FAI- Hip Labral Tear: Is It Surgery Worthy?
Hip labral tear. Hip labral impingement. These are quite the “buzz words” in orthopedic medicine. Technically called FAI (Femoral Acetabular Impingement), these are diagnosed quite frequently. Research states between 22-55% of the population is walking around with a labral hip tear. But, here’s the question: are people actually getting more hip labral tears these days? Maybe. Maybe not. A more likely explanation: we finally have imaging to prove that a hip labral tear exists. Ok, fine. But, just because we have imaging that can finally diagnose a labral tear, does it really require surgery? These arthroscopic surgeries are very popular (yes, I just used the word “popular” for a surgery). Most athletes, elite and recreational, think this is the golden ticket to recovery. But it’s not necessarily true. FAI surgeries are far from perfect. I always tell my patients: “There is a time and place for surgery. When you need it, go get it.” But, surgery should be the last resort, not the first. So, if you think you MAY have a hip labral tear, consider the first recommendation of research: give physical therapy a good go!
This blog is inspired by several patients over the past few years. Some weren’t sure (and they did have a labral tear), some were sure (and they didn’t have a labral tear). But, all of them were motivated to heal their hip pain without surgery. Remember, PT is not harmful. And, with a correct diagnosis, most (not all) people can heal without surgical intervention.
Ok. Let’s all get on the same page. What are we talking about?
Anatomy Review: The Hip and its Labrum
(picture from APTA website)
The hip consists of the pelvic bone and femur. The head of the femur (the blue part above) glides around the acetabulum (hole in the pelvis) to create movement.
The hip labrum is an intrinsic (internal) source of hip stability. The labrum acts as a suction around the hip joint to provide extra stability, along with the ligaments and muscles. In addition, it creates extra coverage and lubrication to the hip joint. Basically, the labrum helps keep the hip happy and healthy.
What is a Femoral Acetabular Impingement (FAI)?
There are three main types: pincer, cam and combo
(image from http://orthoinfo.aaos.org/)
Pincer- Bone on the acetabulum extends over the natural rim and impinges the femoral head. Basically, blame it on the pelvis.
Cam- The femoral head is not round enough to glide smoothly in the hip socket and can bother the labrum. Blame this on the femur.
Combo- Cam + Pincer issues.
Possible Signs of FAI
- Anterior (front) hip and groin pain
- Lateral (side) hip or leg pain
- Anterior thigh pain
- Glute pain
- Clicking or sensation of “pop” during certain movements
- Decreased range of motion and hip tightness
- Pain with hip flexion, squats
When you look at these symptoms above, almost everyone reading will start to wonder if they have a hip impingement, right? I know you’re thinking: “Well, yes, I do have glute pain and some thigh pain. And, you know, now and then my hip does pop.” That’s why it is IMPERATIVE you have a medical professional test your symptoms and not rely on Mr. Google for a diagnosis.
Medicine continues to point in the direction of physical therapy as a first line of intervention for orthopedic issues. It’s more cost effective and an experienced PT will know if you need a referral to an orthopedic surgeon. So what does the research say about FAI? Try a course of non-operative intervention (“aka physical therapy”) for at least 10 to 12 weeks. The physical therapist will be able to clinically diagnose a possible FAI. Here are some common tests I use for a diagnosis:
- Scour test
- FABER
- Hip impingement test
- Hip internal rotation ROM
Note: I have withheld information on what these tests entail because only a medical professional should be performing and diagnosing the outcomes of these tests. There can be A TON of misinterpretation if they are not conducted correctly.
If any or all of these tests are positive, the patient may have a possible labral tear. Does that mean I send them for a MRI? Maybe, maybe not. Some people feel better having a picture of their possible tear. Most people would rather not spend the money if they are going to try PT first. And, a visit to an orthopedic surgeon (with or without a MRI) will go something like this: “Go try physical therapy for a few months. If it’s not better, then come back.”
One of the most consistent findings of hip labral tears is myofascial (muscle and fascia) pain of the quads, hip, back and glutes. Manual therapy and specific physical therapy exercises can be the magic ticket to reducing this pain. And, then, their hip impingement symptoms are minimal to none. So, wouldn’t it be nice to know if your hip pain is really from the impingement or just a myofascial syndrome? I sure hope you’re nodding your head “yes.”
If your hip symptoms don’t improve in 12 weeks, then start the expensive MRI, surgical consult route. At least by then you will be informed and a little stronger going into surgery.
Clinical Case Studies
17 year-old track and field player
While hurdling, he felt a pop and then sudden pain in his right hip. Although his symptoms improved slightly with strength training, his parents decided to have an MRI. The MRI showed a possible labral tear, but nothing conclusive. Significant findings at the initial evaluation:
- Right hip pain, deep ache (1/10) to sharp pain (8/10)
- Pain with hurdling and hip flexion
- Positive scour test and FABER test (minimal)
- Internal rotation was within normal limits
- Weak glutes and intrinsic core
After 3 visits in 4 weeks, the patient reported 70% improvement of symptoms. His physical therapy program consisted of a Pilates program, a non-weight bearing to weight-bearing strength program and specific stretching. At 4 weeks, he was back to hurdling 2x/week with right hip tightness (no pain) that he could easily relieve with his PT exercises. He was diligent about doing his Pilates program and strength program 2-3x/week. Each program was 10-12 minutes in length (that’s it!). Note: I treated this patient remotely. He never received one manual treatment. He healed himself by doing the right exercises to stabilize and strengthen his hip.
44 year old competitive cyclist and avid mountain climber
This patient came to see me three months after his initial symptoms. He stated left hip tightness during his cycle season, but in October of that year he had significant left hip pain while working out with his personal trainer. Significant findings at the initial evaluation:
- Left hip tightness that radiated to his anterior leg
- Tenderness of the anterior hip muscles (rectus femoris, tensor fascia lata) and glute medius
- Positive scour and FABER test
- Hip internal rotation limited by pain and “slide” sensation
- Weak glutes and intrinsic core
After 3 months of physical therapy, the patient reported significant improvement of his symptoms. He continued with PT every other week, then once a month. At 8 months, this patient was back to cycling, personal training and climbing with minimal left hip tightness, no pain. His physical therapy program consisted of: manual therapy, Pilates-based therapeutic exercise, stretching and non weight-bearing to weight-bearing strength and stability. He worked his tail off, avoided surgery and returned to ALL of his activities.
Take Home Point
- If you think you have a hip labral tear, try physical therapy first for at least 10-12 weeks. Ensure your hip is surgery worthy!
© 2016 & Beyond. ALL BLOG CONTENT at duncansportspt.com by Lori Duncan PT
BLOG TALK PODCAST:
Blog Talk – Hip Labral Tear
ABOUT THE AUTHOR
Lori Duncan, DPT, MTC, CPT is a respected Physical Therapist, Manual Therapist and Pilates instructor in Lafayette, CO. Lori is passionate about preventive physical therapy and education and is a nationally recognized presenter. She can be reached at [email protected]. You can also follow Duncan Sports Therapy + Wellness on Facebook & Instagram for more free tips and information.
Research
Phillippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction. J Bone Joint. 2009;91:16-23.
Cashman GE, Mortenson WB, Gilbart MK. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study. J Orthop Sports Phys Ther. 2014;44:604-14.
What about the theory that a hip labral tear left torn would continue to deteriorate making arthritis highly likely. I’m 35. Had a torn labrum and impingement corrected surgically in February (tried physical therapy). My right is not very symptomatic but also torn. Surgery on that in 2 weeks. I don’t want further deterioration of the joint and tear by leaving it the way it is. Insight?
Also interesting is that this is the first site that says many times the symptom is myofascial. That’s all mine ever is and its torture. It still haunts me even post op. The only thing in a year that resolved it was a hip joint steroid injection.
Hi Dana,
Thanks for reading. Well, it depends on the amount of the tear. And, I always tell my patients that just the act of surgery can also cause early degeneration. Someone has been inside your hip with foreign objects and that can be irritating and cause “wear” that was never there before. I say “CAN”…everyone is different. But, if you tried a good round of physical therapy before your surgery and it didn’t work, you likely needed the surgery. I have treated 2 women in your age-range over the past 6 months with diagnosed labral tears. Luckily, both wanted to avoid surgery and their surgeons suggested PT first. Both are back to doing what they want (modified cross-fit, lifting, cycling) because their pain was 99% myofascial, not joint AND they both have an incredible core now. Have you thought about getting another surgical opinion of your hip since you seem to be questioning it?
I just came across this forum. My 14 year old daughter was a competitive soccer player, playing up to 7 days a week. Last June she started getting what we thought were overuse injuries, started in shins, then IT band syndrome, then patellofermoral chondramallesia( knee pain), All of this was in the left knee, she did 6-7 months of pain specific PT, only the IT PT helped. Then in October her left hip started hurting, so back to the 3rd ortho sports medicine person we go. there she was diagnosed with borderline dysplasia in left hip, FAI(cam type) and went back to more PT specific to the hip and REST, no soccer or running for 7 weeks. As we awaited the follow up day she went out to shoot, stronger than ever, but when she came home the hip pain was a 10 and traveled to new areas in the left hip. At the follow up they thought the labrum was torn, and sent us for MRI arthrogram, results showed it was indeed torn. The office we go to in Denver the surgeon does almost no repairs only reconstruction, hes done over 2000 of them. As we await more information from insurance etc- The reconstruction is NOT covered by United Health CAre, if you can believe that!!! wondering if others on here have opted to NOT do surgery and quit their sport. This too comes a t high cost for a girl that lived to play, but I am hearing so many outcomes that are not ideal.
Hi Debra,
You’re in Denver? I’m in Lafayette. Let’s schedule something so I can eval your daughter and give her better information. She is pretty young to just stop dong everything she loves to do. Email me at [email protected].
are you talking about dr white in Denver. Is he any good I need to know my daughter is in horrible shape her so called orthopedic surgeon messed her up more. We live in northern Idaho where the doctors don’t know anything. We cant leave the state on medicare who can help what can we do I am desperate for my daughter she needs help asap. She has already had a failed surgery 20 months ago and she is worse. She is between a rock and a hard place what do we do. I hate northern Idaho these drs up here suck. They dont listen they don’t even know what your talking about. I am orginally from southern california where there is USC UCLA Loma Linda the best of the best but we don’t live in california anymore. Were stuck in this hell hole.
Hi John,
I know you wrote to Debra, but thought I’d chime in. We do have fabulous MD’s here in CO, but that does not mean they should be cutting on every hip labrum. The surgeries almost always fail (I”m sorry to hear about your daughter) thus it is imperative to seek good PT and stabilize the area before surgery or a 2nd surgery.
Hi,
I had gotten a laberal tear 7 years ago. Finally, got an MRI 2 months ago. Diagnosed with laberal tear and tonnis 1 arthritis. Been doing physical therapy for 3 months. Improved alot. Les back pain, hip pain etc. but my groin pain aggravates whenever i sit in the car. Also adductor pain is getting agrivated the more i squat?
Hi Randy,
Glad you are feeling improvement with PT. If your adductor is “making noise” then the glute and/or VMO are not controlling the femur enough. So, the adductor tries to make up the control.
My daughter is now 16, very active soccer player. She had her right hip surgery 15 months ago, after a year of getting the run around and PT.
She made it through rehab like a champ and was cleared to return to training at the 5.5 month post op appointment. Within two weeks she has bursitis in the right side. Back to PT for treatment, cleared three weeks later. Within 2 weeks she was pulled for six months with chronic hip flexor tendonitis. PT two to three times a week and the relief just wasn’t coming, ionto patch finally got her some relief after getting a patch every other day for three weeks straight. PT strengthened everything and she was cleared again.
She is three-four months back to playing soccer and she can’t walk without wanting to cry. And now she is complaining of pinching in the left hip. Saw the surgeon today, definitely hip flexor tendonitis flare and they want to do a cortisone injection as nothing is keeping it away. X-rays on the left hip where a new pinching sensation and popping can be heard show dysplasia. Off for another Arthogram. And surgeon wants to meet after that to discuss repairing the other hip.
My question is we did almost a full year of PT before the last surgery with no help, we have been in PT 10 of th last 14 months since the last surgery and she is still at this point with the left hip. Is trying PT yet again even worth it?
She has decided that she is done playing soccer, wants to clear the flare to play in one final tournament in three months, and is hanging up the cleats for good. Could that be enough? She is heading to nursing school in a year, her surgeon feels it should be done before then. Because it’s not going to get any better. I am just torn!!!! And it got so bad with the right hip that she stood in her classes for four months because sitting was excruciating. The pinching was bad on the right hip with the tear. I don’t want her to go through that again, she lost almost a year of her life waiting for them to figure out what was wrong and do the surgery.
Hi,
A lot of history for a 16 year-old. I’m going to email you directly since her history is so involved. Thank you for reading!
I’d like to hear her email. My daughter is going through the same thing st 16 from Taekwondo.
Am 80 yrs., female, widow, somewhat overweight, low bone density after 3 rounds Prolia (possibly to start different one), 2 tkr, screws & plates from cervical surg., and cyst removed from L4 with repair plates/screw L4,5,6, C1. Now labrum tear and cyst inside hip socket. First cort. inj. helped immensely for 2 days, second helped some after about 4 days. Am post shots 2 weeks. Have continuous low back pain, stiffness, OA, RA, Sjogrens, Fibro (?), lipomas left rib area. Is it advisable to try PT, or is surgery inevitable for me. I live alone, 4th fl. apt. with elevator, no close family to help on regular basis. Activity level very limited due to pain etc. Self care manageable but limited, still drive. Need cane or rollator definitely. Want to stay independent. Would seeking special kind of surgeon be advisable? Your professional thoughts please. Sincere thanks.
Hi,
Thanks for reading and your comment. I always encourage people to try PT or conservative routes first. They are not harmful and most the time it’s what the body needs. Our bodies were designed to move, so many times pain lessens the more we move, even though that seems to be the worst thing at the time with pain. To your question, try PT first!!
I found your article of FAI very informative. I am looking for suggestions. I have a 17yo football player who was diagnosed with FAI a few weeks ago. Treated as groin pull after feeling sharp pain running a 40 for 4 or 5 weeks prior to diagnosis. He has had MRI/A and x rays. Cam impingement based on xray. MRI with contrast showed.. Cholondrolabral undermining of anterior superior superior labrum with mild intrasubstance injury most prominent between 12 and 1 o’clock, No detached tear. Equivocal evidence of sublabral recess in posterior inferior labrum vs nondetached labral base tear. Sports Orthopedic Dr gave cortisone injection 1 week ago. He is on NSAID as well and has been on them for 3 weeks. Has been in PT 2x week and team trainer/PT Assistant has been doing daily work. Any particular excercises you would recommend? Would yoga with a Sports Rehab PT trained in yoga be beneficial Do you know of any braces or Kinesiology Taping methods that may help. The goal of Dr and PT is to get him through his senior season as he is being recruited. He claims it only bothers him firing out of a 3 or 4 point stance. We have talked about stance modification in the future. Right now we are in the cool it down and work on glutes and adductors stage. Any suggestions are appreciated.
Hi Steve,
He needs a TON of glute/core stability. This is not sit-ups, squats and lunges. It’s small movement/muscle work. I would actually suggest Pilates over Yoga at this point. There is nothing like Pilates to train the stability muscles of our body and, so far, it is THE KEY to getting patients out of their pain patterns and back to activity. If you feel you need more information, I do offer online consultations to help you and your athlete progress in the right direction. Thanks for reading and your comment.
Hi Lori,
I am 39 years old and have been diagnosed with FAI and a labral tear in both hips through an MRI. While training for a half marathon in the fall I experienced pretty bad pain in my hips,having trouble sleeping, sitting, walking stairs, etc. I went to PT for about 8 weeks and saw some results but when I started playing basketball in the spring I had horrible pain again so I decided to schedule surgery. After scheduling surgery, i started training, running 25 miles per week and mixing strength and flexibility twice a week. I incorporate many lifts I learned in PT. Ironically, I am now sleeping at night, and have minimal pain when sitting for long periods. I am really struggling with my decision for surgery. I am about a month away. Do you have any recommendations?
Hi Justin,
If you are getting relief, postpone surgery. It sounds like you are getting joint motion (although I wouldn’t recommend THAT much running), strength and stability which is KEY for these labral tears. Maybe schedule it out for 2-3 months. Then, if your pain comes back, its there if you need it. If you continue to feel good, cancel it! I would refrain from a lot of jumping, high impact sports.
I am 64 and in good health. I had a sudden tearing sensation in right hip when twisting around suddenly about 15 years ago. Tried physio etc, and nothing diagnosed. I thought what I had was Gilmore’s groin at the time. Eventually, the searing pain I experienced standing up or getting out of a car diminished, but the hip never felt quite right or well aligned after. The pain returned occasionally when I was run down emotionally for some reason. After a bad case of flu 2 years ago, and after recovery began to experience bad muscle pain in shoulders and hips which became Polymyalgia Rheumatica, treated with corticosteroids. Within about 7 months my hip pain returned and has increased over the past twelve months so that I am now quite lame, pain, spreading to knee and back. Exercise and massage just makes it worse. I’ve had xrays that did not show much arthritis, and then an MRI which showed extreme inflamation and ostoarthritis, a bone cyst etc, . No one mentioned a labral tear, but my doctor, the mri doctor and physio all stated that my pain is not typical of osteoarthiritis and puzzled them. I have tried all soorts of things to help and looking up cysts just began reading about labral tears and this is exactly my symptom – clicking joint, shifting bone, and I believe this was the initial injury exacerbated by the steriods and this is the cause of my pain, not the osteo. I know when I have rested that at first there’s no pain, only after I have used the hip for a while does the pain begin – I want to avoid hip replacement. Could surgery help me at all?
Hi Sue,
Well, I would try to avoid any surgery if possible. Surgery is just controlled trauma to the body. If you think you have a labral tear of the hip, it requires a TON of core, glute strength for optimal rehab. This is not squats and lunges, but more stability-based exercises. And, a good manual therapist is KEY to inhibit, relax the muscles in the area. Where are you? Maybe I can recommend someone.
Well, I have done more reading about that op and I agree about the surgery. I am in Victoria Australia, but I’ve found this book which basically says the same as you – tons of core work -I am going to give it a try. This is the book: https://www.amazon.co.uk/HIP-Osteoarthritis-CAN-Cured-Treating/dp/1541100182
HI again,
Give it a try for sure!!
My 17 year old daughter has experienced hip pain on and off for the past 2 years. First MRI in 2015 was inconclusive for labrum tear or FAI. She has played soccer, basketball and run track throughout her high school career, however was unable to run in spring of 2015 due to hip pain. She has undergone PT for the hip pain originally in 2015, and the pain did subside, but due to more sports and maybe overuse, her hip pain has returned. She had an MRI in June 2017 with dye and cortisone injection. Not much relief from the cortisone, but has started PT again. Diagnosed with FAI (normal configuration of femoral head and acetabulum) and a small subtle tear of the superior labrum at its anterior aspect, she is expecting to play basketball at college this next year. Any suggestions on recovery, strengthening, pain reduction without surgery?
concerned mom
Our experience and I am not giving medical advice, just relaying our experience. You need to find a PT who either specializes in FAI/Labrum tears or has experienced it themselves. My 17 yo who is being recruited for football, specifically remembers the incident when he first experienced pain. He was running a 40 in March. We went through the whole treated for 6 weeks as a groin strain and then orthopedic surgeon who was great and handles all of Clemson Universities hip and ankle injuries. He is also the team Dr at Furman Universities Football program. Had the MRA, cortisone etc.. All within a week to 10 days of our first visit on 4/26. Son has cam FAI and a ripple in labrum between 11 and 1 o’clock. Dr said if he was going into his JR year instead of Sr year he would probably tell my son to get the surgery and rehab his Jr year. Dr also said in his experience he has also seen better PT and healing results if a pt can remember a specific event that caused pain, as the body for a few months will be in healing mode versus a long term repetitive motion wear and tear condition. Went to a local PT and schools trainer who is also a PT affiliated with the local PT practice as well. 3 to 4 times a week for month of May. Followed up with Dr end of May and I told them that the current PT and Trainer although good weren’t being aggressive enough and I didn’t believe they had every truly dealt with FAI pt before. Dr called and told them aggressive pt was needed. Son couldn’t play 2 plays without pain at end of April early May. End of May he played 20 plays in a spring game. After call from Dr PT switched to more aggressive core and glute work. Things got better. End of April he couldn’t jog 1 lap on a track. 2nd week of june he ran 8 by mistake and was pain free for 7 of the 8 laps. I have friends in the PT and Professional Sports world and reached out to them. Found a therapist who specializes and had FAI themselves via my network. I will not name the PT out of respect for the PT’s on this site. 1 virtual session and my son was body squatting with full range of motion and no pain. Based on videos of my son moving and exercising pre injury and watching him move virtually, many of his movements were quad centric. Working on core strength and retraining him to fire his glutes and hamstrings instead of using his quads and hip flexors for everything. 2 weeks of 6 days a week glute, ham and core excercises for 30 mins at a time and my son is now no longer feeling pain and has been doing one on one football training with mild discomfort but as he said it is not painful just a little uncomfortable. Will it last throughout the upcoming football season? We don’t know but he has gone from my Senior season and career is over/ruined, to working like a madman and realizes his play count may be limited each game but he will be playing. He is also on a supplement regime. Glucosamine 2x day, fish oil 2x day, jello or collagen supplements each day as well. Alleve seems to offer him the best relief when needed.He had tried ibuprofen and diclofenac/Voltaran nsaid’s also but Alleve seemed to work better. He has also learned to recognize when things are putting stress on his quads and hip flexors. Example the other day he was doing upper body work in the gym. While doing tricep pushdowns I saw him stop, lower the weight a few times and reposition his feet. When I asked what was going on he said when I tilted my pelvis and hips forward to do the heavier weight I could feel my hip flexors and quads engage. Having done a ton of research in reputable journals and studies most of the adult population is walking around with these conditions. Every case is different. Not really sure about the surgery as it seems about 75 to 85% of those having the surgery are ok afterwards. The other 15 to 25% seem to either still have some pain or don’t ever get full range of motion back. Most seem to be able to have a pretty much normal life without surgery once they have stopped playing competitive sports.
Hi Steve,
Thanks for sharing your experience. You hit the nail on the head. Core/glutes are the key. Interested where you found in the research that 75-85% of people post-op are “ok”. And, if Ok means back to function but not sport. I have found WAY better results with PT only in the clinic and the research is still not very strong to draw any positive correlations. Thanks for reading and your comment!
Lori… Like most parents who have an athlete who has developed FAI, I spent countless hours researching. To be honest I have read so many clinical study articles I don’t recall which one had those numbers. By ok I meant , if memory serves me the investigators in the study saw improvement with ROM and pain reduction, it wasn’t a sports specific article. I can’t recall where I read this regarding sports, but somewhere I read that only 30% of NFL Lineman who have the surgery are able to return to play at the level they played at pre FAI or tear. That may have been in a story about the Defensive Back from University of Alabama who played a whole season with a hip labrum tear. If I find the specific articles again I will post a link.
Hi Terry,
I would look into someone who is a PT that specializes in Pilates and/or hip conditions and understands the importance of the glute/core complex for her condition. I have treated several people and ALL are back to doing what they want…they just have incredible core/glute firing and good patterns of movement.
Hi Lori,
I am a 19 year old collegiate Nordic Skier and cross country runner. This spring I decided to try the steeplechase. However during one of my races I fell over a barrier and have had hip problems for about two months since. I just got an MRI that showed signs on FAI and a slight labral tear at about 2 o’ clock. Right now I am seeing a PT who says it is still ok to bike, freestyle swim, and lift, along with doing the prescribed exercises and stretches. I was wondering if this regimen sounds ok…I am a bit worried that I will make it worse, but I am scared to give up exercising and hope to run xc in the fall.
Thanks,
Carmen
I read your article about the FAI- Hip Labral Tear. You acknowledge us that most of the hip labral tear patients can be healed by the conservative treatment. My friend sufer pain in his hip for several months and the dignosis is “mild injury of right anterior superior labrum”. Last month as he felt better, he went out to work and for more than one hours’ walking, he felt serious pain in his hip. Now, he is lying in bed all day and difficult to sleep at night becaouse of the pain in his hip. Can you give me the advice that which kind of treatment he should take, surgery or conservative treatment? I am looking forward to receiving your answer. Thank you!!!
Hi,
I would definitely try PT first, conservative care. It sounds like the walk exacerbated his symptoms and likely because he does not have the hip/glute/core stability to support the movement. I’m always an advocated of Pilates-based PT for hip labral tears or just find someone who understands the amount of stability (not just strength) needed for the diagnosis.
Hi!
I came across this article as I was specifically looking for information on conservative/PT treatment of labral tear.
My thoughts were exactly that perhaps it has been more detectable recently because of the technology but that may be irrelevant and could possibly by healed with good PT.
However I have had pain in my hip for 4 years and finally a labral tear was diagnosed with mri. My question is – do you think after such a long time PT can reverse the symptoms (which additionally to pain include extreme tightness in my thigh and decreased ROM).
What bothers me most is the decreased range of motion and the fact that the pain worsens each time I even try to do excercise.
Hi Justina,
Quick answer: Yes. Anything is possible and I would give yourself the opportunity to try conservative care (really good care) for 10-12 weeks to see.That’s not necessarily every week, but to really know it takes a few months. You likely just need the right exercises to avoid the hip becoming painful. So far, all of my diagnosed labral tears have avoided surgery and are no longer in pain…hope the trend continues.
Hi All
I am a 34 year old athlete and I ve been struggling with hip pain for the past 6 weeks, I use to be a competitive Tae Kwon Do in my youth and started training after on and off periods of going to the gym / running doing HIIT / standard gym stuff, I have been doing consistent 3 times a week training for the last 2 years.
A couple of months ago I felt my left leg being stiff and sluggish giving me aches down the post-tib / hammies. So I went to my local sports PT which had treated me in the past and since my regular physio was on vacation I had a session with another PT. After the session (a lot of postural testing along with moving my leg in the hip socket) I felt fine, next day my lower back felt like a bag of loose marbles, the leg stifness was gone but I got weaker lower back and clicking like nobody’s business.
I started doing some core streinghthening excercises and I was holding a plank for 45 secs when I felt some low back tension and 3 seconds later I feel a snap in my groin…. After 2 weeks off I felt better and then I got tripped by my son and ended up doing the equivalent of a deep squat and hte pain came back with a vengeance, I am 3 weeks + past that and its still not recovered, I had an MRI late last week hoping to show tendon / muscle damage but the results came back and it turns out I have slightly torn labrum and a small bony island in my left him, according to my GP the report says that the soft tissues are fine.
I have pain when lifting my knee above 90 degrees and when I move it towards the opposite shoulder. I am reading about the surgery woes and I am freaking out, I have an appointment with a specialist ortho but I half expect that he will jump at surgery.
The story and pathology suggest psoas but the ROM loss FAI, my reasoning is that years of intense 4 times a day TKD training should have brought symptoms out earlier.
Hi Steve,
I would still try a course of PT for 3 months to ensure you need that surgery. Get really specific with core, glute stabilization. Try Pilates. Even if you have a little ROM loss and can get your pain managed with PT, it is the better route in the long run. Thanks for your comment and reading!
Hi. I am 24 yrs old athelete who used to play taekwondo since i was 8. I played professionally and was the african championship twice but had to stop playing 2 yrs ago because of my hip labral tear. I did an ultrasound 2 yrs ago and was diagnosed with a tear in the hip and the doctor told me i cant play professionally anymore. So, i stopped tkd unfortunately and didnt want to do surgery at all. This year i began crossfit and exercised on my own but started to feel a great pain in my hip (the one with the tear). So i went back and did another ultrasound and the doctor told me the tear got worse and i had to do the surgery to avoid hip replacement afterwards. I feel now that i have no choice and i really dont want to do the surgery becuase i feel that the results are uncertain. At the same time, i cant live without sports and unfortunately i love high impact ones. So, i would really appreciate your advise and would be glad if i can contact you if possible. Thanks.
Hello. I am a 32 yr old female. I have a labral tear and a paralabral cyst confirmed by an MRA. I am having lots of atypical symptoms. My ROM isn’t that bad and I don’t have a lot of groin pain. My pain is in buttocks and lower back. I guess my SI joints maybe? My legs are super achy too. I am in PT, but am not seeing much results. In fact, some days I feel worse. Is it possible that my problem isn’t coming from my labral tear? I am in near constant pain and am unable to enjoy daily activities. I just don’t know what to do.
Hi Michelle,
Your pain is common with hip labral tears in that you can get back pain, hip pain, outside leg pain, etc. If you’re not getting much results (give it at least 4 weeks) then you may need a different approach to PT. Make sure you are doing a TON of glute (real glute), core and stability work. It’s imperative. And, to your question, even if you have a diagnosed tear, that does not mean it is the main source of pain. Make sure someone is giving you a thorough movement exam and not just using this diagnosis.
I have had left hip pain for over a year, finally diagnosed with an FAI and labral tear in May. I have had the cortisone injection which was a joke and now on round 2 of PT. Just got a second opinion and was told I can live with it or fix it. Problem is I have lost almost all my ability to run which is very depressing. I don’t want surgery and I don’t want chronic pain. Really in quite a way these days. I can’t seem to get any significant relief from any therapies.
Hi Megan,
You just haven’t found the right fit yet. Cortisone is usually not that effective with labral tears unless there is a ton of swelling. Seriously, find a PT who specializes in Pilates. Give it a real shot at conservative care and do not give up! All of my athletes have returned to their desired activity, some with modifications. And, they are pain free.
Glad to see this article. I have had mild groin pain for 2 years. I have been an avid runner (40 to 50 mpw) that entire time. A stress fracture led me to an MRI, which also found a small labral tear in my left hip. I am currently in PT where we are focusing on deep core strength. And I am not running at all. I feel almost symptom free. But as soon as I try to run again, the groin pain returns. It does not really affect my quality of life, except that I really love to run long distance. I feel like I could be just fine with my hip as is, no surgery. But, I worry I’ll never get to do the thing I love again. I am wondering if there is a chance of getting back to my sport safely if I opt not to do the surgery. Cycling just isn’t quite the same!
Hi Kathy,
Are you incorporating glute work too? Not squats and lunges…stability, endurance glute work? I would think you could return to some running, but the distance will be determined by your body’s ability to keep firing the stabilizers in that area. And, just because you have surgery, does not guarantee a better return to sport. It might, but keep giving PT a good try!
Hi
I am a 41-year-old triathlete sub 09h30 athlete, also fairly heavy at 85kgs/194cm. I’ve qualified for Kona and done two other full IM races this year and massive training blocks pre-Kona. Three weeks ago I felt tightness in the hip flexor and pushed through in Austria 70,3 that weekend and have had sharp pain and cant run since (three weeks now)
Generally I have gluet weakness and suffer from gluet spasm which is managed by massage 2-3 times a week when I have big blocks of 25-30 hours a week of training. I should do a lot more insofar as core and gluet hip stabilizer strength work to assist with this but haven’t just because of time
MRI has no confirmed the following: There is a grade 2A tear of the anterosuperior labrum
A well-defined dysplastic femoral bump is identified in relation to the left femoral neck with an underlying cystic lesion measuring approximately 1 cm in diameter. This could be causing cam-type femoral acetabular impingement and may account for the labral tear.
I have huge demands going forward with my sport and want to get on with recovery. Naturally surgery has been advised for the Cam Type FAI but I want to believe that proper physio and bio work to strengthen the hip and the stabilizers/gluet is what will assist in firing the correct muscles to rotate the hip and take the pressure off this anterior. Will this be enough, or will I ultimately have to resort to surgery?
Hi Andrew…I got your email too and replied to you there!
Hello Lori,
My name is James and I play basketball at Ohio University. According to an arthrogram I had about 2 months ago, I have a torn labrum in my left hip, and it can be very painful during our practices. I am also very limited to what I can do in the weight room compared to the rest of our team. I read that you treated a hurdler with a Pilates program and a lot of stability exercises, and I am just curious as to what exactly that entail more specifically? All I am doing for rehab here is strengthening my gluteus and tissue massages at therapy. I would love to find a way to decrease my pain, and in turn, be able to play this season. Thanks!
Hi James,
Thanks for your reply. The best intervention for you is Pilates. So, that is a lot of what I call “off the ground” exercising. Pilats trains the deep core and glutes in all their planes (glute max is a triplanar muscle and needs exercises for all three actions it does) and dissociation. Meaning, the leg, pelvis and trunk should all move independently of each other. This may sound simple in concept, but is hard to achieve and is usually the missing link for a lot of people with hip labral tears. Do you have access to Pilates at OSU as an athlete?? Maybe your coach will fly me out! JK. I would seriously look into a Pilates studio there and look into some beginner classes that focus on stability with mobility. Please reach out with any more questions or feel free to email me. Side note: my cousin is a professor at OSU 🙂
Hi Lori, My name is Terry. I have suffered from left side sharp stabbing pain with weight bearing since 5-2013. Started during exercise, with some pelvic as well. I was speed walking, jogging and biking during this period in my life. It started one day with pain lifting my leg and walking, started limping, then one morning after spending all day on my feet decorating for Christmas I hurt so bad, went to bed woke up, went to get out of the bed and could not weight near at all. Emergency room gave prednisone and I was able to weight bear but it still hurt… I had been to every dr, every test, had some gyno surgery that helped some things but made my pelvic pain worse, diagnosed with pelvic floor dysfunction in 2014, another gyno surgery in 2016, back to PT for pelvic floor dysfunction. I was not progressing according to my PT and she sugggested o keep sirsrvhinh for answers… I had a hip arthrogram that was negative for a tear, ended up at Duke, another mri was done where a 3 d Pic was created and the DR believed I have Fai With a tear. Wants me to have PT for 8 -12 weeks, if no improvement? Recommends surgery, Also 2 steroid injections in the hip joint have not taken away my pain. The stabbing pain is deep in my abdomen, to the left side of the upper vagina and into the groin. Som pain down the front of my leg to the knee only even when sitting, as well as buttock pain on occasion. I have Nena on crutches on and off due to the pain with weight bearing. My pain is from the navel over to the flank straight down to the inner groin. I can follow it with my fingers etc… back pain only on left side when flank is hurting as well. I have pelvic spasms as well on both right and left. I’m now dealing with chronic pain for 4.5 yrs that gradually came on and is now completely ruining my life. No longer very active outdoors with my kids etc.. I’m just not sure at this point that it’s fai with a tear. My hip flexor is so angry, stays sore.. sorry for such a long comment, I’m desperate to get better.. I’m done going to doctors thousands of dollars later 2 general surgeons said no hernias, my hip feels unstable and weak, core and gluteus are very week as well.. Your thoughts are very much welcomed, please reply. Thank you in advance. Sincerely, Terry
Hi Terry,
That is a lot of history. I’m sorry you’ve been through so much. If you are interested in setting up a video consultation, please email me at [email protected]. But, if injections have not relieved pain, likely not the hip joint. Sounds like you have a lot of myofascial pain, but without watching your movement patterns, that is hard for me to comment on. I will always give my stock answer: Try Pilates for true deep core/hip stability.
Afternoon. My name is Tshepang. Just had a FAI and Labrum tear surgery 18 weeks ago and the rehab is very slow. I can do cycling comfortable but walking is not 100% because sometimes I am limping. Not because of pain but I think is that I don’t have a proper balance or my operated him is not yet strong. I am following the program that I feel is very very slow. What do you recommend? Must start running because in January I must start to prepare for Comrades marathon in June. Thanks
Afternoon. My name is Tshepang. Just had a FAI and Labrum tear surgery 18 weeks ago and the rehab is very slow. I can do cycling comfortable but walking is not 100% because sometimes I am limping. Not because of pain but I think is that I don’t have a proper balance or my operated him is not yet strong. I am following the program that I feel is very very slow. What do you recommend? Must start running because in January I must start to prepare for Comrades marathon in June. Thanks
Hi,
Well, the progress should feel slow, but not very very slow. It should tier up every few weeks as your body learns to stabilize the core/hip complex needed for this diagnosis. I recommend that you are getting PT that truly establishes stability at the hip, not jut strength. Dissociation of movement (leg moves freely in stabilized pelvis) and as much range of motion in the hip as tolerated without pain. I wouldn’t run if you can’t walk without a limp. That will set you up for entirely new set of problems.
Hello! I am dealing with all of these symptoms now and have been for at least 3 years. I have extreme pain in my left quad (all over), glutes, lower back and right where my hip flexors are… I sit for my job and it definitely makes it worse. I am literally in the process of scheduling an FAI surgery, but definitely want to avoid if possible. My surgeon is awesome and has encouraged me to explore all other routes prior to surgery, but he ultimately thinks I will need it. I have had an MRI and two x-rays of my hip. He is 99% sure there is a labral tear and a minor impingement. I am curious to get a second opinion, because id love to avoid surgery. I live in California and cannot travel to see you, do you do consultations remotely?!
Hi Jenae,
I do. Email me at [email protected]. Smart surgeon!!!
Hello! I’m a 41 year old Dressage rider and just had my MR Arthrogram last week and they found an anterior focal partial tear in my right hip. I am unwilling to try surgery at this point, but might consider PRP/stem along with the PT. I already do Pilates once a week for SI and low back issues. My pain came on slowly and is generally only with internal and external rotation, and sometimes extension, right now. Are there specific exercises and movements that should be avoided in my Pilates and PT work? I have a general mistrust of PT sometimes as I have had PT’s injure me further or push me way beyond what my body could do without keeping an eye on proper body mechanics and put my low back out. For example when I had PT earlier this week they had nome do deep lunge hip flexor stretches with pelvic clock rotations and this really irritated my hip. I’ve read that these types of movements should be avoided with labra tears! Thank you.
Hi Danielle,
Yes, I agree that the PT’s choice of exercise was not the best for your condition. Here’s the thing. Nothing should hurt the hip. You want to work on stability exercises (clams, fire hydrants, Pilates side series) that create healthy muscle control, but not hip irritation. Rotation of the hip can be healthy, like single or double leg Pilates circles. It’s important to keep the joint lubricated and healthy in as much range as possible–without pain! That is key.
Hello and thank you very much for your informative article! I am new to all of this. I am currently experiencing groin pain which my chiropractor believes may be a labral tear. I’ve had a dull pain in the area for years and it recently has gotten much worse. Painful if I lift or my leg or try lotus position (my left side). I have an appointment with an Orthopedist for assessment at the end of the month. I do NOT want to have surgery. Can you recommend anyone in the Cleveland, OH area that would be a good resource for assessment and non-surgical treatment?
Again, many thanks for all of the information you’ve provided.
Janet
Hello, I’m not sure how I tore my right hip. I think it was possibly a slip down some stairs (while pregnant, so I tried a little too hard to catch myself). After my son was born I started to have a lot of pain in my hip. That will be 2 years ago in March. My pain is so bad at this point some days I can’t even bare weight on my right leg and the top of my thigh aches. It is sensitive to even touch the skin on my right hip and it’s very painful if I accidently roll to my right side while sleeping. I did 1 year worth of PT, before my doctor would order an MRA with contrast to find the tear. I have a consultation with a surgeon 1/22/18. In the mean time I have stopped PT and haven’t done PT in about two and a half months now. My mobility has declined greatly and the pain has become unbearable. I have a lot of lower back pain and can no longer bend over. I fear this surgeon will recommend more PT instead of being proactive with surgery. My other hip is starting to get sore from barring all my weigh on my left leg. Would I be a good candidate for surgery? or do you know if they will suggest anything different? I am only 27 years old.
Hi Jade,
Sounds like you may be a candidate. If you feel you got really good PT (stability/core work more than pure strength) and found your glutes, core, etc…then, yes, you may have to have surgery. And that’s ok. The reason I wrote the post is because most people get an MRI, find out they have a tear and go right for surgery. If you have exhausted all conservative routes (and tell the surgeon that) then surgery may work for you. There is a time and place for surgery…it just shouldn’t be your first option. Hope you get relief soon. Thanks for reading and reaching out.
Hi Blog Friends…I am getting an excessive amount of emails regarding this topic and was curious if anyone is interested in a FaceBook Live Session with me? I can offer 30 minutes this Wednesday at 1:00pm MST. Anyone interested??
I would be interested
I would be interested
Yes I definitely would be!!!
Yes I definitely would be!!!
Hi Clarise and Emma…I’m going to try a FB live next Wed, 2/7 at 2:00pm MST. I will announce of FB to see if we get any interest, but hopefully both of you will be able to sign on. 🙂
Hi– I live in Louisville and just got an initial DX of a labral tear in my left hip. The DO wants to do an MRI followed by a diagnostic injection, and then go with PT and/or iinjections. I am 53 so he says surgery would be a poor choice.
My question is this: do I have to have the MRI? My insurance is not that fabulous and if it all leads to the same end, what use is the MRI?
Many thanks for any thought you might have on this.
Hi Lori,
14 months ago in Nov 2016 at 44 years old, I suffered a femoral neck fracture following a bicycle fall in LA, hitting the cement (I was clipped in trying to avoid a car coming around the corner, and the street was wet). I had immediate surgery, a dynamic hip screw plus a cannulated screw were put in. It’s been a very painful year on every level. I have seen some of the top hip trauma and sports specialists. Some said I should just have a full replacement. Others told me to wait, try to keep my own anatomy, and go through months of PT, which I ultimately did. The bone is healed, though being very active, the IT band is rubbing on the plate or screw and causing significant soreness still. Definitely cannot run and deep squats and one legged exercises cause pain in various places, both dull and sharp.
Another doc recently requested I do a MARS MRI, despite the stainless steel hardware, and saw that there is a ‘moderate labral tear’. This was never addressed in the surgery or any of the follow ups, not sure why any of the docs didn’t consider it to be the cause of some of the pain. This particular doctor said the tear is likely giving me some of the pain deep in the hip, glute and down the leg to the knee. His recommendation is that he’d remove the hardware and do a labral repair in the same surgery (I was waiting to be sure no AVN, though he said he is sure I won’t get it). Sounded good, and then I was told by my trauma surgeon there is not a ton of evidence the labral repair will do much. It did sound logical to do remove the screws and repair the labrum all at once, but perhaps that is too aggressive. I do feel the hardware is causing significant discomfort still and may not ever go away unless it is removed. That means 4 months off or so and I’d have to be very cautious not to refracture, plus a ton of rehab.
So with all that, do you feel there’s a PT path to follow before hardware removal and FAI repair? Or am I just postponing the inevitable? My case is rare given my age, but I have to do something to diminish the pain and suffering longterm.
Hi Jay,
Wow, what story. I will email you. Thank you.
Hi Lori
I’m 40 years old and 3 years ago I fell on the ice on my hip and as a result, have a labral tear. I’ve worked with an orthopedic doctor and tried an injection (did nothing) and a few months of physical therapy that really didn’t help much. I’ve found that getting regular chiropractic adjustments and seeing a massage therapist who is familiar with the condition is the only thing that really helps. I am not in a horrible amount of pain typically, however I feel pain easily when walking long distances, going up steps or hills and carrying anything heavy. I like to hike and it definitely forces me to limit the hikes I do. I’ve been told surgery is the next option however, I’m scared of surgery- the costs, the time it will take to rehab, and I would like to still try to get pregnant and am concerned what this surgery would mean for a pregnancy. I’m scheduling appointments with an obgyn to talk about how a labral tear would affect child birth and if its best to wait until after giving birth to have surgery. I’m very confused as to what to do as I don’t want to be in so much pain for the rest of my life and I don’t want it to get worse. Do you think I should try PT again with pilates?
Thank you!
All useful info!! We are in England I have a 20 year old daughter who is a dance student and has had to pull out of her course due to hip Labral tear pain and also has snapping hit. Under a very good specialist orthopaedic surgeon who specials in young sports people with hip problems. I hear what you are saying about physio however the issue she has is the level of pain makes it very difficult to do the strengthening exercise programme – she’s told don’t do it if it hurts but also told to try and do everyday ! She’s on the waiting list for surgery and is desperate to get back for September … What exercise could she do to keep fitness levels up and keep her spirits up !
I also forgot to mention she’s had 2 cortisone injections – one into hip joint and one into hip joint capsule – minimal improvement. Hip joint capsule alleviated pain fir 2 weeks had a happy dancer for a while ….
My daughter is 15 … she was at a college softball camp doing crunches and heard a pop in her right hip. she has been playing both basketball and softball for the past few months. saw orthopedic surgeon, did xray and nothing structural. she did 2 weeks of strong PT, but still no break from sports. did MRI and confirmed there is a Labrum tear in her right hip. he wants to do surgery. her HS softball just started and she has a big summer of college tournaments that she wants to attend/play. doctor released her to play until ready for her to do surgery. from what I’ve been reading on this blog she needs to continue doing PT?! she is not playing basketball anymore … only playing softball. in your opinion, does all of this seem accurate and safe? can she do further damage by not resting and waiting for surgery? if she continues to play softball and does PT will she make it until August 2018 for surgery? any and all input is appreciated!
Hi Shanon,
Yes, she needs to keep doing some sort of PT for stabilization of that hip. I don’t know if I completely agree about doing a ton of loaded activity until surgery, it could make it worse. I’m not saying it will, but there is an increased possibility. How much pain is she in? Is outside hip or inside the joint? If outside the hip, the surgery will likely not change that. Make sure she gets solid PT for core/hip stability before considering any surgery. Hope that helps!
she does not seem to be in too much pain. it’s the snapping/popping of her hip that took us to the orthopedic surgeon. although she does have a high pain tolerance. if she were to have surgery in March will she be ready to play softball at 100% in June?
Hi Shanon,
Honest answer? I don’t know. That is a very short window of time to try and return to a competitive sport after the surgery.Everyone is different and heals differently. But, if she is in that much pain, she main indeed need surgery. Just make sure the snapping/popping of the hip is from “inside” the joint and not from the RF tendon on the outside (very common) and surgery will not fix that. PT will.
Hi Lori! First off, I don’t play sports and am a fairly out of shape 37 year old Mom of a two year old. So i don’t know if I’m appropriate for your practice. I do have at least one moderate labrum tear/left hip diagnosed by MRI. I’ve had myofascial pain for almost a year now. It’s pretty dibilating and I’m often finding relief on my back. Standing, sitting and walking are all problematic for me. In the past two weeks after a myofascial release of my glutes I’ve become symptomatic on my other hip as well. I’m scheduled to see an ortho surgeon in a month and a half. I’ve been doing a program called Restore your Core for about 12 weeks now and it has given me some relief. I’m wondering if you can email so I can see what you offer remotely/online. I am in Denver but I’m about 45 minutes from you. Or if you can tell me if you have any associates around East Denver. Thank you so much.
Thanks Tara. Emailed you.
Hey Lori,
It’s awesome and crazy that you are still responding to all of these posts- I love it and you must be passionate about what you’re doing. I’m a 26yr old former D1 kicker and fitness lunatic that was diagnosed with a superolateral labral tear about a year ago- treated with an inadequate dose of PT (admitted to me they had never managed FAI/labral tear before), a steroid injection with minimal relief, and activity modification ( I have personally managed it since then and haven’t ran in 1 whole year). I recently started a core stability program on my own and noticed I had huge deficits in my rotational strength, obliques, and ability to control my pelvic floor — and it made a HUGE DIFFERENCE but i still have the clicking and sliding symptoms.
Long story short, I still have minimal symptoms (with near unacceptable functional outcomes ie. no running at all). I am scheduled for surgery in a week and deep down believe this can be managed nonoperatively… but I just don’t know how to find a PT/strength/movement coach that can help me figure this out. Because of my career this might be my only shot to get this repaired in the next 5 years.
– Can this be managed nonoperatively for years on end?
– Do your non-operative patients eventually run again without pain?
– How can I find someone who truly understands these movement/stability/treatment protocols (and doesn’t just follow a protocol that got published online)?
I would love to hear your opinion and would love any guidance you could offer.
Thanks,
Jason
Hi Jason,
I AM passionate about my profession! It’s highly misunderstood and yet one of the best ways to heal the body. Anyhoo, if you think you can heal this without surgery…cancel it! Seriously. If your symptoms are minimal, don’t take the risk (at this point). Yes, my patients get back to what they want if it can be stabilized without surgery. They work their tail off for it, but in the end they are so happy to avoid the knife, they don’t care. I’ll be honest, finding a PT for this is tricky. They are out there, no doubt, but I teach a continuing ed course across the country about true core stabilization…most clinicians are not educated well in this area. That said, look for a PT with a Pilates background. There is no “ONE” protocol for this. No way. Everyone is different. I do offer online consults if you are interested in that route. Everyone has returned to what they want in the clinic and online. Hope that helps.
Hi Lori,
I was hoping to receive some input and ideas regarding tendon release and arthroscopic surgery for a labral tear in my left hip. I was in a rear-end collision when I was 33 and it took about two years to diagnose that my back/hip/groin pain was coming from labral tear. Prior to the accident I was very active: kayaking, yoga, dancing, zumba, gym, hiking, etc. Since the accident I am struggling with simple activity and find there are days I cannot even take the stairs.
I had been seeing a hip orthopedic who recommended the surgery. We tried PRP, cortisone and lidocaine injections, PT, medical massage, etc. and nothing has worked. To be honest though, it takes 6 weeks to schedule appointments and consistent 2 hrs waits each visit. It has made me concerned about how I’d be able to be treated post-op. Due to this I consulted with another orthopedic and he recommended doing BOTH the hip arthroscopic and the psoas lengthening. I was finally getting comfortable with the surgery, but I am deeply concerned about cutting a muscle that may or may not be needed to cut. Myofascial release through medical massage has helped tremendously, but the tendon inevitably tightens back up. PT, limited barre and pilates have helped some, but they are never without pain. I have found an Active Release PT local to me, but it isn’t helping enough.
I feel cutting the tendon is excessive. My hip grinds/snaps and makes a “thunking” sounds in certain rotations and leg extensions. I am unsteady at times, have frequent burning pain along the left-side/bikini line and into the upper thigh and sometimes awoken by deep burning groin pain. I’m about to turn 36 and I’ve been “limping along” for 3 years now.
I’ve read some articles about the efficacy of arthroscopic surgery and sham surgeries in which trials have found little differences in those that undergo the surgery versus those who do not. I am worried since this is a joint and I don’t see how causing trauma to a joint will make it better. Especially since the anchors put in the joint may lead to revision surgery, arthritis or even a hip replacement. It seems like having the arthroscopy done means a hip replacement is nearly a certainty.
I am so depressed and scared about the surgery, but I’m also about to turn 36, am so inactive and have gone from a toned, 5’9 150lbs to a soft, 5’9 180lbs despite PT, massage therapy, and limited exercise (due to the pain). I am worried that I am going to damage the hip by not having the surgery, but I am equally worried that having the surgery means I am condemning myself to a long recovery, pain that may not be any better than it was prior to the surgery and an eventual hip replacement.
Any input or advice would be extremely helpful.
Hi Claudia,
Sounds like you’ve tried all of the conservative routes. If you think you’ve gotten good care along the way with regards to PT and you feel stabilized, then surgery may be the only option. I would disagree about that it means a total hip later. Depends on how you treat your body and hip. Tendon cutting (or psoas muscle?) does seem excessive. Sounds like that muscle continues to get tight either because of poor core strength or reacting to what is going on inside the hip. I”m not a surgeon, but that part sounds excessive.
Hello,
I have been having pain in my right thigh/hip area. I am 36 years old and a mother to 3 kids. It started in Junly 2017 and it was just pain that would just come out of nowhere as I’m walking and startle me to the point where I freeze in my tracks. I ignored it for two weeks and thought it would go away. I did not feel anymore pain until September 2017. The same pain begin to occur again but now it was more consistent and stayed for a longer time. I went an orthopedic specialist who recommended PT. I did some PT 2 times a week for about a month. The pain did not ease. I went to another orthopedic specialist who told me that it looks like a laberal tear/early arthritis. He recommended an injection and I did it and felt no pain for about 4 months. The pain just came back last week. Same pain as before. The orthopedic specialist is referring me to someone for surgery. He does not want to inject me again. He thinks because the pain went away that I would be a good candidate for surgery for laberal tear in the hip. I live in Detroit, MICHIGAN. If you can recommend and give me your input it would be greatly appreciated.
Hi Amy,
You actually may be a candidate for PT. If the injection gave you that much relief and PT is not, then it may be the irritation of the labrum inside the hip causing your pain, not your muscles. It sounds like you’ve given it a good conservative effort, so surgery may be your best choice for long-term pain relief. Just make sure you go into that surgery with good hip stability and strength…as much as you can. I hope you feel better soon!
Hello Lori,
I am reading this info online because I had surgery for a FAI and labral tear in 4/2018. I did 3 months of therapy, a cortisone injection and I am right back to where I started prior to surgery if not feeling worst. I have a “sit down” job as a 911 dispatcher for 12 hrs a day 14 days a month with 3 being in a row. I am just miserable and have an apt with my surgeon in two weeks. I started back to work in Aug on a part time basis to get used to sitting long hours again and went full time in Oct. I believe I have went down hill since October. I am miserable sitting, little relief standing, walking is awful too, I can’t lay on my hip at all-i’m a side sleeper so sleeping is a nightmare….any help advise anything at this point would be great. When I initially went to dr they told me that a hip replacement was inevitable but I was too young and this surg was to buy me 5-10 yrs. At this point I would of rather had a replacement. I read about Pilates on this website, what diff between pilates and yoga? I wont do another shot, it didn’t work at all. I just want relief, please help
Hi Lorryn,
Thanks for reaching out. Difference between Pilates and Yoga is a lot. Pilates makes sure all movement is patterned from a stable core (shoulder blades to glutes is our true core). Pilates is movement-based and ensures the body is always in precise control of its movement. Yoga can use the same principles, but the posture are more static and about flexibility over stability. Sounds like your hip is craving some stability….go do some Pilates!!
Hi, I am 58 yr old female, runner, cyclist and duathlete, I have done a couple of triathlons. Diagnosed w/ chrondomalacia patella June 2018, while in PT for that doing the recommended stretches I felt sharp groin pain…long story short, diagnosed last week Feb 2019 w/ hip labrum tear…at this point unable to walk more than one block without significant pain, glute area entire left leg. I want to get my life back. I have not run, cycled or walked since June 2018…seeing two specialists this month. Last wk they gave me Lido and steroid inject in the hip it helped for maybe 2 days. Is PT an option? Kind of scared of it now, based on what happened while doing it for my knee at at “reputable sports med rehab.”
Hi Karen,
Did you get any relief from the shot? If not, I would try PT for sure! Meaning, that injection is to see if the joint is the source of the pain. If no relief, you know it is myofascial and that may note be surgery worthy. I’m sorry you are scared to go to PT…there are great PT’s everywhere. Happy to help with a video consult if you prefer. Have treated many hip labral tears (successfully) with just good movement re-patterning. Hope that helps!
Lori,
I was relieved to see a blog dedicated to this type of hip pain, and hope that it might lead to some relief. My story is similar to many of your other followers. I’ve been very active in my 20’s, running, soccer and basketball. If I ever did have soreness from my exercise/activity it was is in my butt/hip area, but never enough to stop being active.
In October of 2013 however, I ran a half marathon without much training. I had some groin pain that I couldn’t get to go away for 4-5 months, even without any activity. I saw a PT, and rather than putting me on a treatment plan he sent me to an orthopedic surgeon, telling me that my hip was extremely tight.
The surgeon saw a labrum tear and cam FAI and suggested surgery. It blew me away! How could a healthy 31 year old need hip surgery?! That’s for old people 😉
I got a second opinion from another surgeon and received the same news. Naively, I had my first FAI surgery in spring of 2014. My groin pain turned to hip pain that was unceasing. After the first hip surgery I did PT and was diligent in my strengthening exercises. Fast forward a year later and the pain was getting worse. What I thought was going to help relieve pain, introduced so much more pain that I hadn’t felt before. I never returned to full activity and with the pain, I basically just stopped activity.
Fall of 2015 I saw another orthopedic surgeon who I was told was good at FAI surgeries. Once again, I had another surgery to hopefully fix the first one. I did a PT program after the surgery (twice) and I’m probably worse now than the first surgery. Sitting, standing or lying down hurts. The second surgeon thinks that I have greater trochanteric bursitis. I’ve received two cortisone injections with little relief. If I do exercise/activity, I pay for it for days. My weight has remained at a constant healthy level, so luckily that hasn’t been a problem.
Needless to say, I’m quite pessimistic about my chances of pain relief right now. Five years of this is getting old, but I would love some advice on the next step.
Thanks,
Shawn
Hi Shawn,
I’m not sure you’ve really addressed the source of pain. Meaning, it sounds like your hip labrum was not that actual cause of pain. This is common with hip labral tears and why most never need surgery. Have you really done a lot of stability, good patterning at your core/hip? Are you interested in an online consult?
I have been recently diagnosed with a Right Hip Labral Tear with FAI Impingement. I have done 6 weeks of physical therapy with no success in pain relief nor improved range of motion. I have a second surgical opinion coming next week on Wed. At this point it is getting worse and I can only sit for about 15 minutes before I have to stand. Standing then becomes painful after about the same time limit. I have not been able to be involved in “normal life” activities for over a year now and am not able to play with my kids which is killing me. I hope that the next opinion is surgery so that I can at least get this repaired and move on to recovery with hopes of a normal life soon. Any opinions on whether surgery sounds like it could help would be appreciated, even though I know it is difficult to tell having not been in contact with my personal experience. Thanks.
Hi Chad,
Ok, it depends on where your pain is. Meaning, if your pain is the front tendon area or on the side, surgery may or may not change your symptoms. That is due to a poor muscle/fascia firing. That is MOST FAI pain and never needs surgery. But, you have to find someone who can figure that out. The standard exercises usually don’t work for FAI’s trying to avoid surgery. And, all are different. That said, if you are having deep joint pain, maybe even into your groin then surgery may be the best option. That is likely from the labrum irritation itself.
Hi Lori,
Can you please suggest some medicine which can help to remove the stitch marks after operations?
Thanks,
Kate Johnson
Hi Kate,
Are you meaning the scar? Vitamin E oil, coconut oil, some patients state Emu oil. Rub that around (on closed wounds) in circles, across 1-2 minutes per day and it will decrease any scar tissue that has developed with wound closing.
I am 25 years old and have played soccer since i was four. I am currently in the military and also very into weight lifting. I am currently working on getting my NASM-certified personal training certification. I have a anterior right hip labrum tear that the doctor said was larger than most. They referred me to a surgeon. The surgeon also noticed that the bone at the top of the femur was not as round, and said this could be contributing to the tear. I also have a cyst located within that same hip. I want to feel better because my hip is constantly hurting when I work out or play sports. I am very athletic and like to hit hypertrophy as much as I can. However I am worried that if I have hip surgery, I will not be able to get back to where I am now, and continue to get even stronger. Is hip surgery the better option? I know it will set me back a little but i am wondering about what is the best option and recovery time?
Hi Kelsey,
Big question. If you haven’t tried PT (good PT that emphasizes stability) then I wouldn’t even consider surgery. If you have tried it and hip pain is the same, then maybe. Yes, all surgery is trauma on the body but sometimes necessary to fix the biomechanical (ie. labrum tear, femur) issues that may not be controlled with healthy movement. If you like to add strength on your body then you MUST add the stability component. Hope that helps!
I am a female in my mid 30’s. I have had hip pain and and off for several years. It increased to daily pain and I visited my dr. After xrays, and an mri I was sent to physical therapy for a torn labrum. Therapy did not change anything so the therapist recommended I see an orthopedic surgeon. The surgeon diagnosed me with FAI and said that was the cause of the tear. Have me a shot and sent me on my way. 3 months and no relief later (The shot helped for about 2weeks) I got a recheck. Went over with the physicians assistant how therapy, shots, activity modification ice and drugs were not adequately controlling pain (currently a 7/10) And she suggested more therapy. (After 12 rounds of physical therapy made my pain worse, you can understand why I am hesitant to try this again)
So what is left? She mentioned surgery and referred to it as an elective procedure. (Meaning insurance will not cover it. ) I am already 6 grand in the hole trying to get pain relief that will allow me to function without limping and the only suggestions I am getting are to spend more money on failed options that made the pains worse.I
any and all suggestions welcome.
Hi,
Why is it elective? If you had relief from the shot that is a sign that the torn labrum is a source of pain. Most patients do not have relief with a shot (because it’s usually myofascial). If you have tried PT and you are not getting relief, I’m confused as to why the surgery is elective? That is usually an indication for surgery (and I’m the last person to suggest that.)
That said, has your PT focused on stability (not just strength) of the hip/core/trunk complex? That may be the missing piece. I’ve realized stability is a very forgotten piece. And, for our body to have the best movement patterns it needs stability, mobility and strength.
I really do not know why she kept calling it elective. She must of said it 4-5 times. “If you elect to have arthroscopic surgery you will have to be on crutches and I in a brace and no one wants to do that” was one of the many times she said the word.
I want pain relief without damage to my internal organs from popping pills for so long. I have need taking renaissance June just to function.
Therapy had to address a lumbar disk issue and focused a ton on core strength and stability. But man did it make my hip hurt worse. when I return to the dr I am requesting the other Dr there. Because he didn’t use the word elect. But he did mention something about playing the game with insurance so they would have to cover it.I
Is there anything I can do in the mean time for better pain relief? Pills are not that effective.
Sorry I missed this response! It sounds like you may have had too intense of PT. Pilates may be a safe route for you if you can find one (preferably with a PT license) to help you stabilize that area. That truly is the best medicine.
I am a 56 year old woman. Diagnosed with Trochanteric bursitis, Piriformis syndrome of right hip, SI joint dysfunction, FAI, and Degenerative acetabular labrum of right hip. Also had dislocation of hips as an infant. I have had PT with no change….only exacerbated the problem and pain. Two cortizoid injections. One for the bursitis and the other in the hip joint. This only helped for a very short time and only minimized the pain to a dull roar. I was also given miloxicam for the inflamation. I don’t know where to go from here. I have not seen the surgeon only his PA. This has gone on for about two years now and has only gotten worse. Hurts to sleep, stand, sit, and walk! I am normally very athletic and am not overweight. Love all types of outdoor recreation. That all has come to a complete halt as it only makes the pain worse. The medication does help some but only mask the symptoms and really does a number on my stomach. I don’t want to take meds for a long period of time as well. I am told my age does not make me a good canidate for arthroscopy surgery but possibly total hip replacement at some point. I would like to know how Pilates or any other PT can help. Will that help heal the tears and impingements or keep them healthy and pain free for a time being? HELP!
Hi Mindi. If the cortisone injection wasn’t that helpful in the hip joint then it’s likely myofascial pain. Not all PT is the same so I would search for a Pilates-based PT in your area that will understand the importance of optimizing the stability of your hip before you load it with strength/recreation.
Hi Lori. I recently started PT for a labral tear and FAI. I have constant pain and It’s easily exacerbated these days. My PT is working on soft tissue mobilization, trigger points in my adductors and hip flexors, and mobilizations to calm down the discomfort. Can I start stability exercises with her now or should I wait til the constant ache and pain have reduced more?
Thank you
Hi Aneri,
Start now! Stability is the most important piece for labral tears. Pain shuts down the stabilizers so you need to work on getting them “awake” and that will help calm your pain.