April 1, 2015

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. 3 weeks 5days since my hip labral tear repair… I have been cycling, doing my excercises all as asked but still find my hip clicking and clonking… Does this mean my surgery hasn’t worked or is there something else I should be doing? Soo confused and doing everything I am told too! Thank for any help!

  2. Amy Boring says:

    I have had right hip/groin pain for 11 months. I’m currently taking 800mg Ibuprofen 4X each day. In looking for exercises to lessen pain and strengthen right hip, I came across information detailing Labra Tear of the hip. In doing the research, I came to the conclusion that this might be what is happening with my right hip. What I am asking: Where do I start to have this diagnosis confirmed? My regular doctor is a family practioner. Should I start with her, describe my symptoms and information on
    Labral Tear or straight to an orthopedic doctor? Are there any exercises I can do to ease the pain?
    Thank you-Amy Boring

    • I would see an orthopedist Amy. There should be one or two of them in your area that specialize in hips. You may also need to get an MRI to confirm any hip labral issues.

      There probably are exercises that you can do. I would start with “bent knee fallouts” (under abdominals), glut max contractions (hip), and sidelying clamshells (hip). All of these exercises are in our media tab on our website. The password to get in is “patient”.

  3. I had surgery to repair a labral tear as well as treat some arthritis that had developed in my hip. The surgery was five months ago. I have completed physical therapy and have begun to incorporate some light jogging (a mile or so at an easy pace) into my workout program. While I experience no pain from the actual activity, I have noticed that whenever I do any moderate cardio work (jogging, elliptical, bike, etc.) I experience a shooting pain around my hip and through the IT band for the 3-4 days that follow. It is not a constant pain, but rather a pain that is triggered by some very minimal motion (walking, sitting down, etc.) and can be somewhat debilitating for 30 seconds or so. After that the pain goes away, only to return a short time later when it is triggered again. Any thoughts as to what is causing this? Thanks.

    • It might be a strength issue in the gluteus maximus or gluteus medius. The ITB can become irritable if the strength is off. It wouldn’t hurt to see a PT and get a fresh look at how you are moving and what your strength is.

  4. I’m a healthy 63 year old woman that was in a car wreck in January 2014 and was on crutches for weeks due to a cut on my heel. This caused SI inflammation which has persisted until the present time. Meanwhile, the wrecked worsened pain I was having from a previously diagnosed labral tear so I had it repaired (debrided–Too large of a tear to repair) in August 2014. . Surgeon said it was very difficult to get into my hip and he had to use a lot of traction. I was on crutches for about 6 weeks and had extended PT (20 visits) but nothing fancy–no water therapy– just exercises and modalities. Doctor said in October I still had lots of inflammation and injected it in his office. t. After Christmas I complained that the SI pain was still severe (uneven gait from surgery kept it aggravated I suppose.

    So my hip surgeon referred me to a pain specialist who injected the SI joint under anesthesia and sent me home with a TENS unit. First shot helped for a couple of weeks but second shot hasnt seemed to help. Meanwhile I still have a deep ache in the bend of my leg near the surgical site. I am SO discouraged. Forget sports-I’d just like to ride in a car and walk in Walmart without constant pain. I’ve read that some clinics won’t do this surgery on people beyond their 20’s due to poor outcome. I have been on célèbrex for months and wish I’d never done this. Any suggestions or insight?

    • Rendy some of this SI problem has got to be because you do not plant your weight evenly through your legs. Find the best PT that you can in your area and get some recommendations in terms of safely strengthening up your weak side.

      It might not be a bad idea to get into a pool and do some weight bearing exercises in that type of environment. A good PT should be able to give you some direction with that.

  5. I had a hip scope done 2 years ago to repair my torn hip labrum. After MRI it is revealed that I again have a torn labrum. I did not injure myself so how does this happen? I did all my post PT and was feeling great. Going to a hip specialist this week but just thought you could give your take on this. Hate to have to go back thru 6 months of post surgery again but in pain and cannot do normal things.

    • Ugh. I cannot tell you how that happened again Cindy, but I would try a conservative approach prior to having another surgery. Find out who the best PT’s are in your area and try the rehab approach first. You may find that you can get the pain to go away without going under the knife.

  6. Samuel Rhys says:

    Hi There,

    I am 21 and had 2 labral tear operations on both hips. One in september 2013 a month before I planned to travel to Australia for a year and then got told I need another one and got that done in July 2014, I went to paris a 3 months ago and was in pain for a few weeks after but that went away (groin, butt, hip pain). 2 weeks ago I was painting my office climbing ladders etc and then went on a 7 mile walk with friends and the wednesday after started to get quite bad back pain and butt pain when sitting for a while and a small bit of groin pain and my feet feel kinda numb I also have a tiny bit of hip pain but nothing unusual.

    I went to see a PT in my area, and she moved my hips around quite a lot and got no pain in my hips however when I do one of the exercises she gives me, which is to lay down put my hand under my back tilt my pelvis so the pressure is on my back and lift my leg, my right hip cracks I get no pain when this happens is this ok?

    I plan on finally going traveling in April after 4 years of waiting and am just hoping this pain goes away.

    Thanks

    Sam

    • Generally I think that cracking by itself is not really a big deal. If the cracking hurts that is a different story.

      If you are worried about traveling I would scale back the long walks and do some basic hip and core strengthening under the guidance of the PT.

  7. Ellen Hill says:

    Had complete labral tear that took about 2 years to diagnose. Had fai surgery 11 weeks ago Felt fantastic for 8 weeks. Then I had 4 very active days and l the original pre surgery pain returned. Have been is bad pain for 4 weeks. Do you think surgery failed or should it get better. Pain is actually even down my leg

  8. Ryan Kemp says:

    I had a right hip arthroscopy, femoral osteoplasty and labral tear repair on the 8th Nov 14. The labrum was completely detached in one area and they had to anchor stitch it back on.

    I have been seeing the physio and he tells me everything is progressing really well and I have began a return to run program.

    I can deep squat, lunge walk, run with no pain at all which is good.

    My only worries at the moment is an ache that develops when I remain in a sitting position for too long. After about 30-40 mins sitting at a desk chair, the ache develops and gets worse the longer I sit.

    I find standing up and walking, stretching helps with the ache, but if I sit down again the aching comes back.

    I had a similar ache before I had the surgery, so would this just be residual aching from where the labrum was repaired? How long would should I expect the labrum to be full healed?

    • You probably still have a ways to go to get the hip back to full, maybe another 2-4 months? The aching may be from over-use of the hip flexors that cue in while you are seated. Keep working on gluteal strengthening under the supervision of the doc / PT.

  9. Kyle Waite says:

    I had FAI/Labral repair 6 weeks ago. I seem to be progressing well. However, prior to surgery I had sciatica like symptoms, but an MRI revealed no back issues. I am still getting sciatic like symptoms. Is this referred pain, or could it be piriformis syndrome? I thought it was reffered pain from the fai/larbrum issue.

    • Sciatica type pain more times than not is more of a muscle weakness or imbalance, which in your case is certainly not surprising. Once your gluteal muscles get stronger you should notice a decrease in sciatica type pain. The piriformis muscle tends to become more relaxed when everything else gets stronger. (Sciatic pain and piriformis syndrome have quite a bit of overlap in terms of causality.)

  10. Jordan Pauly says:

    I am 122 Days, 3 hours, 11 minutes and 45 seconds…. ah now 46 seconds from my right FAI and labrum repair.
    Over the weekend I happened to be sitting Indian Style and remember reading a Mens Health article that if a person could get up sitting Indian Style using no hands they would lead a long healthy life (I’m an idiot for #1 believing this crap #2 even trying).
    After doing this I’ve noticed quite a bit of soreness in my op hip in the groin area… I’m hoping and praying I didn’t re-tear something being an idiot… I’ve also noticed some popping coming back after sitting for awhile.
    I hope that some RICE will help get me back to where I was. Why do I hurt? Why the popping? Is this scar tissue or fluid build up?
    I know this is a question for my OS… I just need someone to tell me it’s somewhat normal for what I tried to do.

  11. Hi there I am 2 weeks post labral tear repair I don’t see physio for another 2 weeks. I have been carrying out my exercises as given by the physio on discharge but I appear to be experiencing sciatica type discomfort the entire length of my leg. PWB with crutches is extremely difficult with a young child just wondering if this may be the reason for my pain? Thanks

    • Yes that is possible. PWB is rather important early on. I would try to stick to the protocol. The joint still needs to heal a bit, and full weight bearing early on will slow that down and cause other problems such as tendonitis.

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