and shoulders are stacked…and actively push down into your forearm the whole time to stabilize the shoulder. Slowly lift the top leg and then lower it back down. Be careful not to let your pelvis roll backward and forwards. You should only move the top leg, while the rest of the body stays stiff. Perform 10-20 reps on each leg.
Begin standing in front of a wall, with feet hip-width and parallel, and with a soft bend in the knees. Transfer your weight onto one leg, and press the other foot into the wall behind you. Hinge forward from your hips. Then rise back up to starting position - think about pushing down through your heel and squeezing through the back of your supporting leg in order to stand back up. Create resistance around the supporting hip, and focus on stabilizing the supporting leg throughout the movement. Keep your trunk stiff, and think about the pelvis and spine moving as one unit. Work to get the maximum range of motion out of the supporting hip, but only practice a range of motion that you can control. Perform 1-3 sets of 5-10 reps.
Airplane with Hip External Rotation
Begin standing with feet hip-width and parallel, with a soft bend in the knees. Hinge forward from your hips to perform a single leg deadlift, with your arms extended out like airplane wings. From here, keep your trunk stiff and rotate away from your supporting leg…be careful to resist rotation in the supporting leg (i.e. do not let your supporting knee rotate with you). Then rotate back into parallel, and return to stand. Move slowly, maintaining resistance and control around the supporting hip. Practice a range of motion that is pain-free and controlled. Perform 5-10 reps on each leg.
Demonstrator in photos is Dr. Kerry McMahon, PT, DPT.
MOTI Physiotherapy is a premier orthopedic physical therapy facility with two locations in Los Angeles. Our dance specialist physical therapists have personal backgrounds in dance and/or have undergone additional post-doctorate training to best understand how to treat the dancing body. MOTI’s dance medicine services span from injury prevention dance screens, to injury rehabilitation, to our groundbreaking dance conditioning program Sugarfoot Therapy. www.motipt.com and www.sugarfoottherapy.com