RoseCityPT_Labral Tears of the Hip

By now, if you have been dealing with chronic hip pain for some time or had an acute onset of pain related to an injury, you likely have read or heard about the hip labrum. And have wondered if perhaps you have a labral tear of your hip.

SEPT - OCT 2020 • Issue 8

Labral Tears of the Hip BY LEO QUINN, PT, OCS By now, if you have been dealing with chronic hip pain for some time or had an acute onset of pain related to an injury, you likely have read or heard about the hip labrum. And have wondered if perhaps you have a labral tear of your hip.

What is this labrum? Where is it locat- ed and what does it do? The labrum of the hip is a ring of fibrocar- tilage – think dense rubbery ring – that lines the socket (acetabulum) portion of the hip’s ball-and-socket joint. The socket is located on the pelvis. The labrum acts as a shock absorber, aids in joint lubrica- tion, and provides stability to the joint by deepening the socket to provide a seal which keeps the ball of the femur rooted in the acetabulum. Prevalence of Labral Tears: The prevalence of labral tears in patients with hip or groin pain has been reported to be as high as 22-55% (1-4) . With that shared, one study reported that a labral tear was detected in upward of 41% of male and 43% of female subjects with an asymptomatic (pain-free) hip and no history of a hip problem 5 . With that un- derstanding, we must consider that just because an imaging report (i.e. MRI with contrast dye) discovers a labral problem it does not mean it’s the cause of hip

pain. A comprehensive clinical exami- nation can help determine if a patient’s pain behaves labral like. Causes of Labral Tears: Labral tears can occur from a multitude of reasons with the most common being trauma. Acute injury to the hip labrum can occur through traumatic events such as car accidents, a fall, or while playing contact sports. Hip labral tears also occur due to struc- tural abnormalities of the bony structure of the hip joint (simply, a ‘Pincer' or ‘Cam’ lesion), as well as soft tissue laxity and hy- permobility. Overuse and repetitive motion can put excessive torsional forces across the hip joint and labrum, leading to tearing. Athletes that repetitively perform rota- tional motions at the hip such as soccer, hockey, golf, and dance are at increased risk for injury. Lastly, degenerative osteo- arthritis, sometimes called the “wear and

tear” arthritis, can erode the cartilage in the hip joint and lead to labral tears.

Symptoms: Labral tears are a frequent cause of ante- rior hip and groin pain and often go un- diagnosed for extended periods of time. Symptoms may include: • Anterior hip and groin pain, often made worse with prolonged walk- ing, standing, and sitting. Pain may be dull at rest and sharp with activity.

Mechanical symptoms including, clicking, locking, and catching with the occasional feeling of “giving out of the hip”. Stiffness and decreased range of mo- tion most notably with rotation of the hip. Limping with walking if the pain is severe enough.

Diagnosis: It’s not uncommon that a hip labral tear can go undiagnosed for an extended pe- riod of time and patients are often seen by multiple health care providers before

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Labral Tears of the Hip BY LEO QUINN, PT, OCS

obtaining a definitive diagnosis. A thorough subjective exam - a conversation between the patient and the physical therapist - is essential and consists of a detailed history of a patient’s problem, including the mechanism of injury and pain-inducing and relieving factors. At Rose City Physical Therapy our physical therapists will perform a comprehensive clinical physical exam that as- sesses the range of motion, flexibility, strength, functional movement, and load tolerances of the hip. Also assessed is the patient’s gait (walking, or running if applicable) to look for deviations, compensations, or other deficits. Special tests are also completed that can rule in or rule out the clini- cal suspicion of a hip labral lesion. Imaging: Not everyone with a hip problem needs imaging. Re- search shows that even in people with no history of a hip injury or problem, and pain-free, imaging will likely show a certain degree of changes in the hip joint or labral integ- rity. It’s a matter of relevance based on the clinical presen- tation if imaging results are correlated to one’s problem. For the patient with persistent hip pain that is unrespon- sive to conservative care, imaging becomes necessary. X- rays, MRI or a contrast MRI (known as a MRA) are the most common images. The latter is much more sensitive to de- tecting labral tears of the hip and the image of choice for surgeons suspecting a labral pathology. Treatment: Treatment of hip labral tears consists of either conserva- tive treatment with relative rest (protection and avoiding adverse pain provoking activity), use of ice in the acute stages of injury, and physical therapy. At Rose City Physi- cal Therapy our hip specialists use evidence informed decisions in the choice of treatment and exercise pro- gression used in rehab. If a patient fails to respond to attempts of conservative treatment, surgical intervention may be necessary for labral tears. Physical Therapy includes any and all of the following: • Education! Paramount in success of care. Understand- ing the purpose and function of the labrum is impor- tant, and ways to protect the injured area yet remain active, mobile and strong.

• Gait (ambulation) and functional movement retrain- ing and avoiding movements that cause increased stress on the hip. • Flexibility and motion restoration: Identifying areas of adverse muscle tension, hip capsule (tissue sur- rounding the hip joint) tightness, and inflexibility and teaching patients self-stretching. • Muscle strengthening, including addressing muscle imbalances and areas of weakness. • Manual therapy to help decrease pain and to regain normal ROM and hip mobility. Surgery: Surgery may be required to address structural abnormali- ties that can contribute to labral tears, to repair or to clean up the joint and labral tissue. Surgery may be performed either arthroscopically or by traditional open surgery. In either case, patients typically will be prescribed a course of physical therapy to help return to activities of living and recreational activities including sports in a timely and safe manner. Recovery times from labrum surgery typi- cally take 4- 6 months. Contact us at Rose City Physical Therapy to talk with one of our hip specialists to get answers to your ques- tions, or to set up a free 20-minute consultation to screen your hip and help guide you in the right direc- tion for care.

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Frenchies Modern Nail Care Community Par tner Spotlight

Owner’s Linh and Michael believe nail care is an industry that is ready to be disrupted with a fresh approach to cleanli- ness, quality services, and a strong focus on customer engagement. Frenchies is a clean, natural & healthy nail salon that doesn’t look, smell, or feel like a typical nail salon. Their studios are light, open, airy, and super clean. Speaking of air, Frenchies is especially fresh with no acrylics; which means no chemical smells when you walk inside. Michael and Linh have two Frenchies studios; in Slabtown (opened April 2019) and Beaverton (opened December 2019). They are passionate about locally owned and operated businesses and ready to invest in local employees and the local community and look forward to introducing Frenchies: natural, clean, and healthy nail care options to greater Portland.

Frenchies tag line - We Love Clean™ - is the foundation of their values and how business decisions are driven. The service protocols were developed to go above and beyond OSHA regulations for EVERY service, EVERY day.

Treat yourself. Give Frenchies a call or book online at studios.frenchiesnails.com/portland-or and take advantage of the promotional discount with our fellow neighborhood small business.

The Frenchies team looks forward to welcoming you to their studio and showing you the Frenchies differences.

FOR ROSE CITY PHYSICAL THERAPY PATIENTS We’re happy to offer 25% off all services for Rose City Physical Therapy patients who are FRENCHIES NEW guests (through November 2020). Promo code “ROSECITYPT25” can be used when booking online or call the studios. Frenchies Slabtown (503) 206-6368 Frenchies Beaverton (503) 430-1106

It’s that time of year and each October we support Breast Cancer Awareness. Local author and friend of Rose City Physical Therapy Marjorie Belson wrote a terrific memoir on her experience with breast cancer. We have signed copies of her book at our office available for $11.00. All proceeds are donated to breast cancer research for books purchased through December 31, 2020. Stop by to pick up a copy - a great gift or stocking stuffer for this coming holiday.

Congratulations!

KGW8 School Supply Drive

Thank you to all who helped make our August School Supply Drive sponsored by KGW-8 a success. Your donations go a long way to sup- port local childhood education. In addition, Rose City Physical Therapy contributed 3% of our August net income to the cause.

Congratulations to our physical therapist Ari Witkin, DPT, and his lovely wife for their new baby boy. Seen here with daddy...cam- era shy and flirting.

Portland inspired

Nutrition recipes

Curried Butternut Squash & Pear Bisque

Heat the olive oil in a 6-quart soup pot over medium heat. Sauté the onion, stirring frequently until soft, about 5minutes. Add the squash and pear, season with salt and pepper. Decrease the heat to low and cook stirring occasionally until the squash softens up and caramelizes a bit, about 15 minutes. Add the curry powder and continue stirring for 1 minute to bloom the curry flavor. Pour in the apple cider. Raise the heat back to medium, add water, and simmer until the squash is completely cooked through about 30 minutes. Finally, stir in the cream and bring the soup back up to a simmer. Adjust the seasoning with salt and pepper to taste. Carefully liquefy the hot soup by batches in the blender. Pour the soup into bowls, garnish with a dollop of crème fraîche and dill fronds. This soup can be made a day in advance chilled and kept refrigerated overnight. Makes 6 cups. “This soup is so easy to make, I feel like I'm getting away with something by using water instead of stock. Water lets the squash speak more loudly and re- alize its full potential in this soup. Pears, winter squash, and apple cider all appear on farmers’ stands at about the same time. Their varying degrees of sweetness has a natural affinity for one another when combined. The addition of curry powder to this soup conjures up images of genies and magic carpets while keeping flavors firmly local.” - Vitaly Paley

A fall favorite by Portland’s international acclaimed chef Vitaly Paley of Paley’s Place, this vegetarian soup is simple and decadent. Rich flavors take center stage as the creaminess, heartiness, and sweetness strike a heavenly balance with squash and pears getting a nice curry kick.

4 tablespoons extra virgin olive oil 1 large onion peeled, halved, and sliced thin

1 1/2 pounds butternut squash, peeled, scraped, and cut in 1-inch cubes 1 large pear (such as Bosc) peeled, halved, cored, and coarsely chopped

Salt and freshly ground black pepper 1 1/2 tablespoons mild curry powder 1 cup apple cider 3 cups water 1 cup heavy cream Crème fraîche Dill fronds for garnish

Portland-based internationally acclaimed chef Vitaly Paley of Paley’s Place www.paleysplace.net

Try these exercises to help maintain healthy hips Exercise Essentials

GLUTE BRIDGE Lie face up on the floor, with your knees bent and feet flat on the ground. Lift your hips off the ground until your knees, hips and shoulders form a straight line. ... Squeeze those glutes hard and keep your abs drawn in so you don’t overextend your back during the exercise.

RESISTED LATERAL STEPPING (Strengthen Hips & Glutes)

Wrap a resistance band just above both ankles. Stand with both legs hip-width apart so that there is tension on the band. Keeping your chest upright, back straight, and knees slightly bent, take a large step with one foot away from the opposite foot. Follow through by stepping in the same direction with the second foot, back into the original stance. Repeat this same maneuver into the opposite direction. Keep moving back and forth to the right and left in this manner until you have repeated the exercise at least 10 times.

Exercises copyright of

www.simpleset.net

Not all exercises are appropriate for every person. Please consult with a healthcare provider before starting.

PAC 12 FOOTBALL AND MASCOTS

Exercise For Your Mind

K S R J Z E S V C I P R R A G U O C H C T U B M J D J O P O F U B R A L P H I E V D C U Y H P D O S P E S U X B C G P E H K H D D F C A A U L B W A C B W B D W K A L A A L Z O V L N T R L Q Z A D E R O J W D X X K R G R K T A O U Y A B B Z K N T U O Q Z F L E U H C S U W Z Y K P E E M C B P A I P T R A V E L E R J N I K I R H B P I Q G R T N Z L B X W U S S Q H R J S I C L E V C Q X E S E N A O I H C P T V A J K T T R W H C M D I V N B T Z Z R R A Y P A C C Y A A E P T C A H Q A O Y Z A M E R S J K O V X E N R F J I Q W B X E T R D N T K P I S I K K A G F I K I K S B T F B G O C R Y S P F V J J P U R O Z M U S E O V X Y N J B V O I N O P I G O M S R O S C O L C D T N I Q W F N F R O T J X Z A F D N C G H D A K N N H J X F K E N Z G C O B Z P T A B O P D L Y H E S E J L G Y O A H E F B N S R S H P W A I K G B A Y T O P N A B T H R Z R T E T Y F Q W F B D J W Q N G C F A W O S J O U C E A D A B W O S J E A E O I K O X I A X S H B H H T P D E W R Z V Y K S U H E H T Y R R A H V T S E J V D J N O H L N U N F C F L N W A S H I N G T O N Y H I X E V W L A N E E D X B C O L O R A D O O Q Q A J T A C D L I W A M L I W D N A R U B L I W L F K PAC 12 FOOTBALL AND MASCOTS K S R J Z E S V C I P R R A G U O C H C T U B M J D J O P O F U B R A L P H I E V D C U Y H P D O S P E S U X B C G P E H K H D D F C A A U L B W A C B W B D W K A L A A L Z O V L N T R L Q Z A D E R O J W D X X R G R K T A O U Y A B B Z K N T U O Q Z F L E U H C S U W Z Y K P E E M C B P A I P T R A V E L E R J N I K I R H B P I Q G R T N Z L B X W U S S Q H R J S I C L E V C Q X E S E N A O I H C P T V A J K T T R W H C M D I V N B T Z Z R R A Y P A C C Y A A E P T C A H Q A O Y Z A M E R S J K O V X E N R F J I Q W B X E T R D N T K P I S I K K A G F I K I K S B T F B G O C R Y S P F V J J P U R O Z M U S E O V X Y N J B V O I N O P I G O M S R O S C O L C D T N I Q W F N F R O T J X Z A F D N C G H D A K N N H J X F K E N Z G C O B Z P T A B O P D L Y H E S E J L G Y O A H E F B N S R S H P W A I K G B A Y T O P N A B T H R Z R T E T Y F Q W F B D J W Q N G C F A W O S J O U C E A D A B W O S J E A E O I K O X I A X S H B H H T P D E W R Z V Y K S U H E H T Y R R A H V T S E J V D J N O H L N U N F C F L N A S H I N G T O N Y H I X E V W L A N E E D X B C O L O R A D O O Q Q A J T A C D L I W A M L I W D N A R U B L I W L F K

WORDS SEARCH: PAC-12 Football & Mascots

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ROSE CITY PHYSICAL THERAPY

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I n t h i s i s s u e : Labral Tears of the Hip by Leo Quinn, PT, OCS Frenchies Modern Nail Care Special Offer Congratulations to our physical therapist Ari Witkin

KGW8 School Supply Drive

Locally Sourced Recipe: Curried Butternut Squash & Pear Bisque October Breast Cancer Awareness Month annual promotion.

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