Seven Crucial Things You Need to Know About A Hip Labrum Tear
Up to 22%-55% of patients with hip or groin pain have a hip labral tear (1). This diagnosis often leads to extensive diagnostic testing and significant healthcare expenses. Patients with a torn hip labrum typically see an average of 4 healthcare providers, undergo 3.4 imaging tests, and try 3.1 treatments over a span of 21-32 months before receiving a proper diagnosis. (2,3)
Not surprisingly, patients are looking for answers, evidenced by more than 100,000 online searches for variations of “labrum tear hip” and ”labral tear hip” each year.
The good news is that chiropractors are one of the top four types of providers consulted for a hip labral tear (along with orthopedic surgeons, PTs, and PCPs) (2) Chiropractors are well-equipped to diagnose and manage these patients, provided they OWN the best-practice diagnosis and treatment.
Want to OWN it? This blog and tutorial videos will review the essential skills to make you the provider of choice for a torn hip labrum.
The two new top tests for accurately diagnosing a hip labrum tear
The essential exercise recipe to help your hip labrum patients recover fast
1. What Is the Hip Labrum Anatomy?
The hip joint, a complex ball-and-socket mechanism, owes much of its integrity to the acetabular labrum. This fibrous rim, varying in shape from triangular to round or irregular, is crucial in enhancing the joint's stability. (1) Critical functions of the hip labrum include:
Acting as a shock absorber to distribute pressure evenly across the hip joint.
Limiting excessive movement of the femoral head within the socket, thus stabilizing the joint.
Aiding in joint lubrication and maintaining synovial fluid for smooth movements. (1)
Over time, the shape of the hip labrum tends to become less triangular, especially in older adults. Damage to the labrum can lead to hip destabilization, increased joint stress, and accelerated wear. (1)
In the Western world, a significant majority (86-94%) of hip labral tears occur in the anterior quadrant (7,8), where the labrum is more vulnerable due to diminished blood supply, mechanical weakness, and higher stresses from limited bony support. (1)
2. How Does a Hip Labrum Tear Develop?
Labral tears of the hip are often the result of underlying conditions such as femoroacetabular impingement (FAI), trauma, dysplasia, capsular laxity, and degenerative changes. (4,5) Among these, FAI is the most common precursor, characterized by egg-shaped deformities in the acetabulum (pincer-type FAI), femoral head (cam-type FAI), or both (mixed-type FAI). (4,6)
Types of FAI
FAI is notably implicated in most hip acetabular labral tears, driving abnormal articular loads and increased pressure within the joint. This mechanical stress not only precipitates a labral tear but also contributes to cartilage delamination and, ultimately, secondary osteoarthritis. (9) The most highly cited article (9) regarding FAI and hip labral tear summarized the etiology:
“Cam impingement caused damage to the anterosuperior acetabular cartilage with separation between the labrum and cartilage. During flexion, the cartilage was sheared off the bone by the non-spherical femoral head while the labrum remained untouched. In pincer impingement, the cartilage damage was located circumferentially and included only a narrow strip. During movement the labrum is crushed between the acetabular rim and the femoral neck causing degeneration and ossification. Labral damage indicates ongoing impingement and rarely occurs alone.” (10)
Deeper dive: Chiroup subscribers can visit the Clinical Skills tab for a comprehensive review of best practices for diagnosing and managing FAI.
3. What are the Most Common Torn Hip Labrum Symptoms?
Torn hip labral symptoms can include pain in the following areas (2):
Groin: 72%
Greater trochanter region: 44%
Buttock: 40%
Thigh: 36%
Back: 26%
Symptoms of a torn hip labrum mirror the typical distribution of pain referred from the acetabulum. (11-19)
Hip labral tear symptoms usually develop gradually, often worsening at night, and range from a dull ache to sharp discomfort during certain movements. (20) More than half of patients report their hip labrum pain impacts running, athletic activity, walking, pivoting, sitting, and climbing stairs. (2,20)
Additional hip acetabular labral tear symptoms include: (21-23)
Clicking
Catching
Locking
Giving way
4. What is the Best Torn Hip Labrum Test?
One recent consensus paper identified over 23 hip labrum special tests to diagnose FAI or hip labral injury* (21). Yet, only a few are proven effective. (21,24)
*Differentiating a hip labral tear from FAI is challenging since both affect the same tissues. (H) However, that differentiation may be inconsequential since both conditions are part of the same pathological spectrum and treatment is similar.
Historically, the FADIR test has been considered the most specific torn hip labrum test. (4) However, a new study of 283 patients published in The American Journal of Sports Medicine concluded that two other tests might be competing for the title of the “best hip acetabular labral tear test.”
“The Arlington test is more sensitive than the traditional FADIR [94% vs. 43%], while the Twist test is more specific than the FADIR in diagnosing hip labral tears. [72% vs 56%]” (24)
Arlington test
The clinician grasps the supine patient’s calf and ankle and moves their lower limb into a FABER position (Flexion, Abduction, and External Rotation). The clinician then moves the patient’s limb into a FADIR position (Flexion, Adduction, and Internal Rotation) while “bouncing” the hip via subtle alternating internal and external rotation. Reproduction of anterolateral hip or groin pain suggests hip labral lesion with reported 0.94 sensitivity and 0.33 specificity.
Twist Test
The patient begins facing the clinician, squatting with both knees bent 30 degrees. The patient shifts both knees back and forth to maximal excursion in a windshield-wiper-like motion. Next, the clinician holds the patient's hands for balance while the patient transitions to stand on one leg and does the “twist” by rotating their pelvis back and forth. Reproduction of groin pain or apprehension suggests hip pathology, i.e., labral tear, etc.
Deeper dive: Check out this prior blog and video tutorial on a comprehensive hip orthopedic exam.
5. What is the Best Torn Hip labrum Treatment?
Conservative torn hip labrum treatment includes hip strengthening, hip manual therapy techniques (soft tissue therapy, joint mobilization, neurodynamics, etc), functional activity-specific retraining, and education, including pain neuroscience education. (21,25,26) This conservative torn hip labrum therapy approach has proven merit for short-term and long-term improvement. (21,27,28,29)
“Findings suggest no statistical significance regarding operative vs non-operative management of acetabular labral tears.” (29)
“The research discussed in this review agreed that conservative management of acetabular labral tears produced measurable improvements in pain and function among the athletes studied, including their ability to participate in sport activities. Based on these findings, it appears that conservative management is effective at rehabilitating athletes with acetabular labral tears.” (28)
Hip labral tear treatment for uncomplicated cases typically favors conservative approaches, including manual therapies and exercise. Despite this, many orthopedic experts still consider arthroscopic surgery the gold standard. (28,30,31) Ultimately, the choice of hip labral treatment hinges on the patient's response to initial conservative measures and is influenced by factors such as age, activity level, hip structure, and cartilage health. (32)
6. What are the Best Torn Hip Labrum Exercises?
First, some background on torn hip labrum exercises:
Typically prescribed hip labral exercise frequency is 3-7 times per week, and the duration is 3-12 weeks. (25)
Adding core strengthening is significantly better than hip strengthening alone. (33)
Supervised active core and hip strengthening programs are more effective than unsupervised, passive, and non-core-focused programs. (34)
Specific exercise types and progression should be customized and closely monitored, utilizing criteria like time frames, pain-free mobility, exercise tolerance, perceived exertion, pain levels (VAS), repetition capability, and limb force symmetry. (25)
A comprehensive hip labrum exercise program should consider the following components: (25,26,36)
Hip strength and motor control (side-lying hip abductions, clams, etc.)
Core stabilization (planks, bird dog, dead bug, etc.)
Kinesthetic awareness (standing, kneeling, side-lying balance exercises, etc.)
Compound functional movement (squats, lunges, hip hinge, etc.)
Cardiovascular exercises (bikes, elliptical machines, etc.)
Sample hip labrum tear exercises
ChiroUp subscribers can view a complete hip labral tear exercise program here.
The specific ways in which exercises enhance outcomes remain unclear; however, the reasons could involve increased strength in the hip muscles and changes in the movement of the hip joint, such as decreased hip adduction angle during single-leg squats, indicating an improved ability of the hip joint to bear weight. (21) And hip labrum tear exercises remain crucial in managing hip-related pain, regardless of the potential need for surgical intervention. (25)
Deeper Dive: Check out these popular ChiroUp webinars on identifying and eliminating common triggers that perpetuate hip pain.
Webinar: Hip Abductor Weakness and Lower Cross Syndrome
Podcast: A Chiropractic Approach to Hip Pain
7. How Do I Educate My Patients About a Hip Labrum Tear?
This one is easy…with ChiroUp, you can effortlessly empower your patients with personalized, condition-specific reports in seconds. From tailored exercises to expert recommendations, our fully customizable reports ensure your patients are well-informed and engaged in their treatment journey.
Experience the difference for yourself – fill out the form below to access a sample condition report now!
Conclusion
Navigating the complexities of hip pathology, especially labral tears, requires a deep understanding of the right diagnostic tests, exercise regimens, and treatment progressions. Hopefully, this article provides a roadmap for evidence-based chiropractors to refine our approach, emphasizing the importance of a tailored, patient-centric strategy.
As chiropractors, we have the unique ability to offer comprehensive care that addresses the root causes of hip pain, ensuring our patients not only recover but also thrive. Embrace these insights to solidify our role as the most trusted authority in conservative musculoskeletal care.
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