Help Needed: Hip labral tear

[CdnStix]

Has anyone out there ever had a tear of the labrum in the hip? and if so, what rehab did you do for it and did it help?

I had a bad ski crash last spring and tore up my right hip/abdominals pretty badly. Couldn't even engage my abs to sit up after the crash because they were torn so badly. The abs healed ok but after months of trying to get back to my normal activity level I kept having pain and swelling in the front of my hip (in the hip crease). Had a MRI done on my hip which showed a tear in the labrum. I did 5 months of intensive physiotherapy with a hip specialist before ski season to try and get my hip strong enough to sustain the day on the slopes. While I did see some improvement from physio it seems to have stopped improving now that I am adding more activity and I'm getting very frustrated.

The doctor tells me I should avoid surgery at all costs because hip surgery is tougher to recover from than knee surgery (which unfortunately I have had 3 times already).

 

[altagirl]

What part is not improving - i.e. are the issues you are having related to strength, pain, or flexibility (or all of the above?)

 

[itri]

ShannonD had surgery for a labral tear last season and is back skiing this season. I don't know that she's been on the boards lately, but you may want to try messaging her (you may need to get to 25 posts to be able to do so).

 

[CdnStix]

What part is not improving - i.e. are the issues you are having related to strength, pain, or flexibility (or all of the above?)

Flexibility is coming slowly. Strength is getting better but where my right leg was always my stronger/dominant one my left one is now. Don't feel that in some activities but I can really feel it while skiing and have a hard time holding my edge when turning left and weighting my downhill (right) ski. Biggest issue by far is still pain and swelling, and stability. Hip keeps "catching" inside the joint when I put my leg in certain positions - which is painful and feels unstable.

While it has improved a lot since the injury last March and through physio, as I started adding in activity/exercise again it is flaring up. It doesn't hurt much when I don't do any kind of activity or exercise at all but the truth is I'm not happy with that. Maybe if I was a couch potato I wouldn't care but I'm not and need to be active for my own sanity. I can put up with the pain (and do get that "screw it I'm doing what I want regardless of how much it hurts during or after" attitude) but it is wearing on me. Just wonder if there is more (or something else) I could be doing to help it along.

 

[CdnStix]

ShannonD had surgery for a labral tear last season and is back skiing this season. I don't know that she's been on the boards lately, but you may want to try messaging her (you may need to get to 25 posts to be able to do so).

Thanks itri.

 

[altagirl]

Flexibility is coming slowly. Strength is getting better but where my right leg was always my stronger/dominant one my left one is now. Don't feel that in some activities but I can really feel it while skiing and have a hard time holding my edge when turning left and weighting my downhill (right) ski. Biggest issue by far is still pain and swelling, and stability. Hip keeps "catching" inside the joint when I put my leg in certain positions - which is painful and feels unstable.

While it has improved a lot since the injury last March and through physio, as I started adding in activity/exercise again it is flaring up. It doesn't hurt much when I don't do any kind of activity or exercise at all but the truth is I'm not happy with that. Maybe if I was a couch potato I wouldn't care but I'm not and need to be active for my own sanity. I can put up with the pain (and do get that "screw it I'm doing what I want regardless of how much it hurts during or after" attitude) but it is wearing on me. Just wonder if there is more (or something else) I could be doing to help it along.

So I guess my main question is whether there is any realistic hope of this healing without surgery? If you've got a big enough tear I'm not sure what's realistic. I know the labrum is similar to the meniscus in the knee, and I've dealt with new tears (I've had several surgeries, but am pretty opposed to any more unless I really feel I have to) where I was experiencing catching by doing a lot of road biking/stationary biking and yoga - combination of keeping the surface worn smooth and stretching to make sure that I'm not developing imbalances and tightness that makes the situation worse. I don't know that those react the same, but if you're opposed to surgery that might be worth a shot. The cycling I'm talking about would be low resistance, high mileage with plenty of stretching afterwards to prevent IT band issues. Obviously you'd need to be careful that the stretching isn't causing more damage in the process.

I've also had good luck with acupuncture helping with swelling, and it can potentially help with healing in general - the idea that it's stimulating blood flow to promote healing. That's probably also worth a try.

 

[Shannon D]

Hey there. Sorry to hear about your hip. I was diagnosed with a labral tear in my left hip in August of 2011. Mine wasn't the result of a traumatic injury, it was biomechanical and exacerbated by years of running and cycling. I had a 5 anchor repair, correction of CAM impingement and psoas release in January 2012 and I'm fully back on the slopes this season and I'm also running and cycling again. The typical return to sport timeframe for this surgery is 3-6 months depending on whether you have any cartilege issues in the joint. My decision to have surgery was pretty straightforward, I was in pain every day and my hip snapped with every step. It would hurt super bad if it was cold, and I was basically limping around all the time. I couldn't excercise at all, I could barely tolerate a trip to Ikea. It just wasn't a way I was willing to live my life.

Since the labrum is avascular, it will never heal on its own. I have read that some people are able to compensate and be normally active through PT, but I've also read an greater number of accounts that after many months of PT work people determine that they are not satisfied with the results and end up with surgery anyway. Yes, it's harder to recover from than knee surgery, but I can tell you that I am 100% satisfied with my decision to have mine repaired. I still have some weakness in my left leg, but that's no one's fault but my own. I have almost zero pain now and I'm living my life, rather than sitting around watching others live theirs. Also, my case is a little different since I also had a procedure done to correct dysplasia, also on my left hip, 6 weeks after my scope, so my recovery timeline and issues are a bit different than the average labrum repair.

My advice would be to get other opinions. I saw 4 different specialists before I found the right fit and felt truly comfortable both with my diagnosis and with the recommended treatment plan. Also, make sure that if you choose to go the surgical route, you and your surgeon both are comfortable with the underlying cause of your tear. It may be simply due to your accident, but you may have underlying impingement issues that need to be corrected to prevent the labrum repair from failing. Choose a surgeon who does a lot of them, you don't want just any hip and shoulder guy. It's a highly specialized procedure, so you want someone with a lot of experience.

Good luck and I'm happy to talk more in detail if that's helpful. Don't be afraid of the surgery, just make the choice that's right for you.

 

[CdnStix]

Hey there. Sorry to hear about your hip. I was diagnosed with a labral tear in my left hip in August of 2011. Mine wasn't the result of a traumatic injury, it was biomechanical and exacerbated by years of running and cycling. I had a 5 anchor repair, correction of CAM impingement and psoas release in January 2012 and I'm fully back on the slopes this season and I'm also running and cycling again. The typical return to sport timeframe for this surgery is 3-6 months depending on whether you have any cartilege issues in the joint. My decision to have surgery was pretty straightforward, I was in pain every day and my hip snapped with every step. It would hurt super bad if it was cold, and I was basically limping around all the time. I couldn't excercise at all, I could barely tolerate a trip to Ikea. It just wasn't a way I was willing to live my life.

Since the labrum is avascular, it will never heal on its own. I have read that some people are able to compensate and be normally active through PT, but I've also read an greater number of accounts that after many months of PT work people determine that they are not satisfied with the results and end up with surgery anyway. Yes, it's harder to recover from than knee surgery, but I can tell you that I am 100% satisfied with my decision to have mine repaired. I still have some weakness in my left leg, but that's no one's fault but my own. I have almost zero pain now and I'm living my life, rather than sitting around watching others live theirs. Also, my case is a little different since I also had a procedure done to correct dysplasia, also on my left hip, 6 weeks after my scope, so my recovery timeline and issues are a bit different than the average labrum repair.

My advice would be to get other opinions. I saw 4 different specialists before I found the right fit and felt truly comfortable both with my diagnosis and with the recommended treatment plan. Also, make sure that if you choose to go the surgical route, you and your surgeon both are comfortable with the underlying cause of your tear. It may be simply due to your accident, but you may have underlying impingement issues that need to be corrected to prevent the labrum repair from failing. Choose a surgeon who does a lot of them, you don't want just any hip and shoulder guy. It's a highly specialized procedure, so you want someone with a lot of experience.

Good luck and I'm happy to talk more in detail if that's helpful. Don't be afraid of the surgery, just make the choice that's right for you.

Thanks so much Shannon D!!! I'm glad to hear that your surgery was successful and you are back running, cycling and skiing. You must be so happy that you can do those things again. That does give me hope, although hearing what you went through before your surgery I am thankful that I can at least walk around without a significant amount pain! I am always aware of my hip because of the twinges I get with certain movements or position changes but don't feel pain with every step now.

I've tried to slowly ease back into running over the past couple of months but the pain gets so bad after a few kilometers that I can't even run uphill and have to walk. Running definitely is NOT good for this hip injury, and that really sucks!! At least I've tolerated skiing so far (or I would lose my mind) but consecutive days are becoming increasingly difficult as the season progresses.

They did find a Femoroacetabular Impingement (FAI) as well when I had the MRI done which is obviously a pre-existing issue since it is a structural abnormality. Can't say for certain whether there was some damage to the labrum from the FAI before the crash and the crash made it worse, or if the tear is strictly a result of the stress on the hip joint during the crash. All I know is I didn't have hip pain before the crash.

I have been told that the tear will not heal due to lack of blood supply (like you said as well) so it was always a question of whether physio would help manage/alleviate the pain to avoid or defer surgery. The hip physio specialist I've been seeing here has had good success with minimizing symptoms by strengthening the hip stabilizing muscles in ways that it takes some of the stress off the hip joint. That is why the sports med dr that I saw recommended that course of action first (which I do appreciate). It has helped a bit but he also said if I don't see enough improvement over the 6 month program it may not be enough for me. I also go for massage regularly to keep the muscles from tightening up because of how I "guard" it. All that helps but does not solve the problem.

Really appreciate your feedback and I will probably bug you again with questions if that's ok? I just don't know anyone that has gone through it before. I have another appointment with my physiotherapist in a week and a half and I think it is time to talk to him about alternatives. Thankfully we do have a couple of highly experienced surgeons in Calgary that specialize in hips. Might be time to get a referral and see what they say.

 

[CdnStix]

So I guess my main question is whether there is any realistic hope of this healing without surgery? If you've got a big enough tear I'm not sure what's realistic. I know the labrum is similar to the meniscus in the knee, and I've dealt with new tears (I've had several surgeries, but am pretty opposed to any more unless I really feel I have to) where I was experiencing catching by doing a lot of road biking/stationary biking and yoga - combination of keeping the surface worn smooth and stretching to make sure that I'm not developing imbalances and tightness that makes the situation worse. I don't know that those react the same, but if you're opposed to surgery that might be worth a shot. The cycling I'm talking about would be low resistance, high mileage with plenty of stretching afterwards to prevent IT band issues. Obviously you'd need to be careful that the stretching isn't causing more damage in the process.

I've also had good luck with acupuncture helping with swelling, and it can potentially help with healing in general - the idea that it's stimulating blood flow to promote healing. That's probably also worth a try.

The only activity I was actually allowed to do until November was spinning on my road bike on the trainer (and at very low resistance like you said). Oh how I hate the trainer! After a month of that and getting tired of spinning in the garage on a sunny summer day I thought I would go out for a spin on my mountain bike. What do I do? have a stupid fall going over some roots and cracked a bone in my foot. So after a couple weeks of resting both my hip and foot it was back to the trainer for me - with an air cast on one foot and my riding shoe on the other. Pretty funny site if you walked by and saw that in my garage! Strayed away from it once I started skiing and trying to run again. I should get back on the trainer now though to try and keep the joint moving and lubricated.

I love yoga and try to do it but any kind of deep bend is problematic. Sometimes I can't straighten my leg back out without readjusting it because of how it "catches" inside my hip joint. Really have to listen to my body and modify a lot.

Will also try acupuncture. Thanks for the suggestion. Booked an appointment for tomorrow. I've tried it for other injuries, and for general health issues, but must admit the thought of having needles jabbed in or near my hip makes my stomach turn. Acupuncture needles are completely different but I keep thinking of the contrast injection they did into the joint when I had the MRI done. YUCK - that was not a pleasant experience!!

 

[Shannon D]

Yeah, you can bug me anytime.

And the bike trainer...I've logged more hours in the garage than I care to count over the last 18 months.

 

[altagirl]

Will also try acupuncture. Thanks for the suggestion. Booked an appointment for tomorrow. I've tried it for other injuries, and for general health issues, but must admit the thought of having needles jabbed in or near my hip makes my stomach turn. Acupuncture needles are completely different but I keep thinking of the contrast injection they did into the joint when I had the MRI done. YUCK - that was not a pleasant experience!!

Yeah I've had the contrast injections in my shoulder and that was NOT fun. Acupuncture OTOH is actually pretty relaxing for the most part - definitely helps to keep those two kinds of needles as entirely different things in your head!! And I know sometimes they have them above or below the area they are actually working on, like they're trying to get the whole energy meridian flowing, so like when we worked on my knee recently I had needles in my opposite elbow, the affected thigh, calf, and foot and one or two around the knee. But it does definitely seem to help with pain and inflammation in my experience.

 

[altagirl]

I love yoga and try to do it but any kind of deep bend is problematic. Sometimes I can't straighten my leg back out without readjusting it because of how it "catches" inside my hip joint. Really have to listen to my body and modify a lot.

Also - I have a friend with FAI and one of the yoga things that she found helpful is a modified pyramid pose. (Assuming your impingement is in a similar area - basically front of the hip when folding forward).

Basically, you step one foot back, feet probably 3' apart, but instead of a normal pyramid pose, place the front of your front foot up on a block so you're doing a calf stretch. You can even have the back of a chair or table handy to hang onto with your upper body, but from there, work on keeping hips squared and going into the forward fold as it feels comfortable, both legs straight and quads engaged and reach your hips back behind you. Keep flexing the feet, reaching your toes back towards your shins. Because the whole back line of connective tissue on the body is so connected, adding in that foot calf stretch should make a noticeable difference in feeling more open in the front of the hip once you're done. Enough that if you've only stretched one side you should feel a difference. I'd hold that for probably 10 breaths per side. I think the nice thing with that is that you don't have to actually bend at the hips as much to get the stretch because you're adding in the ankle/toes.

 

[CdnStix]

Had a follow-up with my physio this week. In December I started the "maintenance" portion of his hip rehab program which essentially consisted of a couple of exercises a few times a week in addition to more regular physical activity (including skiing which I was allowed to start slowly in November). When he retested my hip strength, range of motion, etc, it had declined dramatically from December and was actually worse than when I started the program last summer. Yikes! I knew it didn't feel that great but we were both really surprised by that. At least I know it wasn't in my head that my hip doesn't feel great.

His opinion is that while the exercises do help, as soon as I introduce some other kind of more intensive activity it flares up too much to get the full benefit from the exercises. Would be fine if I was happy not doing anything other than my physio exercises. That's NOT going to happen. He's referring me back to the sports med dr to discuss "other options" including possible referral to surgeon.

In the meantime we are taking a few steps back and re-introducing some of the more intensive exercises from earlier in the program to try and get some strength/range of motion back. Will also continue with massage, acupuncture (both sports & traditional Chinese) and modified yoga (thanks for the modified pose suggestions altagirl!)...and of course I'll keep skiing anyway to try and stay sane.