Physiotherapy for Labral Tears of the Hip
Physiotherapy for labral tears of the hip can be effective in individuals who have been referred for this condition. The majority of patients who have hip labral pathology have been diagnosed with femoroacetabular impingment. Individuals can have impingement secondary to a pincer lesion or cam lesion (i.e. bone spurs). Some patients can also have a mixed presentation with both a pincer and cam.
Patients most commonly present with an acute or gradual onset of pain along the anterior groin region. Pain may also be present in a c-shaped distribution around the hip joint. Some patients may report clicking or snapping, while a minority may also experience symptoms posteriorly. There are many causes for hip pain and labral pathology is just one. A careful workup to exclude other common conditions such as hernias, osteitis pubis, back pain, and problems related to the pelvic floor and reproductive organs must also be performed.
Patients will be worked up with xrays, a MRI, and if the patient is a surgical candidate a 3D CT scan may also be performed for preoperative planning.
The Role of Physiotherapy for Labral Tears
Physiotherapy should be used for the initial management of labral pathology. Additional treatment may consist of an intra-articular injection. In general, physiotherapy for labral tears should progress through phases. Restoration of the hip joint’s normal range of motion is an early goal. Along with this, soft issue mobilization (specific to the adductors, tensor fascia lata, iliopsoas, and quadratus lumborum) should also be performed, as well as, strengthening core musculature and lower back muscles. Finally, working on agility and functional exercises in multiple planes can be undertaken. The timeline for this aforementioned approach can be over 3-6 months in the non-surgical setting.
Following surgery, rehabilitation progresses in more milestone driven manner. While different surgeons may utilize different protocols, the general principles include:
- Phase I: Protect the joint and avoid inflammation/irritation. There is no weightbearing for 4-6 weeks and no active open chain hip flexor activation. Work towards optimizing range of motion over 6-8 weeks is another key focus.
- Phase II: Work on gait progression and proximal/distal control.
- Phase III: After 8 weeks, progression towards functional exercises such as lunges, single leg balance activities, and bridges can be initiated.
- Phase IV: After 6 months, return to sports can be initiated although it may take upto a year for maximal recovery. Running is initiated at 5 months and when this can be performed well with good mechanics and without pain cutting and agility work can be done. Ultimately, phase IV can only begin when there is sufficient functional strength, good proximal and distal muscular control, and absence of symptoms.