October 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. I am female, 65, moderate weight/health, with a degenerative tear of the anterosuperior labrum and moderate osteoarthritis. Pain is severe when tying shoes, raising knees, etc. Walking is fine. Range of motion is severely limited. Would like to go back to yoga, biking, and exercise. I’ve seen an ortho doc and will see a hip surgeon today. Everyone is suggesting complete hip replacement. Your input will be very much appreciated. Thanks!

    • I would get a few opinions from different orthopedists. If the level of arthritis is “bone on bone” and the pain is severely limiting your everyday life, a total hip is a good option.

      Realize however Paulette that hip replacement prosthetics do not allow for total, uninhibited hip range of motion. Certain yoga positions may not be obtainable, and narrow bicycle seats may not be a great idea. I am not saying that you shouldn’t do these things after a hip replacement, but you will have to modify what you do. The real upside here is that almost all patients report a drastic decrease in pain.

      The first few months after a hip replacement are very inconvenient. Stick with the rehab protocols and you will ultimately be very glad that you had the surgery.

  2. Monica Mosier says:

    Hello!
    I’m 31 years old, I weigh in at 195lbs height is 5/6 and have been in pain since June 8, 2014 I am a Federal Law enforcement Officer with the Department of Justice and have a long career ahead of me!
    I was at work I walk anywhere for 6 to 10 miles in a night, while doing a check walking at a brisk pace me hip felt as if it jolted forward and a loud snapping sound then sharp stabbing pains with every step!
    I went to the doctor’s they did x-rays and they said they see nothing it’s “probably” a hip stain or hip flexor! Remain out of work till further notice! They put me through 2x a week physical therapy for 4 weeks it did nothing but get worse and since my 2nd visit to physical therapy the doc told me to return to work on lite-duty NO running, standing, bending, stairs, jumping, and well basically nothing that involved movement :( So the doc has called in an MRI because now he “thinks” it a labrum tear which is what I thought it to be all along. Now it’s the hurry up and waits game dealing with workers’ comp…… I guess what I’m trying to get at is will this get better or not! I’m so scared they are going to medically retire me. I’ve read on many forums that out of all the comments there was like 2 people that surgery fixed the others were all like “it’s worse now than it’s ever been” or ” since my surgery I can’t walk and I’ve been on morphine since”
    I love my job if they decide I’m okay to return but limited duty, they could still deem me medically unfit for law enforcement! Even a limp could kill my career!
    What is the % of full recovery?

    Please help depression is setting in 

    • Monica you need to know if you have a sizable hip labral tear or not. If you do, from what you are telling me I am guessing that having the labral surgery will probably help. If you are able to get a few opinions from doctors and confirmation from an MRI that would be helpful.

      The rehab from the surgery takes time, probably a few months. You are going to have to be patient about this if the labrum has a significant tear.

  3. I am scheduled for an MR Arthrogram LT hip. don’t like the idea of the needle but not sure why I am still having pain after 4 years after I pivoted on my heal and had a pain so bad I could not walk. I am 53 and don’t know if surgery is something I should consider or just live with the pain. They have not suggested physical therapy but I have had a bad back for some time now I am aftaid this surgery will make my now stable back bad again.

    • At this point Karen I don’t see why you shouldn’t try some physical therapy and see if strengthening helps. Depending on which state you live in, you might need a prescription from a doctor. In my opinion it is always a good idea to try every conservative measure prior to having a surgery.

  4. I have been having lower back pain for 4 yrs. I was told I had a disc problem and ant to Pt. It never helped. I Then went to a Chiropractor who told me I didn’t have enough curve in my spine.During all of this I kept telling them ” my leg feels out of place and it keeps giving out”, nobody seemed to care or say the back and leg may be tied in together.I finally got an answere after X-ray picked up a tear in my labrum which was later confirmed by an MRI. The surgeon said it looks to be a good size tear and quite a bit of damage, he will no more when he gets in there.My question is will my back feel better after this surgery?

    • In the long term Sue I would guess that having more symmetry with strength in the hips would be a good thing for your back. The positive effect however would probably take some time to feel, perhaps a year after the surgery or more.

      In the short term it is possible that the back would bother you a bit more simply because you will be dumping most of your weight on the non-surgical side.

  5. I had arthroscopic hip Labrador repair and the Google bursa removed. It doesn’t hurt to walk. Do I really need the Walker if I’m walking slowly and carefully in my home? Crutches are impossible for me as I don’t have upper body strength and am uncoordinated.. Using the.. Holding my leg up actually hurts more.

    • Mary I would stick to the doctor’s protocol. If the doc doesn’t want full weight placed through the leg, his reasoning is probably based on research. Humor him / her for the time being until you get the “green light” to walk without an assistive device.

  6. Hello,
    I had a hip labral debriment and illiopsoas release in June of this year. I am not getting any better. I also have a torn gluteus Maximus tendon along with piriformus syndrom. What can I do to help rid me of the horrible pain I am in.
    Thanks for your in put.
    deni

    • Geeze. A torn gluteus maximus tendon is a problem that can contribute to piriformis syndrome. I would find the best physical therapist in your area and get an evaluation. It sounds like you need to work on strengthening the supporting structures.

  7. Ok. This is going to be a little long.
    I first started having hip pain while pregnant with my first child. (He just turned 6 in Sept)
    Well, during delivery, I had a partial dislocation of my right hip. Ever since, I have had off and on pain at random times.
    About 4 weeks ago I was carrying my daughter and had to run her to the potty. In doing so, I did something to my hip. It was uncomfortable that day, but the next few days were horrible. Walking, sleeping, driving etc were extremely painful. I went to see a well known orthopedic in sports med. they X-Ray Ed it it was ok. During the course of the exam he said “with certainty it is the labrum”. Have me take a course of prednisone and it felt better, but not “cured”.
    Niw tonight, I went to step up onto a hay ride and my hip is killing me. It hurts in the same spots, but this time weight bearing bothers it. Previously it was just movement. The range of movement this time is decreased drastically. I can not get comfortable to go to sleep. I am really thinking that I may not be able to walk in the morning.
    He never said it was a tear. Just said to do the pred and continue my barre class since it was going to do what he would order in PT.
    I go back to him next week. I am wondering what to expect. Should I go sooner or wait a few days? Should I not bear weight if it’s painful?

    • It does sound to me like your labrum might have a tear. In order to be sure the MD might order an MRI to confirm. I would nix the barre class until everything calms down. It wouldn’t hurt to see him earlier. I don’t think that you are in any immediate danger, but it wouldn’t hurt for him to see you sooner rather than later.

  8. Hey All! Recently, I had what I would consider to be extremely successful hip labral tear repair in Michigan. I am 51 years old, and very active. My main problem was that I could not sit for more than 2 minutes. I ride a semi recumbent bike, elliptical, and used to run for exercise. I teach physical education, and recently retired coaching track for 25 years. I also coach gymnastics and was a participant for most of my life. After trying not to fall down in my driveway of death this past winter, I finally went to the dr in May 2014. It was decided that I had a significantly labral tear. That was not the full extent of the diagnosis, but it was part of it. The doctor decided to repair my hip and also to repair a bone spur. I am very close to having hip dysplasia. The doctor indicated that my tear was just the straw that broke the camel’s back. I was a three sport athlete in high school, but gymnastics was my favorite. I was a hurdler in track and field, which all contributed to the demise. Hip surgery was on June 12th 2014 and I was released from physical therapy on September 2nd. At that final appointment, I was able to run on the treadmill. I ran for 3 minutes, then walked for 2. I repeated that a few times. Since then, I have some discomfort in my left hip when I lift my leg to get on my semi recumbent bike. However I fieel like I am definitely moving forward and that the hip surgery I had was extremely helpful. My groin pain went away immediately and I just feel like I’m making great progress. If someone says that you need an MRA, I found that the MRA was extremely helpful for the diagnosis. The surgeon was able to get me in right away but I wanted to wait until after the last day of school for this procedure. Consequently, I spent my entire summer in physical therapy. My physical therapist did my husbans’s shoulder physical therapy, which is why I chose him. He had done my husband’s shoulder physical therapy, which is why I chose him. He was not actually one of the physical therapists attached to my surgeon’s office. I was extremely happy with my entire experience. I thought physical therapy was very helpful and I followed all the directions exactly. I don’t think you can go through rehab without that time frame for healing.

  9. I had labrum repair surgery in February 2013. After a year and a half I was finally pain free. I started running again 4 weeks ago and my hip is starting to hurt again and now I have runners knee. Am I damaging my hip? Should I keep running and hope I’m building strength and it will stop hurting? I’m frustrated because I love to run and want to run, but I don’t want to ruin my joints. Thanks!

    • Orange have you built up to the running? Given that it has been quite a while since you have run, I would start by walking on the treadmill and SLOWLY building up your tolerance. Treadmills tend to be a bit more cushy than running on concrete.

      I would also have the hip looked at by a PT to see how the strength of the gluteal muscles are doing. Runners knee is usually a sign of weakness in the gluteals.

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