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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