The hip joint is comprised of a ball (the head of the femur) and the socket (the acetabulum). The hard cartilage (labrum) that stabilizes the hip joint is vulnerable to tearing during sport. Femoral acetabular impingement (FAI) is a hip condition in which the head of the femur (thigh bone) rubs abnormally against the rim of the acetabulum causing friction. This may ‘impinge’ or ‘pinch’, and eventually damage the labum.
Labral tears affect the labrum, a ring of cartilage that surrounds the acetabulum. The labrum holds the head of the femur in place while allowing flexibility in the joint. Femoral acetabular impingement there is abnormal fiction in the hip joint leading to poaching of Labrum. This leads to a deformity of the femur or the acetabulum.
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Labral tears occur in sports which involve sudden stop and turn movements combined with jumping and landing such as rugby, tennis, netball, athletics. It is also more likely in sports that involve extreme movements such as rowing, martial arts and dancing. Structural defect of the acetabulum often where it is too shallow, may lead to tearing where there is trauma or overuse. Gymnasts are particularly affected by this. Femoral Acetabular infringement (FAI) occurs as a result of the particular shape of the head of the femur and/or the acetabulum.
If you have a Labrum tear they will be swelling around the joint causing pain in your hip and groin. Emily also be a clicking catching locking or pinching sensation the groin. These symptoms only come on when the condition has progressed, in most cases label is produced no immediate symptoms.
With femoral acetabular impingement you may feel pain in your hip or lower back and pain in your groin groin that radiates to your buttock. Emily also be a thing for pension sensation on the affected hip. Will experience stiffness and loss of motion in your hip.
Your physiotherapist will make a diagnosis after an assessment of your history and physical examination. Diagnosis will only be confirmed by taking X-rays to investigate the femoral head and acebabulum position. Stress X-rays will provide valuable information to confirm pinching of the femoral head. CT scans and MRI scan will be the best to visualize a labral tear.
What needs to be tested
- The movements from your ankle, knee and hip (how they interact with each other)
- Lumbar and Sacral vertebrae
- Pelvis (forwards and backwards tilt)
- Muscles surrounding the hip joint
- Core muscle control and pelvic floor muscles
- All the thigh muscles that attach onto the Femur (Quadriceps, Hamstrings, Adductors)
- The Sciatic and Femoral nerves
- The articular surface of the Ball and socket joint of your hips
Risks and complications
Without treatment most labral tears and Femoral acetabular impingement may lead to early osteoarthritis of the hip joint.
If you do not need surgery, you will usually see an improvement in both labour tears and FAI within 2 – 3 weeks. If you have surgery, a partial Labrum excision will need 6 – 8 weeks recovery. A torn labrum 3 – 4 months. Surgery for FAI usually needs 3 to 6 months.
In all the surgery cases you will need to follow a structured physiotherapy rehabilitation program.
If you think you may have a labral tear or FAI you should seek medical attention. Physiotherapists are equipped to assess the intra-articular structures by taking it into different ranges of movement to establish where the pinching of the labrum or femoral head is located. Orthopaedic surgeons usually opt for X-rays and MRI scan to confirm the diagnosis.
Torn Labrum Treatment
- Acute injury treatment
- Soft tissue massage
- Electrotherapy treatment
- Laser (Low Level Laser therapy)
- Acupuncture & Dry Needling
- Heat packs (Thermal therapy)
- Kinesiology Tape
- Rigid Strapping or taping
- Neurodynamics (Nerve tissue mobilizations)
- Dynamic Strapping
- Strengthening exercises
- Guided loading protocol
- Stretches (Static, dynamic and ballistic)
- Moon boot
- Compression Bandage or Sleeve
- Supportive strapping and taping
- Biomechanical Analysis
- Gait Analysis
Physiotherapist use manual therapy and soft tissue therapy to help relieve your symptoms.
It’s the range of motion in your hip and spine, within your pain limits.
You may begin:
- Slow resistance exercises for the buttocks, quadriceps, adductors and hamstrings such as isometric adductor squeezes, as your pain allows.
- Stretches for your hip flexors quadriceps, hamstrings, adductors, internal and external hip rotators and calf muscles.
- Non weight bearing walking in the pool and swimming (freestyle)
You should be able to demonstrate almost a full range of motion in your hip and walk without pain.
You may begin:
- Deep water running and swimming at high intensity interval. Avoid breast stroke.
- Try to walk normally without a limp.
- Walk on a treadmill, gradually increasing speed until you can jog without pain.
- Cycling and working on a cross trainer and stepper as the pain allows.
- Box step ups
- Core stability and gluteal activation exercises such as single leg bridges.
If your symptoms don’t respond to physiotherapy treatment
If your symptoms have failed to respond within 2 – 3 weeks of non surgical treatment we recommend surgery. Depending on the Orthopaedic surgeon, the severity and location of the tear, an arthroscopy is best. This is a minimum invasive procedure where to scopes are inserted with minimal damage to the soft tissue structures surrounding the hip joint. During the surgery the Orthopaedic surgeon aims to repair the tear and stimulate new cartilage growth. FAI will need a decompression surgery to the affected hip.
Other Causes of Hip pain
- Joint – Hip joint pain, Labrum tear, Osteoarthritis of the Hip joint
- Muscles – Gluteus muscle strain, Quadriceps muscle tear, Groin muscle tear, Hamstring muscle tear
- Tendons – Quadriceps tendinitis, Gluteal tendinitis, Hamstring tendinitis
- Bursa – Hip Bursitis
- Ligaments – Inguinal ligament sprain
- Nerve- Pinched Sciatic nerve over the hip
- Bone – Femur Fractures, Avultion fractures or Stress fracture of Femur Head
- Iliotibial band