December 21, 2014

Hip Labral Repair Rehabilitation: What To Expect

The hip labrum is a cartilaginous ring that extends around the outside of the hip socket as seen in the illustration below. Hip labral tears manifest as sharp, nagging pain deep in the hip or the groin areas. Pain associated with a hip labral tear may also refer down the thigh towards the knee. Car accidents and chronic repetitive stress imposed from years of sports or yoga are often root causes of hip labral tears. Women appear to be much more susceptible to this type of injury.

Hip labral surgery is a comparatively new orthopedic procedure that seeks to repair the labrum and thus stabilize the hip socket. This type of surgery is becoming less invasive from year to year: the patients that we see now have very small surgical scars and fewer post-operative precautions.

Precautions & Expectations in Regards to Hip Labral Repair Surgeries

1. Almost all post-operative labral repair patients are “non-weight bearing” for a minimum of two weeks following the surgery. Patients use crutches during this time frame. In terms of rehabilitation, I ask patients to lie flat on a bed or on the floor for a period of time each day that he or she is using crutches. The purpose of this is to allow the hip flexor muscles to relax into a neutral position, as suspending one’s leg while using crutches does require prolonged flexion of the hip.

2. Swelling in the hip area is an inevitable effect of surgery and causes the surrounding muscles to “shut down.” Isometric exercises are typically started shortly after surgery in order to minimize the negative effects of swelling. The gluteus maximus, gluteus medius, hip adductors, and hip flexors can all be trained gently through isometric exercise. There are many resources on the Internet that can lead you in the right direction in terms of isometric exercise instruction.

3. Pain in the lower back and pelvis following labral repair surgery is common because of muscular imbalance. The spine in general does not handle asymmetry well: if one leg cannot accept weight well for a prolonged period of time, the lower back and pelvis are loaded too heavily from the stronger side. In order to minimize this effect, in rehabilitation we encourage the patient to work on idealizing the mobility of the lower back and pelvis through a series of exercises. It also goes without saying that the sooner the patient regains his or her strength and weight bearing capacity on the surgical side, the better the lower back and pelvis will feel.

We have two (2) exercises on our “media” tab under the abdominal section: “pelvic clock” and “pelvic control” are good ideas in terms of restoring lower back and pelvic alignment. The password to get into the exercises is “patient.”

4. Healing from this surgery generally takes a long time! It is not uncommon for patients to experience discomfort six months after the fact. The important thing to remember is that if you notice positive differences from week to week (or month to month), you are going in the right direction! We will typically ask patients to record the distance that they can walk before pain sets in and then use this as a baseline for comparison.

5. With hip and knee surgery in particular, people have the long-term tendency to develop habits that keep them from maintaining full weight and strength through the leg. Avoid crossing your surgical leg over the uninvolved leg when seated, and when standing, force yourself to bear your weight equally through both legs. The body will often unconsciously try to default over to the non-surgical side because it has learned to do so. Initial post-surgical weight bearing precautions are a necessary evil: people need to re-teach their bodies to accept weight equally, and this may takes months of practice.

About Dan Baumstark, MSPT, CHT

Dan is a physical therapist who specializes in sports medicine & upper extremity rehabilitation. He is certified by the American Society of Hand Therapists, and he has extensive continuing education in manual therapy from the Michigan State University School of Osteopathic Medicine. Google+

Comments

  1. Hello my name is Eric I’m a 22yr old male. I had left labrum surgery back in June, it is now November and I am still feeling pain constantly in my hip, With certain movements and motions. I am an athlete, I hurt myself playing basketball but I do Mixed Martial Arts and have been pursing it as a career. My doctor said I wouldn’t be able to any of that till Jan 2015,I am kinda worried cause I am experiencing pain and I haven’t been lifting any weights or doing any explosive exercises to trigger pain. Since I haven’t been exercising fully I fell my calfs, and hamstrings are so sore I’m definitely worried that my hip won’t recover from this. Just maybe a little insight, if this is normal experiencing pain like this? And if so what can I do too get back in the gym quicker?

    Thank you any suggestion would help
    – Eric

  2. Hi, I had a lavrum repair and cam removed. I was going well for first 5 weeks. Ever since I started walking(now 8 weeks post) my groin is throbbing after I walk and do exercises! I’m still icing as well as having some swelling like feeling behind the trochanter! Could this be bursitis and what can I do. I try resting a day but it doesn’t seem to help. Thanks

    • The feeling behind the trochanter could easily be bursitis. The groin pain may be from a lack of overall strength because of the inflammation associated with surgery. The re-introduction of walking causes this in many instances. I would talk to the doc about it and in the mean time only walk where you have to walk. Limiting our exercises to the ones that you learned on the mat or bed is probably advisable. I would also run that by your PT.

  3. Deborah Parker says:

    Hi:

    Can you give me a list of Specializes that will do a labral repair in the hip area. I believe there are two Doctors at John Hopkins and one in Nashville, Tn. Thanks.

    • Deborah there are specialists who do hip labral repairs in just about every major city. Our physical therapy clinic is in Washington DC, and there are three or four surgeons who do it here. New York City has a place called “The Hospital For Special Surgery”, they do that type of work as well.

      I would also check out hospitals that are part of a medical school. They should have adequate resources to tell you who the best people are who do hip labral repairs. Washington University in Saint Louis, Vanderbilt University, Hopkins, and UPenn are a few schools that should have resources.

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