April 19, 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. frustrated wife says:

    Hi Dan, My husband is a very active 42 yo who doesn’t sit idle well. He is 2 weeks post op and doing much better than either of us expected. I am however very concerned because he was told to use crutches for 3 weeks (weight bearing as tolerated). A few days after week one he stopped using crutches full time. He insists he’s not putting full weight on the leg. What damage could this noncompliance cause?

    • My adage is “better to be safe than to be sorry”. He should have a transitional progression into weight bearing. Going cold-turkey off of crutches after only one week is not a great idea, especially against medical advice. He could possibly pull one of the surgical anchors out of place (they take at least three to four weeks to heal in place).

      Having said that, if he is not encountering any marked increase in hip or groin pain, my guess is that he is probably fine. A good idea would be to use a single crutch as a transition to full weight bearing.

  2. erica herring says:

    My so has mutlipule disabilities njust had hip flexor surgury done. on the 31 of jan and how long does it take for the incision to heal.looks smaller but still open.

  3. Hi! I am writing again because you always give out great info. I wrote to you last year after a long recovery from a labral repair & anchor in August. I’m much better and am 2 months post-PT (10 weeks worth). I have been slow in getting back into an exercise routine..elliptical, walking, stretching. Last week I decided to take it up a notch and did a group weight lifting (very light weights) and a couple of boot camp style circuit training classes. I had the obvious typical all over muscle soreness, but my hip is sore near my scars. And a little achy, but I think I am just a nervous-nelly about it. Is it just because the muscle needs to build back or am I overdoing it? Are there any obvious signs or symptoms that I’m overdoing it? Thanks for your input!

    • If you are just sore near your scars I wouldn’t be too concerned about it. You demanded a bit more of the muscles and they are just likely reacting to it. The thing to be concerned about is sharp pain in the groin.

      You still need to slowly increase the routine, nothing abrupt. Give it a day or two to recover form those types of work-outs and as always remember to listen to what the hip is telling you.

  4. Hi Dan!

    I am a college student currently in the middle of my semester trying to figure out when I should do my surgery. How long do you think it would be from surgery time to me being able to hobble on crutches to class? I cant miss a whole lot of school and I would be alone during most of the summer.

    I am an athletic 20 year old with a labral tear in my left hip.

    Thank you!!
    MT

    • Hmmmmmmmm, it depends on how involved the surgery is. I have seen patients in here who were getting around pretty well two (2) weeks after surgery. I am guessing that you can expect to be on crutches for at least two weeks, so plan accordingly.

      Given that you are young I am guessing that you would be able to get to and from class 2-3 weeks after surgery.

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