August 20, 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. Hey Dan,

    I had hip labral surgery the 16th of December last year. Rehab was going well, but recently I have had extreme groin soreness. My hip flexors feel fine, but I have had increasing groin pain/ muscle soreness. I was beginning to began sport exercises again, but now I have groin pain after doing exercises I was doing weeks ago. I feel like I am regressing. thoughts? Thanks

    • Pain deep in the groin tends to be more of a function of the hip joint rather than something muscular. Was there some hip joint arthritis or degeneration involved initially? It wouldn’t hurt to consult the doc about this. I would also see the PT and have him / her take a good look at how your glut max and glut medius are firing.

  2. Nikolas says:

    Hey Dan,

    I had arthroscopic acetabuloplasty and femoroplasty, along with a repair. of my labrum. I’m now 6.5 weeks post op, but I’m starting to get a pain in the front of my hip that was never there before the surgery. I’m seeing my surgeon on the 30th for my 8 week post op appt. I’m just concerned that I may have reinjured my labrum. I’m otherwise pain free with more range of motion than I had pre-surgery.

    • Nikolas the head of the femur can make contact with the socket in a weird way when the hip is weak. At this point I am guessing that what you are experiencing is a function of hip weakness rather than a re-tear. Re-tears usually occur with a fall or some definable incident.

  3. Good morning
    I am having hip labrum repair and removal of the bursa surgery in August. I have an anterior maserated tear from 12 o’clock to approx. 3 o’clock on my left hip along with a bursitis from a fall.
    I am a PACU nurse, I am looking for strengthening exercises to do prior to surgery. I want my back in tip top shape along with my pelvic area.
    I have increased my protein intake and I already take multi vitamins, calcium and Vitamin D.
    Post op I hear water/aqua therapy is the best and I have access to that.
    As stated I would like pre-operative strengthening exercises and information on post operative exercises.
    Thanks
    Toni

    • Start with the gluteus maximus contractions and clamshell exercises on our website (the ones with the patient lying on the table). (media tab, password is “patient”, then go to hip exercises). Go gently!

      The post-op depends on what the surgeon does, and timing is important. I will default to the surgeon’s specific protocol for post-op.

  4. Madison says:

    Hey Mr. Dan,

    I have a torn labrum and iliopsoas, they are getting fixed next Friday. I can’t be on crutches more then 5 weeks! I’m going to be starting college -far from home- as a freshman and I really don’t want to be on crutches or in a brace or really walking with a limp. How long, generally, until people are back after labrum repair, iliopsoas repair then release? I’m active and have been strengthening my hip with hopes that will aid in recovery. Teenagers bounce back faster, right? So how long do you think I’ll be out?? I have ROTC, soccer and cross fit waiting for me and I’m ready to push through recovery to get back to everything. Yet, I understand I need to heal and follow the PTs instruction.

    Thanks,
    Madison O’Conner

    • Madison the iliopsoas tear throws some extra time into that rehab and recovery. I would guess that you would be on crutches for at least three weeks, then partially weight bearing after that. If I were your PT, I would tell you that the higher level activities (Crossfit and soccer etc) will take a good 3-4 months to get back into. Better to be safe than sorry, you will get there!

  5. Wazeem wahid says:

    Hi

    I had surgery six months ago and i am now building to running however i still have a small pain which makes my hip very uncomfortable wen i completely extend myself. Have i tore it again as this was the same pain i had before my op.

    Thanks

    • Wazeem I would get it checked out by a PT so that you can get an accurate picture of the strength and mobility of everything around the joint. If the pain is only with running it probably isn’t a re-tear.

  6. Please can you tell me the name of a doctor who has done many hip labral repairs in the Seattle, WA area?
    I live in a small community within a two and a half hour drive of Seattle. My community has no such doctor. A physician’s assistant looked at my MRI and says there is a suspicious area that he thinks could be a tear and despite his saying that I have good space between bones as seen on x-rays, that I’d likely have a hip scope or hip replacement. I really think I need a good 2nd opinion from someone recommended. Thank you for your website. This is a scary situation for me and probably for many others.

    Just in case it could be relevant I’ll add this: I’m 65 year old active, road cyclist female. Have pinching at groin that gets aggravated while sleeping, but I walk without pain. Initially had adductor and hip flexor pain. Pain mostly caused by too many sit-ups, plus & changing bike shoe cleat position from toe out to straight, plus lots of repetitive motion, of course.

    • Susan I would call a few PT clinics in the Seattle area an ask them for a surgical recommendation. I live in Washington DC, so I really don’t know of any surgeons out in your neck of the woods. PT’s are generally a good resource for that: I know of one good PT that I went to school with who lives out somewhere near you. His name is Paul Groschel. He might be a good lead if you can find him. (Try Googling him)

  7. Hi Dan,

    I have an inferior labrol tear in my left hip. i did Irish dancing for many years and I now teach yoga – Forrest Yoga. Is there anything I can do to heal this without surgery and if I have surgery will I still be able to do yoga and teach afterwards?

    Many thanks,

    Janine

    • I have a few friends who are similar to you. Back off the yoga for a good month or two and let any inflammation in the hip joint calm down. I do think that placing your hip at stretched end-ranges with some yoga positions is not helping your condition.

      One of my friends who has a labral tear still teaches yoga: she just spends almost all of her time walking around the class helping out students with poses rather than holding the poses herself. I would also get in to a structured hip stabilization exercise program. Get some exercises from a PT.

  8. Hey Dan,
    Im 3.5 weeks after hip arthroscopic surgery and FAI for repairing the labrum. My doc said i can go swimming after 3 weeks, so Im surfing because surfing is much, much easier on my hip than swimming. He said that he doesnt want me to surf for 4 months, but he said swimming was ok, and swimming is wayyy worse on my hip. Hell before surgery i couldn’t really swim with my right leg. But when i surfed there was absolutely no pain. Do you think I can still surf? I’ve already had about 5 solid sessions had absolutely no discomfort on my hip while surfing.

    Also, how hard would it be to tear the suture anchor off?

  9. Shannon Moss says:

    Hi Dan
    I currently have a labral tear in my right hip. My orthopedic surgeon is suggesting surgery but I was wondering if theres anything else I could try to fix it first as surgery is my last resort?
    Kind Regards
    Shannon

    • Shannon I think that conservative measures should always be taken, surgery ought to be the last resort. If you haven’t seen a physical therapist I would highly recommend that. Try to see a PT who has at least ten years of experience if you can. Strengthening of the hips and spinal mobility work may help you a great deal.

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