Labral Tears – A Complete Breakdown of Treatment, Prevention & Causes

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The cartilage surrounding the hips is known as the Labral (hence Labral Tears). Injuries in this part of the body are common in sports with intensive hip rotation such as soccer, and in some cases long distance running. While it may be treatable, it may render athletes and runners unable to compete for the duration of the recovery.

The hips, as any other body part, are very sensitive to over use. An injury to the cartilage, although can be very painful, is completely treatable. There are many exercises to help in preventing hip injury. Quite often the athlete doesn’t notice the injury until the situation worsens. It’s vital to have all the information necessary to avoid serious damages in the hip as tears sometimes happen gradually.

This guide will give information on the physiology of the hip structure, symptoms, treatments and tips on how to prevent cartilage damage also known as Labral Tears.

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What is a Labral Tear?

The labral is a cartilage that sits over the hip bone uniting hip and femur together. This cartilage is responsible for assisting the hip in rotation movements, also helps in balance of the upper and lower body. This region is commonly known as the “ball- and- socket joint”. The scientific term for the cartilage is labrum. Without labral cartilages, the repetitive friction of the bones would erode the area, making it harder for the bones to slide back and forth. The labral keeps the bones together helping the normal functioning of the joints. Sports that require repetitive hip twisting or cutting are more prone to suffer this kind of injury. Usually, soccer, hockey and even long distance running.

These tears occur when the cartilage slit away from the socket, causing pain and discomfort all around the hip area. The repetitive friction of the labral with the bones  tear the cartilage. In severe cases the cartilage slides away from its socket.

This injury makes it difficult to run, jump or walk. These tears develops gradually. It’s common for athletes to not notice the injury until later when the damage becomes more serious. Quite often the pain extends towards the knee, as the bone connecting the hip and legs ends in the knee (femour).

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What is the use of the Labral cartilage?

The cartilage extends around the hip, the socket area, and the top of the femur, acting as a kind of “glue” connecting the hip and femur together. Basically, it helps enable the normal functioning of the joints. This area is essential for keeping the hip correctly balanced, in turn, helping with walking and jumping movements. Repetitive rotation and cutting movements exhaust the cartilage. It may rip apart when the rotation movements of the joints exhaust the tissue. Poor training or incorrect exercises over time will damage the cartilage, therefore, small damages can become bigger if left unchecked.

Recent studies have found the labrum expanding on the outer side of the socket joint. This extra articular cartilage has a good blood flow, in contrast with the intra articular part which lays inside the bones and is made of  tiny vases connecting each other. According to studies injuries in the extra articular cartilage are easier to heal while damages in the intra articular area are more difficult to repair due to the lack of blood flow. Blood carries essential nutrients to the bones, then fluid blood circulation helps restore damages quite easily.

Though cartilages at difference of muscles do not heal by themselves, a right exercise plan can prevent future injuries.  However, once the cartilage is damaged clinical intervention is the best solution.

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What causes Labral Tears?

Many conditions can cause labral tears. The most common is repetitive twisting or cutting performed in sports such as long distance running or hockey. It’s also fair to say that irregular bone structure can cause the joints to move irregularly. Over time, this can lead to tears forming in the  cartilage. Additionally, Genetic conditions or bone abnormalities can also cause cartilage deterioration. In many cases the bones move improperly when connecting with each other, and as a result damaging the cartilage. The tears can also be the consequence of sudden or extreme joint movements. Other causes are natural bone deterioration due to aging or lack of flexibility.

Causes in the hip include:

  • Natural deterioration due to age
  • Joint overuse due to intensive training
  • Car accident or any other impact can cause cartilage slit away from its socket
  • Lack of flexibility and strength in bones and muscles
  • Poor or inefficient training program, the muscles are not properly conditioned for high level of training
  • Poor posture may shift weight towards one side, a problem in other parts of the body may put extra pressure in the hip bones.
  • Weak joints and or frail body structure, natural tendency to damage
  • Wrong footwear may cause incorrect balance or posture
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Risk Factors

The labral cartilage doesn’t heal by itself. Available treatments focus on recovery through stretching and strengthening exercises. In more severe cases the most effective treatment is surgical intervention. For this reason is very important to have an adequate understanding of the risk factors.

Numerous reasons can increase the chances or damage. Essentially, any repetitive twisting or cutting movement may end in injury. In addition, poor flexibility and strength can add to an eventual damage in the area. Extra weigh in the hips or problems on the lower back can also affect the cartilages. What’s more, genetic predisposition to cartilage deterioration is quite common in adults.

Hip impingement is another risk factor. impingement is a condition where the femur ball doesn’t move correctly when touching the hip bone, this causes wrong friction between the bones which in turns can develop into arthritis. According to the sport injury clinic, the principal cause of hip impingement is the hip bone or femur being bigger than normal, so this overtime damages the cartilage. This condition is present in nearly 80% of the patients with impingement condition.

Incorrect hip rotation may affect other areas of the body as well. Being aware of the movements is the first step to treat labral tear. Often the bones don’t fit well together, in this case the only way of achieving recovery is through surgery. Being aware of the causes of pain is vital in order to avoid greater damages. Sometimes mild injuries can built overtime. The damage becomes more serious when the athlete experience severe pain in the hips, thighs, legs and knees. According to  Physiotherapist Shane Armfield,  22% of athletes reporting pain in the hips suffer from a tear. This is especially typical in athletes who make the same repetitive movements of the hips. Being aware of any pain or discomfort is the best way to treat labral tear successfully.

Most Common Risk Factors associated with tears

  • Hip impingement, abnormality in the femur ball or hip bone
  • Repetitive twisting or cutting movements
  • Weak bone structure
  • Poor posture or other related issues on the back
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Labral Tears Symptoms

Depending on the level of injury, the symptoms can go from mild pain in the hip area to finding it quite hard to walk or stand. In some cases the athlete may experience a snap feeling as if being pushed from the back. This is because the femur can’t perform the usual rotation movements within the hip capsule.

Pain can occur while participating in any physical activity such as running, jumping, etc. The athlete may also experience pain when turning towards the sides. Walking or bending can be very difficult in severe cases.

It’s also important to notice that this cartilage is a tin tissue that connects the joints together, so any damage in the tissue will make it harder for the joints perform their normal functions. A damage in the joint tissue affects the rest of the body as muscles will find it hard to move, so they have to distribute the weight towards other areas of the body. Therefore, the pain can extend further to the knee or lower back. In many cases the pain comes gradually, the person affected with labral tear may not be aware of the injury until later when the conditions have worsen.

Common Symptoms to look for

  • Acute pain in the back and front of the hip
  • Discomfort when walking, running or performing any kind of activity involving hip rotation
  • Sore hip and lower back
  • Sometimes the pain expands towards the knee area
  • Muscle stiffness, discomfort, ache in the hips and the surrounded area
  • A stalling sensation when walking
  • Shifting the hip towards one side, unnatural walking due to pain in one side of the hip

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Diagnosis

A visit to the doctor is the best way to get an accurate assessment of the condition. After an exam the practitioner will have more information on the best treatments to successfully repair the damage. A doctor will assess the activities performed by the athlete the level of fitness, mobility, flexibility and other risk factors such as bone structure and health history.

The most common method to find the source of pain is applying pressure in key areas:  front, side and back of the hip. Although an X ray or MRI (Magnetic Resonance Imaging) exam may be carried away in order to see in more detail the causes of pain. This exam looks into bone degeneration, slit cartilage and other small damages in the area.

Another way of having a more accurate diagnoses is through a MRA (Magnetic Resonance Arthrography) exam.  An article published on The North American Journal of Sport Physical Therapy tells “in the past years arthroscopy of the hip joint is becoming more common as a technique in both the diagnosis and treatment of hip pain” ( TNAJST). MRA enables the doctor to view exactly where the damage is, using a camera to access the joint in detail. MRA exam is both diagnosis and treatment since the doctor can access the injury and repair the cartilage at the same time.

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Treatment of Labral Tears

To achieve full recovery it’s really important to follow an exercise plan that helps condition the area. The labral cartilage, as explained earlier, doesn’t heal by itself. However, a good flexibility and strengthening exercise plan is essential to conditioning the body and prevent the injury. Non-surgical treatments focus on developing strength in the muscles.  Surgical methods repair the cartilages through re-fixation.

The level of injury will determine which treatment is the best. Non-invasive treatments sometimes are enough to alleviate the pain enough where the athlete can reach a good level of fitness and go back to the usual training. Although, tears are very particular in that a correct exercise plan will focus on developing flexibility, strength, and healing the pain, but the injury is still there.

As said before the cartilage doesn’t heal on its own so it’s very likely that although a non-invasive treatment may be very effective to nullify the pain, it doesn’t solve the issue in the long run. Depending on the injury level, the patient may be able to recover and not suffer this injury again. However, the most effective way of achieving full recovery is through surgery. Surgery intervention allows the tissue to be stitched together, so the whole structure is properly repaired.

Non-invasive treatments:

A correct exercise plan will consist of improving muscle strength, correcting posture and developing good training techniques. It’s important to carry out exercises with the supervision of a physiotherapist, as they will know the best techniques and a credible one will be aware of your bodies requirements.

In addition, developing flexibility is quite important, flexible muscles in general help bending and turning without damaging or over-stressing the tissue. Gradual conditioning is the best way to reach a good level of mobility without damaging the cartilage.

Using a special band, SERF (stability Through External Rotation of the Femour), is another method to correct unwanted hip movements. This elastic band is adjusted to the hip, around the thighs and knees in order to help the femur in with proper rotation movements. This is an extra tool to support the hip while training.  The SERF band alongside physical exercises are excellent treatments for mild cases. Remember that is crucial to pay attention to legs and hips while training as well as correcting any poor balancing, or incorrect  movements to prevent further damage.

Other ways of treating pain is with anti-inflammatory medicine, as they help to reduce pain in the muscles. Taking anti- inflammatory medicine plus an exercise plan to improve flexibility and strength of the joints can work in some cases. Depends on the level of the injury the person suffering this condition may recover pretty well. However, as the labral tear condition can become chronic if not treated properly,  it’s wise to consult a doctor even if the pain has gone.

Pain Nullification for mild cases

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Surgical Intervention

In most cases this may be the most effective treatment to repair labral injury. An MRA or arthroscopy increases the chances of achieving full recovery.

The MRA or arthroscopy consists in making a small incision in the area, a small tube (arthroscope) with a camera attached at the end is introduced in the hip. The doctor has a full view of the bone, an image on the screen guides the surgeon to the affected areas. In this procedure, the labrun is attached to the bone. Through this intervention the tissue  is reconstructed to its original form.

This procedure is known as labral re-fixation. The advantage is that the incision on the hip is very small compared to previous interventions in this area. In addition the chances of success are very high, given the doctor has a more accurate view of the cartilage. Recovery time is from 4 to 6 months, assuming the correct rehabilitation plan has been put in place. This treatments is very efficient relieving pain, also the patients can go to their normal training plan after the recovery times has passed.

This is standard practice for this kind of injury. Surgeons have adopted this treatment as it’s the most effective. Most cases end with the athlete achieving full recovery.

In severe cases where the labrun is extremely damaged the cartilage has to be removed. This procedure is more delicate and requires longer recovery time.

In other cases the ball and socket joint is broken or don’t fit properly so the surgeon fits a joint made of metal and plastic. This kind of joint adjust to the body and works doing the bones movements as if it were the original joints.

After hip surgery the patient may have to use crunches for some time. This helps the bones stay in place, speeding the recovery process. Recovery time can take from 4 to 6 months, depends on the injury. The patient must follow post-surgery physio exercises in order to conditioning the muscles and bones to their normal state.

Runner's Guide to Labral Tear Runner's Guide to Labral Tear

Prevention

In order to prevent hip injury the athlete should carry out exercises to improve flexibility and strength in the area. It’s also very important to go through the training in order to correct any wrong movement that may affect the joints.

Make sure you have the right footwear as this is crucial to support the body during long hours of training. It’s also important to check the body balance, as any injury in one area can affect other areas, hips included. This is why is vital to check the posture, lower back and legs. Also, Be conscious when dropping or lifting weight as the hips are prone to resent extra weigh in either side.  When sitting, jumping, walking, or even standing be conscious of the movements, although it can be hard sometimes  but this can prevent later injuries.

There are also a number of food supplements that help runners to avoid muscle inflammation. These products are known for improving muscles strength, boosting the immune system, and giving the body all the extra nutrients it needs to perform at high capability. Besides, a good balance diet with plenty of proteins and mineral is key to prevent bone and muscle damage.

Although, a labral injury may be unavoidable depending on the case, increasing awareness on how the muscles work is essential to prevent injury

Prevention tips

  • Adjust exercise plan to your level of fitness
  • Don’t put any extra weight on the hips
  • Correct any movement that is not done properly use SERF strap if necesary
  • Wear adequate trainers, having the right footwear is extremely important when facing a long run
  • Improve flexibility and strength through regular exercises
  • Check that your posture and balance is right
  • See a doctor if you are not sure about the sources of pain as they can give more detailed information
  • Have a balanced diet eat plenty of anti- inflammatory foods such as fish, nuts, broccoli and olive oil
  • Don’t overstretch your body if you feel tired

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Yoga

Yoga is an excellent way to prevent hip injuries, as many stretching exercises focus on body balance and flexibility. There are also many recovery exercises extremely beneficial for the general functioning the body.

Tortoise pose

This exercise helps stretch the back and is an excellent pose to revitalize the muscles.

  • Sit on the floor with arms and legs extended
  • Bend towards the front of the body extending the arms to the sides and slightly bending the knees
  • Arms extend to the sides
  • Cross over your legs, bending the torso towards the floor
  • The face chin should touch the floor
  • Hold in this position for few seconds

Rabbit pose

This pose stimulates body metabolism.  Stretching abdomen and spine helps promote a good posture.

  • This pose starts sitting on your bottom
  • Bend your torso touching the floor with your head
  • The head should be closer to your knees
  • The arms extended should touch your heels
  • Hold for few seconds

Butterfly pose

This pose helps to correct back posture and relieves tension in the lower back.

  • Sit on your bottom with the legs extended
  • Bend both knees so the sole of your feet are touching
  • Help with your arms to keep the feet in position
  • Hold in this posture for few seconds

Locust pose

This pose is beneficial for the hips, thighs and back

  • Lie on your abdomen
  • Arms stretched to the sides, head towards the front, chin touching the floor
  • Rise your legs and pelvis as much as you can keeping the torso on the floor
  • Hold there for few seconds

Forward bend

This pose is very simple and has great impact on the spine helping to correct the posture

  • Standing with the legs slightly apart from each other
  • Extend your arms and bend your upper body while the arms extended
  • The whole body should be a 90 degree angle
  • The back should be straight as well as the arms and legs
  • Stay in this position for few seconds

 

Runner's Guide To Labral TearRunner's Guide to Labral tear

Tortoise and Rabbit pose

These are some of the exercises that help improve flexibility in the hips. The frequency of the practice is very important. You must practice yoga few times a week in order to achieve a good level of flexibility. Constant exercise helps the muscles to gradually increase flexibility. Yoga also helps relax the body. this is vital to avoid any tension that may stop the normal functioning of the body or make some areas difficult to move. Yoga helps relief tension accumulated, supports blood flow, improves oxygen circulation, revitalizes the body and corrects bad posture.

If you haven’t thought about doing yoga, think about it, this is a great way of achieving a great balanced body free from injury.

To sum it up

As we now know, the hip joint is essential for overall stability of the body. It helps balance the upper and lower body. The cartilages leave enough space between the bones, so they don’t deteriorate with the constant friction and the Labral cartilage is like a thin sponge, providing cushioning to the joints. At the same time, labral tissue transports essential minerals from one part to the other, this helps the good functioning of the body, like an effective machine. Genetic conditions can cause deterioration and cartilage can get damaged because of weak bones, high level of training or wrong bone movements. Aging or a sudden accident can also increase the chances of injury.

Repetitive twisting still is the main cause of labral deterioration. It’s vital then to have enough information, as an early diagnosis would help prevent further damages. In many cases injury happens gradually, the athlete doesn’t know the condition until later when the pain is more severe. A pain in the lower back or some other body part may not relate to the hip at the beginning, but it can indicate a hip injury is there or stem from it. Consult a doctor if the pain persist for several days.

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Unfortunately, labral cartilage doesn’t heal by itself. This means the only way of fixing the damage is through an exercise plan or clinical intervention. For mild cases, an adequate exercise program focusing on developing flexibility is enough to nullify the affects of condition. In cases where the injury is more severe, the only way of treating the cartilage is through a labral re-fixation. This can sound overwhelming but studies suggest the majority of the interventions for labral re-fixation are successful. This is thanks to modern technologies. Arthroscopy is the ultimate technique to repair tissue, making a big impact on patients who may fear not going back to regular activities.

In severe cases when  the labral cartilage  needs to be removed, the  intervention tends to be more delicate.  However, most cases are very treatable even the delicate ones, and the patient can go to their normal life in few months after the intervention. Exercise is the best way to maintain a healthy body and improving flexibility and strength helps avoid injury. Being aware of hip movements while training it’s also quite important. Correct any exercise or consult with a trainer about which exercises are best for your body.

Bandages like SERF or special footwear help doing the right rotation movements. What’s more an adequate diet is also quite important. Make sure you eat enough vegetables, fruits and minerals as they protect the body giving all the nutrients they need.

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The body is very complex. A damage in one area can definitely affect other areas. This is why is really important to have a deep understanding of the implications of a hip injury. An injury in this area will affect the balance of the whole body,  making walking extremely difficult. Your body is going to be here for some time so listen to the signals, be aware of the strains, get to know the essentials,  how certain body parts work and what is best. Ask yourself, What do you need and how they can you become more efficient in the way you use it. Be aware of your own structure, your shape and your physiology.

This is for your own benefit, in order  to cross your limits and push to the maximum, be sure your body is ready to push forward,  be aware of your own limitations.

Stay well and carry on running!

Some of the sources used while conducting our research

The purpose of this article is to inform. Everything written here is based on scientific research and professional advice from several sources. Although the information has been wisely researched this is not substitute for professional medical advice. If you’re suffering from pain in the hip, or any other region of your body, make sure to talk to your doctor as soon as possible.

 

Sources

  1. J. Craig Garrison, PT, PhD, SCS, ATC | Michael T. Osler, PT, DPT, CSCS | Steven B. Singleton, MD, FACS, Rehabilitation after arthroscopy of an Acetabular Labral Tear, Online Resource,
  2. Allison Mumbleau, PT, DPT, SCS, Physical Therapist’s Guide to Hip Labral Tears, Online Resource,
  3. HJS, Hip Arthroscopy, Online Resource,
  4. HoustonMethodist, A Patient’s Guide to Labral Tears of the Hip, Online Resource,
  5. Derek Ochiai, MD, Injury Prevention: Hip Labral Tears and FAI Syndrome, Online Resource,
  6. InnerBody, Hip Joint,
  7. NHS, Labral tear, Online Resource,
  8. HSS, Labral Tear/Torn Labrum of the Hip, Online Resource,
  9. Sports Injury Clinic, Labral Tear of the Hip Joint, Online Resource,
  10. UCSF, Hip Injuries: Labral Tears, Online Resource,