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.

Discussion

  1. Lauren says

    Hi- I had a mini open FAO surgery 10 days ago to address a labral tear, impingement and to remove a cyst that had developed. I developed some femoral nerve issues following surgery and have no feeling down the whole leg on the inside. I was told to wear a large brace that locks my knee and that I was weight bearing as tolerated. I did not feel the need for crutches so I did not use them. Yesterday while I did not have the brace locked, I took a hard fall and landed on my knee on the post op side. I was wondering if this could have possibly caused the labrum to tear again since it was a pretty hard fall 10 days post surgery.

    Thanks

    • says

      Lauren two thoughts here:

      1. The big bulky brace might actually be placing pressure on the femoral nerve. Have the doc check it to make sure that it is not digging in to your thigh
      2. You certainly should see the doc in regards to the fall you had. A compressing motion may not have torn the labrum, but it would inflame the joint quite a bit. Better to have the doc look at it.

  2. Marco says

    I got an FAI surgery on my left hip 13 days ago. I was feeling much better already but must have over extended myself a bit. I only did a light walk (6 minutes) and the next day walked 3 blocks. I hobbled across the sidewalk too fast. I’m crippled now. What is the likelihood this pain is a retorn labrum? I’m praying it’s just inflammation from a bit of overuse. How easy is it for sutures to be retorn? The doc said I could walk without crutches if the pain was fine. Apparently not. Any thoughts are helpful.

    • says

      Typically these post-ops are on crutches for at least a few weeks. You certainly irritated the joint, but it usually takes something more like a fall to jar an anchor loose. You should see the doc and have it assessed. No appreciable weight bearing in the mean time, use the crutches.

  3. Maxine says

    I had open surgery for tendon pulled away from bone in right hip, scar is 8 inches. Dr told me he drilled 2 small holes in hip pulled tendon through and tied down. Two of my bursa were inflamed Dr. said he cleaned them up, not sure what that meant. I used crutches for 6 weeks. I use a cane now. It’s been 3 months now. I get achy pain in my hip area after walking for 20 minutes. I wake up with achy pain, usually goes away after I get up. I went to the movies last night, it was 2 hours long, I got up this morning and my hip is achy and tight feeling sometimes feels like a pinching feeling. Is this normal, since my surgery has been 3 months?

    • says

      Maxine that sounds like a considerable surgery. 3 months is not that long, so I would certainly expect soreness etc. for a few more months to come. Make sure that you are sticking to a gentle strengthening routine, preferably under the supervision of a PT or the doc. It sounds like you still need to strengthen the gluteus maximus and medius among other things.

  4. Cynthia says

    I have bilateral Avascular Necrosis of the femoral heads (early stage 2 pre-collapse), as well as tearing of the Labrum only in the symptomatic hip. I have been advised by a THR surgeon to hold off on having the painful hip replaced until I can’t take it he pain any longer. I’m almost certain my pain is from the tear and wonder if I would be a candidate for an arthroscopic repair of the Labrum (or is concurrent AVN a contradiction)? Thanks so very much…not sure which way to turn!

    • says

      Ugh. It seems like it would be a waste of a surgery for the labrum if the femoral head were to go in to full AVN at some stage. You would probably be better off having the THA, hopefully that would take care of both issues at one time.

      I think that vascular compromise (AVN) would make the labral surgery more difficult to recover from, not to mention an increase risk of causing the AVN to advance.

      It never hurts to get a second opinion from an orthopedist who deals with hips on a regular basis.

  5. Tara says

    Dan,
    I have been back and forth about having surgery on my torn hip labrum for 2 years now. It just seems to get worse and I have tried other things . The pain doesn’t keep me from doing most things but it always lets me know it’s there. Do you think surgery is the best option?

    • says

      Have you done PT? I would exhaust all conservative methods prior to surgery. The bottom line is if conservative measures have been taken, and the pain is still enough to be a significant problem in your life, it might be a good idea to have surgery.

  6. Eleanor says

    Dan,
    I had a labral repair( 1 cm with CAM lesion) back in November and was good until February. I have been in PT trying resolve the pain in both hips, they said I have psoas tendonitis. Both hips feel like pre-surgery and the pain never stops…. What’s your opinion on that diagnoses?

      • Eleanor says

        I have had tendonitis before and this doesn’t feel right. X-Rays showed the right hip fixed and the left had extra bone.

        -Does it make it any difference that I am a 16 year old female?

  7. Ann says

    My son has a torn labrum in each hip. I should mention he had an avulsion fracture in right hip one and a half years ago that was surgically repaired open induction internal fixation of AIIS. He tore both labrum during football drills. He just had the right one fixed surgically a week ago. Doctor said we can fix the other in 6 weeks but I wonder if that is a good idea or wait to give the right hip more time to heal. My son wants to get back to sports so he wants to do it sooner. I wonder if I should just wait the 12 weeks and then get the other one done. It would mean he would lose his sophomore year. He plays football basketball and baseball. He is 15 years old. Would like to take the most conservative path in order that this chronic situation with his hips can be resolved for good. What can we realistic expect having the surguries so close together? He is doing it with the hopes of being able to play basketball late December and get in his baseball season. I am thinking he won’t be ready by February to play at the level he likes to play so why don’t we take time and spread out the surgeries and let him come back strong in his ju jot year.

    • says

      I agree with your thought. Take the time for the rehab and the surgeries. I would wait the 12 weeks to allow healing etc.. Losing his sophomore year would probably be a blessing in disguise.

      You probably need to have an intervention with your son in terms of his sports. From the limited information that you gave me it sounds like he is trashing his body. Two hip surgeries and an avulsion at his age does not bode well for the future. Could he be convinced to drop football and keep the other sports? I do feel like I have to tread lightly when giving advice like this, but your son does have to live with his body for the rest of his life. Football is high velocity, ballistic, and brutal. I thank my parents for not allowing me to play football.

  8. Jill Dourte Smith says

    I have a 14 year old daughter that plays volleyball and basketball. We just left the orthopedic doctors office with the MRI results of a labrum tear in the left hip. She is really bummed as this will obviously mean missing her freshman year of volleyball. The doctor gave us the advice that we could continue to do PT and strengthen the muscles around it. Basically do anti inflammatory treatment and icing to continue to play through the pain. Bottom line is tear is not going to repair itself. Some patients end up coming back after PT and still needing surgery and some just decide to live with it. Not sure the living with it approach will work out well with a multi sport athlete. Could really use some advice as to where we should go from here. Will the hip be better after surgery or is she still going to have long term issues? Is surgery worth it if that is her ultimate outcome. Still pain? Tough to tell my 14 year old that we are just not sure of the best solution for her.

    • says

      Most people will go the conservative route first. Getting the strength ideal in the gluteal muscles will sometimes drive down the pain enough so that the patient can do everything that he or she wants to do.

      If your daughter has done the conservative route and the pain is not under control, surgery might be a good option. Make sure that you find a regional orthopedist who specializes in hip labral repair. The hip will probably improve a lot after surgery, but it will take many months post-op for that to happen.

  9. Tracy says

    I had my labrum tear operated on and fixed last Monday. It’s almost two weeks later and my ankle, knee and wrist joint on that side seems to be stiff.

    Is this normal?

    Kind regards

    • says

      Could it be from the crutches for the wrist?? Also if you are putting limited weight on that side this can affect the lower joints a bit, as can swelling. What you are describing is not common, but I have heard of it before. You should always run these symptoms by the doctor to keep him informed.

  10. Joe says

    Hello,

    I had surgery to fix a torn labrum and to reshape my femoral head(FAI). Physical therapy was going great. I’m two months out and all the sudden my hip started to click and snap. It’s been a little over a week since that started and now I can’t do physical therapy. My hip is hurting a lot and it’s like I never had surgery. Did I retear my labrum?

    Thanks,
    Joe

    • says

      Joe I would take it easy for about 2 weeks. Let the soft tissue structures rest. Walk only where you need to.

      In terms of a re-tear, I would take a trip to the doc and have him or her assess it. there is no way to be sure without evaluation.

  11. Emily says

    I had a hip arthroscopy exactly 3 months ago where they repaired my labrum and shaved off some bone from my femur. I understand that this is a long recovery process but I also thought I was supposed to see positive gains, even if slowly! Well, about 3 weeks ago I had a sudden spike in pain levels that got worse until I’m at the level I am today. I had not changed my activities at all and the pain only go minimally better on a steroid my Dr. prescribed (He knows what’s going on). But now, after the steroid, the pain is increasing again. Before this spike in pain, I could walk a pretty good distance without pain and only feeling sore and my hip tired. But now I can barely walk a few steps without sharp pains. I do not think this is normal. I would honestly be less concerned if it hadn’t felt so good before the spike because I would simply think I had three more months until the pain could go away, but I am honestly concerned that I have a re-tear! Is this possible at only 3 months after surgery? What else could it be if rest, a steroid, or anything I’ve tried hasn’t helped. I’m seeing my Dr. next week, but I wanted to hear if there was any other input.

    • says

      Emily I have seen some people who ramp up the walking too quickly who end up with increased pain. I would keep the walking to a minimum for a good couple of weeks to let the inflammation calm down. 3 months in my opinion is still a bit early to be walking longer distances.

      If you didn’t fall or otherwise jar your leg I think that it is not probable that you re-tore.

      I would see an experienced PT to help manage the timeline with you.

  12. Dan says

    Hello, I’m 33 and was diagnosed with a hip labral tear last year after almost 12 months of investigation (originally was thought to be a bulging disc) and pain is particularly aggravated when sitting. I had surgery six months ago. My femur bone was shaved due to FAI and because the tear was much bigger than the MRI originally showed, approx. 30% was removed and the remaining tear required five suture anchors. Beginning stages of arthritis was also noticed.

    With only slight pain relief after four months I had a follow up MRI and have discovered another tear adjacent to the attempted repair. It’s unknown if it has torn since or if the surgeon didn’t repair it all initially, and now has recommended a second surgery to repair the new tear. I had a cortisone injection and this only aggravated the pain.

    I am sceptical of having surgery again since the first surgery hasn’t helped. However the pain affects my quality of life, as sitting is not something that can be avoided in work/life. Physio/dry needling offers much pain relief but this only lasts a couple of days. I wanted to wait at least six months post op to see if the pain would improve but I feel like I have plateaued and do not want to go through life in this much pain, so am considering a second surgery. There seems to only be one surgeon in the city that I live in who is experienced in labral repair surgery. I did get a second opinion and there are others who have experience in debridement, but I am unsure which method I should choose, because my research suggests that labral removal can cause a susceptibility to arthritis later in life. After a failed first surgery is it recommended to attempt repair again or just remove it?

    • says

      I am sorry that you have to go through this. That is a tough question. If it were me I would stick to the surgeon who specializes in labral surgery. Labral removal will more likely lead to osteoarthritis later in life, but you are probably already more susceptible to that because of the prior surgery.

      If you have no quality of life and you have exhausted the conservative options (I would wait at least a good eight to twelve months from the surgery date), talk to the surgeon again. Good luck.

  13. Piper says

    Over the past year, I had a FAI with label repair and arthroplasty on each hip. I hadn’t lost much strength and physical therapy was a breeze for me both times. That is until I started having problems with my hip flexors. My hip flexors both had very bad reactions to the surgeries. I developed extreme tendinitis. Now, I used I be a gymnast and after the first surgery I tried to go back but it didn’t really happen because my hip wasn’t ready. I ended up getting the second one done and not returning to gymnastics. Since I haven’t been doing any high intensity sports, I thought my hip flexors would start to feel better and not get worse. But, unfortunately, I was wrong. I still experience very intensive pain because my hip flexor is so tight. I had my first surgery one year ago on my right hip and my second one in March of this year on my left. One symptom I remember from when my labrum was torn (they were both definitive tears) I could sit with my legs separated on certain days. Just recently I got that feeling again in my right hip, the one that I had surgery on a full year ago. I saw my doctor not too long ago and he checked my hip with a range of motion test and he couldn’t catch a tear so he thinks it is just my hip flexor. But, this was before I felt the pain when I sit with my legs apart again. I am not supposed to work out my hip flexor because they said it will only get tighter and it is extremely painful when I do exercises for it. I try to stretch it but it never seems to help. I finished my physical therapy a couple months ago and I am able to run and jump but it’s the slow controlled exercises that are very painful. I am supposed to be going back to my doctor shortly for my one year check up and I’m not sure what to tell him because I think he is just going to say it’s my hip flexor and make me do more PT even though I did it for about a 1 1/2-2 years straight. I don’t know why I’m still having pain but it is mostly when I walk normally or with haste or even when I am just laying down. I’m not sure what to do. Thank you for your time.

    • says

      I would find the best PT in your area that deals with hips. Call around. Sometimes it is a good idea to get a fresh pair of eyes on the problem. This sounds to me like a mechanical issue. Something might be too weak and the hip flexors are compensating for this.

  14. says

    I had surgery to repair a hip labral tear, FAI bone shaving, and cartilage repair. I am 5 weeks post op, still non-weight-bearing, and have only been given the clearance to do isometric strengthening PT exercises. I will soon go in for my 6 week post-op visit and expect to be given clearance to begin weight-bearing (I assume to tolerance with the possibility of needing crutches or a cane, if needed). I will be returning to work at around 8 weeks post op. My job requires about 1-2 miles of walking daily. I’m wondering how realistic it will be to go from non-weight bearing to walking that amount on a daily basis. What distance do you see most patients be able to tolerate regularly after surgery? Should I expect to gradually not use crutches or is it possible to walk without them right away? What is the best way to rehabilitate from this surgery? Do most people recover well if they go slow and don’t do too much too soon or do you see common setbacks with this type of surgery? Thank you for your insights!

    • says

      Rachel I think that it would be a very bad idea to go from non-weight bearing to full weight bearing that abruptly.

      With the doc’s permission, I would start with placing some weight through the leg while using the crutches and slowly increase the load that way for several days. I have seen many people who have developed significant inflammation from walking too aggressively to early.

      Make sure that you and the PT have a plan in terms of phasing in weight bearing.

      • says

        So, continue to be gradual, even though I’ve been non-weight bearing for 6 weeks? I haven’t tried to walk on my own, so I do not know what I can do yet. I keep reading about the damage too much too soon can do. In general, do most post op patients keep daily walking to a minimum? At how many weeks post op would you expect the average patient to be able to tolerate 1-2 miles daily? I really appreciate your site and insight – thank you!

        • says

          Yes, I tell my patients to gradually start weight bearing once the precautions are lifted by the doc. The whole “cold turkey” thing in my opinion is too abrupt.

          Every patient is different, but I would say that it would take the average patient 4-8 weeks (once the precautions are lifted) to build up the kind of walking tolerance that you mention.

          • says

            Thank you so much! You should write recovery and healing protocol standards to be used by all physicians, physical therapists, and patients. I believe the variances, although expected, may negatively impact patient outcomes. The hip is such an intricate joint and recovery protocol is as important as surgical skill. Thank you for making your skill and insight accessible!

  15. Taryn says

    Hello,

    Almost 1 year ago I underwent surgery to repair my torn right hip labrum and osteoplasty. Initially my recovery went very well. I had no problem running at roughly 6 months post-op and at 9 months I went back to playing in a recreational basketball league. It wasn’t until about 2 weeks ago at one of my basketball games, that I was jogging down the court and then stopped to change direction. It wasn’t really an abrupt stop and I wasn’t running full speed, but when I went to turn direction and run down the other end of the court that I felt a sharp deep pain in the same hip. I didn’t feel like the same severe sharp pain I got when I originally tore my labrum years ago, but now my hip feels how it does prior to surgery. It’s that deep dull pain and just really tight all over. I’m very afraid that I may have retorn my labrum but I am not sure since the pain isn’t super severe like when I originally tore my labrum. Could this be somethjng else hopefully?

    • says

      It could be a few things. Sometimes the head of the femur will “impinge”, or hit, the top or inner portion of the socket in a weird way. It can be suddenly very painful and jarring, and the pain can last for weeks as the inflammation calms down. It could also be a disruption in the labrum.

      In either case, I would have it checked out by the doc. You probably should have the mechanics of the hip assessed to see if you have any glaring weaknesses that could contribute to impingement. I think that it goes without saying that you also need to let the hip rest for a while. If it was a bad labral tear your hip would get “caught” all of the time and it would be very difficult to walk.

  16. Lisa says

    Approximately 20 years ago I had orthoscopic hip surgery for what was from the description hip labral tear, or as they described it my acetabular was wrapping around my femor head — am pretty certain they took it out. Afterwords they asked me about grinding and I had none. Over the many years since it has gone from being the best thing ever to the worst. The pain gets worse and worse, have resorted to a cane this month.

    6 months ago I returned to the doctor who made the call to do surgery, he took x-rays and suggested starting with cortisone. Nothing very aggressive, the coritsone relief was short lived. I have tried to just work through the pain, especially since x-rays it show only moderate arthritis. He seemed to encouraged moving/walking.

    My question is 3 fold how long do the replacements last? Do they actually get rid of the pain or just replace it with another? And are there more aggressive ways to manage the pain and use PT to forestall a replacement that I can ask my doctor about?

    Thank you! And for those going forward with surgery, I hope the new treatments take age into account age, and how your body changes over the post op decades.

    • says

      The hip replacement surgery can be miraculous in terms of changing pain. I know tons of people who had the surgery who have said that their hip pain essentially went away. The lifespan of a hip replacement nowadays is probably 15-20 years.

      It sounds to me like you have already exhausted some of the more conservative options. Cortisone and PT are usually tried first. If you haven’t done PT lately I would try that for a month or two and see where that gets you.

  17. Kate says

    Hi there – would really appreciate you’re advice. I had surgery 8 weeks ago on my labral tead – a repair not debridement. I also had some bone taken away due to hip impingement. I was off crutches after a week and have been making progress but my hip is still always clicking and my walk is not balanced. My gluteal muscles are really weak – as they were ore op. I feel like a lot of my symptoms (the weakness and the clicking, not the pain) are still there. I’m afraid either the tear wasnt repaired or that it’s torn again. Any thoughts on this? It’s really getting me down! Thanks

    • says

      Kate it is going to take a minimum of a couple of more months to get that weakness corrected. In the mean time the symptoms that you described are to be expected. Make sure that you have a good PT and are sticking to the rehab protocols for your surgery. Also make sure that the doc is aware of your symptoms and your progress.

  18. Andrea says

    Hi Dan,
    My mother who is 59 years old, has been diagnosed with a labral tear, FAI, and mild dysplasia. In Canada, hip arthroscopy is not as common of a procedure as it appears to be in the US or England. She has seen a surgeon in England who feels she is a candidate for this surgery. My concern is not only is she considering having surgery very far away from home, but I question the long term success. If she is likely going to need a hip replacement anyway (although apparently her joint space right now is ok), what is the benefit she will see from the scope? I am also concerned about her being on crutches for a minimum of 2 weeks since she is a violinist and already has a history of shoulder, neck, and wrist injuries so hobbling around on crutches for a few weeks will likely hurt everything else! She is in quite a lot of pain when she walks, only relieved by doing pool therapy 3x/week and a fairly extensive home exercise program. A hip replacement seems a little extreme given that she doesn’t have OA (yet). Any advice would be appreciated since I don’t have a lot of experience with hip scopes (I am a physical therapist here in Canada and work a lot with THA patients so am very familiar with the successful outcomes of that procedure!) She has seen one surgeon here but he won’t do the scope because of her age :-) But the surgeon she saw in England apparently does them all of the time on an “older” population.

    • says

      Andrea in my experience hip scopes are most often performed on patients in their thirties or forties. Outcome measures with this type of surgery do obviously become worse as we age. The fact that mom does not have appreciable OA is great. I would go with the conservative route for as long as possible. Cortisone injections have also bought many people a lot of time. My mother had hip issues for quite a long time, and she held out to 68 years of age before having a THA with the help of PT and cortisone injections. She is doing fantastically with the THA.

  19. John says

    My wife had her hip labral tear repaired about 3 weeks ago. She had recently mentioned she had some clicking in her hip. Tonight our 3 year old son just ran up behind her and hugged her legs while she was standing still. This hurt pretty bad and now seems to be clicking more.

    She has been off crutches for nearly two weeks with both her Dr’s and PT’s blessing. And range of motion has been better then projected.

    Whats type of force from a jarring motion is typically required to retear and new repair? She has a Dr appointment in about a week in a half. Should she wait or contact him sooner, or just make sure she mentions it to her PT later this week?

    Thanks for all of your responses to all the previous questions.

    John

    • says

      The clicking after the surgery is quite common. I would think that your 3 year old would have to be extremely strong to dislodge anchors (it would be more likely to happen if your wife was knocked down). The more likely effect would just be a temporary increase in inflammation. In the mean time I would keep the walking to a minimum and allow the joint some opportunity to heal. I do agree that she should bring this up to the treating PT when she has a visit this week.

  20. KC says

    I am almost 12 weeks post op labral repair. The other day I was moving some boxes out of my office, they were not heavy and I had no pain at the time I was moving them, but pain started several hours after and has lasted for several days despite rest, ibuprofen and ice. I can imagine that I could have compromised my repair, but dont know why else I would be having pain…

    • says

      It does sound unlikely that you damaged the repair. This may be a strain of one or more of the smaller muscles that control the rotation of your hip. If the pain does not subside it would be a good idea to let the doc know what is going on. I would limit my walking in the mean time to allow healing.

  21. Brianna says

    Please help me, I’m 17 years old. I had the first hip impingement surgery at the age of 15 and the second at 16. Everything was looking good for a few months until I couldn’t put pressure on my leg to walk anymore because the pain in my groin area was so unbearable. I’ve done chiro I’ve done PT I’ve seen my surgeon a countless number of times. It is now affecting my sports and my job as a waitress. I’m 17, I feel like I have the body of an 80 year old. What do I do? Weird thing is My right (first surgery) hip hurts more than my left.

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