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1080 Views 1 Reply Latest reply: Sep 20, 2012 8:18 PM by JamesJohnsonLMT RSS
Margaret75992 Rookie 4 posts since
Nov 9, 2010
Currently Being Moderated

Sep 16, 2012 6:29 PM

LABRAL HIP TEAR

I am a 48 yr old woman runner and I fell (in my home, not running) and believe I have a labral hip tear. I haven't been to a doctor for an official diagnosis, but everything I have read points to this. I rested for a month by not running and have started back now but with pain in my hip. Are there any physical therapy exercises I can do to help heal this because I cannot afford surgery?

  • JamesJohnsonLMT Legend 1,160 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Sep 20, 2012 8:18 PM (in response to Margaret75992)
    Re: LABRAL HIP TEAR

    Like many other supporting fascia in the human body, the labrum is not well-vascularized enough to just "heal" without surgery. However, depending on the location of the tear (if indeed you have one), you may not need to repair it.

     

    Research in the form of meta-analysis of patient records and examination of voluntary subjects without pain, has shown that patients without pain often have tears of which they are unaware, and those without tears often have symptoms normally associated with a labral tear. This does not mean that it does not matter, but that there is more to a tear, and to hip pain, than simple logic would suggest. Seeing is believing, and belief can produce problems of its own. The mind can focus on a perceived pain source and amplify it in perpetuity. Ever have an annoying itch that suddenly disappeared when you were distracted? An image of pain can take on a life of its own, too, but unlike an itch, you cannot forget a diagnosis.

     

    Let's suppose a tear is suspected. A fall can result in a tear, but so can years of overuse, or simple overextension of the hip joint, such as one might encounter during a stretch or yoga class. It may have already been there before the fall. It is more likely if the conditions surrounding the tear are unfamiliar. Years of stretching within one's comfort zone can actually increase the flexibility of joint tissue by creating a demand the body meets with a chemical response to soften the tissue, making subsequent stretching less likely to cause harm. In your case, there is nothing you could easily have done to prepare for the fall that resulted in your hip pain, but a tear is only one possibility. Let's look at some others, if you are not ready to blow thousands on an MRI to diagnose a tear.

     

    Blunt trauma to the hip can result in a bruise to the bone or periosteum ("skin" of the bone), pull the attachments of tendon to bone resulting in an avulsion fracture, what may be called a stress fracture, or an outright fracture or fragmentation in the joint itself. There can be inflammation of the bursa (bursitis). There can be FAI impingement that was aggravated by the fall. Each condition can be isolated to a high degree with appropriate yet inexpensive tests. In my view, a cheap x-ray would be a wise move to rule out these more obvious problems. Labral tears are often diagnosed after years of treatment or therapy produce no permanent results, and more expensive testing is warranted. The healthcare system would be brought to its knees if every athlete went for an MRI after a fall, so I applaud your desire not to pile on, but you may never know for sure without a definitive test involving high-resolution soft-tissue imaging.

     

    Tears are classified based on their position and degree of tear, but once again, there is no guarantee a tear translates as pain, unless it interferes with other tissue including nerves. In that case, pain is almost guaranteed, and surgery is the only way out. However, I agree that you should explore minimally invasive strategies before turning to the knife. Not all labral-tear surgeries result in freedom from pain. Even if a tear is detected, there can be concomitant pathologies that are actually responsible for some or all of the pain.

     

    There are core muscles and intra-pelvic muscles and ligaments that can be strained in a fall, producing symptoms that can be interpreted as physical damage to the hip joint or capsule. Some muscles acting on the hip, can produce pain-referral into the hip joint, mimicking physical damage when the problem is surmountable without breaking the skin. Because you are in favor of exercises, I would find a qualified physical therapist who can examine the movement of your hip in such a way that a tear or other problem requiring surgery can be isolated or tentatively ruled out. A doctor is likely to perform the same diagnostic maneuvers, but would send you to therapy anyway.

     

    However, despite my reservations about the safety of x-rays, your risks might be greater if you do not rule out a fracture of some kind, even a bone chip in the joint. Since not every healthcare practitioner can prescribe, particularly for something involving radiation, you will probably be referred to a physician who works closely with a competent PT, the best case scenario for you. Choose the wrong practitioner, and they will happily push for surgery you may not actually need. Expense alone is not enough reason for you to avoid surgery. In addition to not solving other related neuromuscular pathologies, the tissue trauma that surgery represents can actually produce them.

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