February 28, 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. Hello my name is Eric I’m a 22yr old male. I had left labrum surgery back in June, it is now November and I am still feeling pain constantly in my hip, With certain movements and motions. I am an athlete, I hurt myself playing basketball but I do Mixed Martial Arts and have been pursing it as a career. My doctor said I wouldn’t be able to any of that till Jan 2015,I am kinda worried cause I am experiencing pain and I haven’t been lifting any weights or doing any explosive exercises to trigger pain. Since I haven’t been exercising fully I fell my calfs, and hamstrings are so sore I’m definitely worried that my hip won’t recover from this. Just maybe a little insight, if this is normal experiencing pain like this? And if so what can I do too get back in the gym quicker?

    Thank you any suggestion would help
    – Eric

    • I’m experiencing the same exact thing. I had my labral repair in august. I’m a registered nurse and was a two sport collegiate athlete. I still worked out regularly until all this occurred. In January I finally tried to go back to work and still couldn’t even work my shift. I’m only 23. I’m so scared I’ve lost my hip, my career, and my old life. I’ve done everything I possibly can to make it better and just got a cortisone shot on friday which I’m hoping will help. I hope it gets better for you.

    • Hi I had my surgery back in August, done the physiotherapy they told me to do and while at home doing my exercising I felt something click in my hip. Pain kicked back in now, swollen and still walking with a limp. Not good. Went back to hospital and now I have to wait for mri scan again, something don’t feel right. Every time I lift my leg it’s cruches

  2. Hi, I had a lavrum repair and cam removed. I was going well for first 5 weeks. Ever since I started walking(now 8 weeks post) my groin is throbbing after I walk and do exercises! I’m still icing as well as having some swelling like feeling behind the trochanter! Could this be bursitis and what can I do. I try resting a day but it doesn’t seem to help. Thanks

    • The feeling behind the trochanter could easily be bursitis. The groin pain may be from a lack of overall strength because of the inflammation associated with surgery. The re-introduction of walking causes this in many instances. I would talk to the doc about it and in the mean time only walk where you have to walk. Limiting our exercises to the ones that you learned on the mat or bed is probably advisable. I would also run that by your PT.

  3. Deborah Parker says:

    Hi:

    Can you give me a list of Specializes that will do a labral repair in the hip area. I believe there are two Doctors at John Hopkins and one in Nashville, Tn. Thanks.

    • Deborah there are specialists who do hip labral repairs in just about every major city. Our physical therapy clinic is in Washington DC, and there are three or four surgeons who do it here. New York City has a place called “The Hospital For Special Surgery”, they do that type of work as well.

      I would also check out hospitals that are part of a medical school. They should have adequate resources to tell you who the best people are who do hip labral repairs. Washington University in Saint Louis, Vanderbilt University, Hopkins, and UPenn are a few schools that should have resources.

  4. Please can someone give me some advice or some hope. I was experiencing groin pain for a year before I actually got diagnosed with a labral tear. I’m a registered nurse and need to walk, squat, twist, turn, lift, and even run a my job. I’m only 23 and just recently graduated. I had surgery in August and was having a long recovery and a lot of pain, even compared to others in therapy with me that had the same procedure. Then in November I fell. I’m terrified I reinjured the labrum or tore something else or ruined the surgery. My doctor and therapist don’t think so. Since I fell I had pain in the groin where I did before and after the surgery as well as a new pain lower down in the groin more towards my back side. I tried to go back to work in January and only made it through two shifts. I couldn’t walk the day after my shifts and they put me back on medical leave. I just got a cortisone shot this past Friday and I don’t have relief like I was expecting just yet. It says it can take 2 to 5 days to take affect so I may be jumping the gun because it’s Sunday. But I’m terrified. What if I wasted my time and money at college for a job I can’t even have. I don’t understand how there can’t be something wrong with the amount of pain I’m having still. Any advice or words of encouragement would be great.

    • Julianne I would call around and find the best physical therapist in your area who deals with hip issues. If it means going out of your insurance network, do it and at least get in a few sessions. You need one-on-one attention for a good hour at a time. Your mechanics need to be evaluated, and a really good PT should be able to push you in the right direction in terms of working on any tight structures and introducing some focused strengthening.

  5. I had labrum hip repair and and the shaving of the femoral neck to fix the impingement 4 weeks ago. My recovery seemed to be much quicker than I anticipated but just the past 2 days I was on a work trip and did a lot of walking around in a big city. My groin area seems very sore and much more painful than the previous 2 weeks. My question is if I have been pushing myself too much and what the likelihood of me popping an internal suture could be.

    • Back off with the walking and activity John, you probably did too much. No way to be absolutely sure if you messed up an anchor unless if you had some sort of diagnostic test. From the sounds of it though I don’t think that you did any major damage, just inflamed it a bit.

    • John you did probably walk too far, but given that it has been 4 weeks since surgery you probably just inflamed the joint a bit. Back off the walking a bit and let the doc or PT know what is going on.

      The return to activity needs to be gradual.

  6. Hi, this is the most helpful sight I’ve come across! :)
    I was just after some help, I had a hip labral tear repaired a week ago and 25% cartilage glued back down, I am still on crutches and doing my physio exercises each day, I have been told to weight bear on my leg and feel I can do this ok… Apart from a strange pain down the front of my quad. I am just worried about how much I should be doing at this point as I don’t want to do any damage by over doing it… I am very sore today and feel like I have took a step back. I don’t know wether to rest it for a few days or keep trying to be active! I have not started with a physio yet and any help or hints you could give me would be great!
    Thanks :)

  7. Hi Dan, I had a labral repair in June 2014 after having had chronic debilitating pain since 2012. It is now 7 months post-op, and I am still in extreme pain. I have been told I had a failed rehab, and my back has compensated for it greatly.

    I live in the DC area and was wondering if you or your staff have experience treating spine and hip problems together. If so, please let me know who, as I would really like to make an appointment to come in! I feel like I have lost my entire life to the pain I live in every day.

    I hope to hear back from you!

    • Sorry to hear about that Jenna. All of us here do have experience in spinal and extremity rehab. Feel free to give us a call at 202-223-8500. Dana Logan does tend to see a fair number of hip patients form some of the local hip surgeons.

  8. Hello, Ihave been diagnosed with a left labral tear from a Mri and going for CTs an shortly . I wAs diagnosed 12 months ago and was recommended for surgery . I am hesitant to go under knife . Been active my whole life but never in sports on a team. I think it is due to have more bone mass in my hip joint Which may have cause the tear from impingement . First few months were terrible as I was playing basketball on it . Now 12 months later i am completely inactive otherwise I have pain going down both quads (which leads me and drs to believe it may be bilateral) I did get a cortisone shot and felt better for a month so I started swimming , then boom it came back. I’m ok now that I’m not active but that’s not life for me.

    Also I am having pain when in deep seated position for few hours , I feel need to extend my leg to relieve pain. I also am having some referred pain. I get some uncomfortable shooting pain a little through urethra , and also my buttocks and also Into my rectum a little and also my tailbone area . Sometimes that area gets numb . I went to urologist , everything ok. He said it’s probably because of the tear that all my muscles are very right down there and to sit in a bath tub with warm water to loosen up. Never did that btw .

    So at this point I think the dull aching consistent pain over last 6 months and lack of ability to be active, is now driving me to get a CT scan and get surgery . I have always questioned if I need it or not , but too much weird stuff is going on to keep procrastinating .

    Just to throw this in , last night I woke up because i moved my hip, let wrong and I felt a snapping pain. Wasn’t bad just jolted me up. Also I need a quick 3 min run, and was in pain for 2 days with stomach pain, nausea a – which we’re some of my initial symptoms .

    What do you think? Are these possible symptoms of labralbtear ? And do I see like a good candidate for surgery ? 33 male .

    Btw never did I go for PT, I don’t see the the point . If I go for a light run or swim I get pains down my quads to my knees high side and I get in stomach pain .

    • Adam many of those symptoms are consistent with a hip labral tear, but something doesn’t sound right. The bilateral symptoms are not normal.

      Yes it is possible that there are tears on both sides, but it also may be possible that something is going on with your lower back. I would get in to see a new doc who specializes in spines (orthopedist), or perhaps even really good physiatrist (physical medicine).

      I am also a bit biased Adam because I am a PT. I would certainly have a very experienced PT look at you to get an impression. Surgery should always be the last resort.

  9. i had hip surgery over 2 ys ago . hip laberal repair. my Hip is hurting again. It wakes me up at night. I have been attending a zumba class. My hip does not hurt during class. it hurts more after I a sit long time or stand on that leg. I would of thought after 2 yrs I should be able to be back to normal. Is there such thing. I have been in a zumba class off and on for over a year. Should I be more concerned , I don’t want to quit zumba. suggestions ?

    • Stephanie if I were a gambling man I would bet that the Zumba classes are contributing to your pain in a major way. Lay off them for a month and see what happens. If the pain goes away, get to the doc or PT and work on strengthening for a while. You may very well get back to taking the classes.

  10. Kate Ruggieri says:

    Hello my name is Kate and I have to share my story. I had ACL reconstruction in Feb of 2014, which went okay. It was the second tear in the same knee. First tear was in 2004. So months of PT knee was doing okay for a women in her late 40’s. Tried to walk this summer and I would come home with sharp pain in my right hip. Mainly in the groin area. I was at my 6 month post op for my knee and told my Dr about my hip pain. Had the MRI and sure enough had a labrum tear due to a Cam impingement. Had surgery Sept 10 and started with thePT a couple days later. I had so much trouble from the beginning of PT. I thought I was going nuts I was told I would feel better in a couple weeks. Always a sharp pain in the hip. I tried so hard at PT somehow never felt any better. Went back to Dr after thanksgiving and he said okay we will try injecting with a product like synvisc. I got worse and now, I’m going crazy. Finally, just had a follow up, did an x-ray( finally) and I am at end stage arthritis. My only option is total hip replacement which will happen in 3 weeks. I think the Drs need to do more x-rays if a patient is not progressing at PT. At least after 3 months of PT with no good results. I also think Drs should tell the patient that this might happen. I thought it was my fault! Not everyone heals after this surgery. Thank you

    • Kate I do think that diagnostic tests are always a good idea (x-rays etc), especially if PT is failing after a few months. My guess is that the doc was hesitant to consider end-range arthritis with you because you are very, very young for that condition. You must have been a gymnast or some type of athlete for a long time.

      The silver lining here Kate is that a hip replacement will get rid of the pain.

  11. 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!

  12. 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”.

  13. 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.

  14. 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.

  15. 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.

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