What is it
The hip labrum is a fibrocartilage structure which attaches to the bony rim of the acetabulum (hip socket), it is about 2-3mm thick and has many functions but acts mainly to help provide stability to the hip joint. The labrum helps to stabilise the hip joint by deepening the socket by about 20%. It provides shock absorption and pressure distribution, provides a seal for the joint, and it resists vertical and lateral motion of the femoral head (top of the thigh bone).
Studies show that up to 22% of athletes who complain of groin pain have a labral tear in the hip. However, almost 75% of cases of torn acetabular labrum have no known direct cause.
Possible causes of labral tears
- Trauma – either an acute injury (eg. a fall) or due to chronic repetitive trauma, especially with activities involving hip rotation (eg. taekwondo)
- Weakness and poor control of the deep stabilising muscles of the hip.
- Anatomical variations which lead to a pinching effect in the hip joint such as additional bony growth on the neck of the femur or socket of the hip
- Capsular laxity/Hip hypermobility
- Hip Dysplasia
Typically, diagnosis of a labral tear can be made by your physiotherapist based on the description of your symptoms, mechanism of injury and with a series of orthopaedic tests to the hip. In some cases, diagnosis may need to be confirmed with imaging. X-ray of the hip joint may also be carried out in order to eliminate other structural issues of the hip. The injury is not always visible on a straightforward MRI scan or CT scan, MRA tends to be the diagnostic investigation of choice.
Symptoms may include;
- Anterior hip, groin or buttock pain.
- Pain, particularly with deep hip flexion and twisting of the hip.
- Clicking, locking &/or giving way in the hip.
Initial management of this condition will always involve rest from aggravating activities, often accompanied by a course of anti inflammatory medication. Your physiotherapist will perform a biomechanical assessment to determine muscular imbalances, assess movement control and determine the likelihood of any related structural issues. Treatment will generally include;
- Joint mobilisation and stretching to restore any limited mobility
- Progressive strength/stability exercises (including balance & proprioception) and functional retraining to improve techniques and reduce unnecessary/abnormal loading of the hip joint
- Deep tissue releases
In the more severe cases, or when conservative management has failed to resolve pain &/or dysfunction, surgery may be indicated. This can involve re-attachment of the labrum, debridement of the tear (removing the damaged section of the labrum) and/or surgical repair of other structural problems.