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 (see Why all the Fuss about the Gluteus Maximus and The Clamshell Exercise). 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.”
Great for ankle stabilization training! Use it for single leg balance, air squats, or as a way to cushion your knees while performing exercises in a kneeling position.
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.
PhysioDC Podcast: Experts Talk About The Hip
Andrew Wolff, MD (orthopedic surgeon) and Dana Logan, MSPT (physical therapist specializing in hip rehabilitation) discuss everything that you need to know about advances in hip surgery and conservative management. This episode is a must for anybody wanting to know more about FAI, hip labral surgery/reconstruction, and rehabilitation of the hip.
Visit our PhysioDC podcast page.
Hi there. I had hip arthroscopy done a month ago. Once the Dr went in he saw that it was an old tear and all he did was clean it up. He said there was no impingment taking place so he didn’t need to do anything else. I had been experiencing pain from deep in my groin all the way around to my Iliac crest and had very limited Rom, I was also born with hip dysplasia and my right foot turns in a little due to it. I started having issues when my hip would lock up during any type of hip hinging motions. I’m also a professional physique competitor. I was progressing very quick through PT and the only restriction i had was to be on crutches for a week or 2. I have followed everything to a t, even weened back into work. 2 weeks ago I pivoted to turn to talk to someone and my hip caught and almost took me to my knees. Ever since then my pain is back and I can’t last more than an hour on my feet so I put myself back on crutches. Should I be worried? Have i back tracked?
I would have the ortho check that out to be safe. That does sound to me like you had a quick little positional impingement with the twist, and you can certainly be more susceptible to that while your hip is still weak. Take it easy and let it heal.
Hi I had hip surgery as well about 6 weeks will be April 11th. The doctor repaired two tears and the shaving of the bone. I am still on the walker, in a lot of pain and now my same leg is swollen. see is from my hip to my toes. Should I be worried or do I need to be seen.
I would see the doc about the swelling issue.
Hi, At 51, I had arthroscopic surgery (debridement) for a labral tear in my right hip. It’s been 1 year and all has been going well until 2 weeks ago when, as a preschool teacher, I injured the same location of my hip and am feeling sharp pinching pain in my groin that is impacting my lower back as well. Is this typical? Will rest, ice, ibuprofen work despite daily activity with preschool students? Or do I need to make an appointment?
Thanks!
Injured teacher
It could be a couple of different things, my money is on a strength or alignment issue. I would get it checked out.
Hi Dan,
I am about 10 months post-op for a labrum repair and cam type fai. The pain I’d had from the tear prior to surgery was gone almost immediately after the repair. I did have issues with swelling around the hip, as well as pain and tightness in my hip flexor that started at the time I made the move from 2 crutches down to 1/off completely, and has continued. I had a repeat MRI at 4 mos which confirmed the repair/anchors were intact and negative for other injury, so I was told to give it time and continue with PT. I have had 2 steroid injections around the psoas bursa, with some improvement. I rhave eturned to work which includes long hours on my feet, and frequent air travel so it has remained irritated despite restricting hours/day initially. In December I found a trainer with an athletic training/PT background that gave me more stretching options for the hip flexor and simple balance/strengthening to go along with the PT exercises that I have continued at home. It did improve some with this, and a 2 week break from work travel to the point that I finally began walking normally, although still with discomfort.
Over the last 2 mos I have hit a point that sitting in one place longer than 30 minutes I have pain/discomfort through my hip/groin and around the side of the hip and into the thigh, and when I stand up for the first minute or so of walking I get a catching sensation on the outside of the hip, this will also happen if I walk too quickly or too much. I am also noticing a catching sensation in the front of the hip again, groin pain and pain high up in hamstring as well. I have had swelling since the surgery that has continued pretty consistently. I have continued PT exercises, stretching, foam-rolling, icing, some form of cardio most days (swimming, elliptical, stationary bike) as had been suggested by the dr. I have tried yoga to tolerance, and a couple of spin classes recently with low resistance just trying to find something that will work.
I am a runner and generally active person, and itching to get back to some sort of normal workouts and to running again, and if nothing else get through a normal work day without feeling miserable. I understand recovery from this procedure takes time, and my range of motion is definitely better than months ago, but I feel like I am now going backwards. With the continued swelling, groin pain, and now return of catching sensations is it possible I have re-torn the labrum or other injury? Do I just need to give it more time, or should I return to my surgeon? I don’t want to waste anyone’s time, but something just doesn’t seem right. Thank you!!
I would back off the exercise routine for 1-2 weeks. That might be difficult for you to handle from a mental standpoint, but this sounds to me like you are a bit overtrained.
Hi, I am 10 weeks post-op on my left hip. I have been having a lot of discomfort in my back left glute, it gets the most painful after sitting for long periods of time (working) and sometimes after too much time standing. Is this because the glute muscles are just so tight? Or is there another reason for this.
Thank you!
Tight muscles are usually weak muscles. I would guess that this should slowly abate the stronger your buttock muscles get. This may take several more months to get there.
Hello. I am about 4 1/2 months post op from a torn labrum repair (with micro fracture) on my left hip. 8 weeks of crutches with no weight bearing. Things have generally progressed well. However, over the last month or better I’ve had a catching sensation with a shooting sensation when I release pressure off of my leg (usually after standing with equal weight for 30 seconds or longer). I reported this to my surgeon (very well respected) about 6 weeks ago and he said he wasn’t concerned with this “catching.” Not much improvement on this front, really. I have increased my stretching and strengthening exercises some over this time but don’t feel like I am over doing it (3-4 times per week). I was released from PT about the same time (6 weeks ago). Just wondering if this “catching” when lifting my leg after standing with pretty good pain is normal. Any suggestions on either rest, exercise or anything else to get through this? Thank you very much!
I would back the strength training down to twice weekly for a few weeks at least and see if that changes anything. If there is a low level of inflammation in the hip I would guess that it could be manifested in the way that you describe.
Thank you! I’ll back off and see if it improves. Appreciate your time.
I had arthroscopic labrum surgery on my right hip a few weeks back. He also shaved my hip and femur. I know it takes a while but is my skin sensitivity down my thigh normal? It is so painful that it wakes me up at night. It hurts more than my groin. And how do I get this to stop, ice? Massage? It hurts to even have my pants rub up against my leg.
I am guessing that this is a nerve sensitivity? I would let the doc know about it. This might be something that medication could take the edge off of, but alas pharmaceuticals are not my bag. I did have a patient once tell me that she wrapped her upper leg with ace-wrap in order to lessen the sensitivity of her clothes.
Hey, 1 year post op. 100% pain free. On going flare up for the last 6 months. Physio didn’t work. MRA last month says there are subtle irregularities of the labrum near the original site and there is some extension of contrast into the inferior labrum. He didn’t have any preop Mra to compare it too. Pain is in groin and front of the hip. Sudden outward/twisting movements give me a pinching pain. Pain is very similar to pre-op pain without the limp. New physio is suspecting possible inflammation. Surgeon wants me to look at steroid injections. Any ideas? 6months pain is very frustrating. Thanks.
Forgot to add it was a slip and overstrerch of the hip that caused the flare up.
If the slip was six months ago, there certainly could be a tear associated with that. I would do as much conservative management as possible, including PT and the injections. There is also something to be said about allowing appropriate time to let the soft tissue heal. That is tricky to do, because walking in many cases tends to be an irritant. I would maybe ask the doc and the PT if it would be prudent to unload the hip with crutches for a week?
Thanks for your reply. Unfortunately my recent MR Arthrogram last month came back negative for a new tear. I personally dont think the quality was as good as my original diagnosing scan. Physio has noticed there is a significant amount of resistance with outwards and upwards movement of the hip.
Thanks
I had left hip labrum tear and it was surgically repaired seven weeks ago. I had a cam “bump” on the femoral head shaved smooth. In order to do this the surgeon had to carve away the cartilage on the femoral head. He then drilled three holes in the bone in order for the cartilage to respond better and regenerate. I am in PT, but it is going very slowly. I am only stretching and squeezing glutes and abs. I want to do more. At this rate my PT says I should not think about competitive waterskiing until 2019. My desire is to get on the water in May. One PA told me after three months the site should be healed and I can not damage it . I may just get pain from swelling but not hurt the repair. What is the case here.
I would agree with the PT. Waterskiing in May sounds premature. I do think that there would be potential to re-injure with higher level activities this early because of the lack of muscle support.
I got my right labrum repaired 10 days ago. I also had a cam & Pisner lesion that was shaved down. I still have clicking when i stand up or straighten my leg in my hip. I also have pain running down my thigh to my knee as well as in my right glut med. is this normal post op especially the clicking? I called my ortho & he said it’s normal for up to 8 months post op but it still worries me.
For 10 days out I am going to agree with the orthopedist. This may bother you for a while. Stick to the rehab protocol.
I’m at post op day 29 now. I had an FAI combined, AIIS and they did an osteoplasty, rim trimming, AIIS decompression. I am still on crutches at 60% weight bearing, but my right (surgical) hip pops when going up stairs, is this normal or did I accidentally do something bad?
The rectus femoris (one of the hip flexors) has origin right on the AIIS. It would not surprise me if this tendon is causing some popping sensation while you are flexing the hip actively (such as when you ascend stairs). Ask the doc about it, but this is probably par for the course.
I had hip impingment surgery, my labrum was too damaged to repair so was removed. This was 9 days ago. Was out of it after surgey so didnt ask alot of questions. How is my hip ok without a labrum to keep it stable. As of now i can toe touch with effected side. My 2 week appt is approaching, but im very nervous i won’t be ok w/o the labrum. Also i have always been very flexible will u be when healed, like sitting indian style is the only way i sit, which has been hard to not do. Will i do this again?
If it were me, I would avoid extreme positions of the hip. Indian style sitting is probably not a great idea. I would focus on getting the strength of all of the supporting muscles ideal, gradually over time and per the doctor’s protocol.
I will defiantly follow instructions. I was just wondering if i was going to, in your opinion have my flexibility. And also how my hip can be stable without the labram.
The labrum provides some stability to the hip, but it is not crucial.
Thank you for your time, and providing this forum.
I have apparently suffered a labrum, and to quote my MRI analysis: There is detachment and truncation of the superior, anterior superior, and posterior superior labrum over a length measuring 2 cm AP consistent with labral tear. Impression: Left acetabular labral tear extending from anterior superior to posterior superior labrum.
Attending specialist only suggest physical therapy due to my age (64). I suffered with this injury for 6 months before this MRI. They sees reluctant to suggest surgery? Is this tear too big, in a unique location, or just surgery restricted due to age? Overall, my movement and structural support is better last 30 days, but burning sensation in the joint area. Mild edema adjacent to left hamstring tendon due to this injury. What is your recommendation? Thanks. I can walk a mile on demand.
Conservative management is always the best idea to start. Many patients with labral tears can rehab the strength up to a point where activity is not painful.
Does the labral tear cause the problems to the tendons, etc., due to the change in your gait, or due to physical pressures put on the hamstrings, etc.?
I would think that it is usually the other way around. An imbalance it the muscles around the hip may cause certain muscles to be overused and other muscles to be underused. This can cause long-term stress on the hip joint and labrum.
I am 13 weeks post op for labral repair and cam and pincer shaving. It felt great for until about 5 days ago. My activity has not increased significantly . I have been taking spin and weight classes since 4 weeks post op. The only change has been some light ploys ( jumping jacks etc.). but not crazy.. I feel that the front of my hip is slightly swollen and I have muscular pain but no significant joint pain. Does this seem normal???
My guess is that you might have some hip flexor tendonitis. I would back off the exercises for a week or two and let it heal. I would also have it assessed by the PT.
Hi there
I see this thread is a few years old but hoping you’re still answering and thanks in advance.
I had hip labral tear surgery three weeks ago on both sides at once. The doctor is amazing and helped to invent this method
He doesn’t really think PT helps but prefers people to move at their own pace in recovery. I used an ice machine, didn’t need crutches even on the day of surgery, in fact was waking slowly the day of.
I’m using a stationary bike for maybe 20 minutes a day and almost walking like nothing happened.
I’m in my 40s and a woman.
My questions are these;
I do ballet and turning out even very gently still hurts a lot so I’m not forcing it. How long should this take to resolve?
Will being peri menopausal and having an irregular period slow recovery? I am not on any replacements and am vegan FYI
Overall I am healthy, the tears were not the worst or least he’s seen.
He stitched the labrum both sides into the bone, shaved bone and cleaned up some cartilage. I naturally have thinner cartilage so he doesn’t believe I have arthritis
Since the surgery I feel pretty good; I have a little groin pain still, I have numbness in one outer thigh which I hate but apparently will resolve. Also some burning in the numb area. Tightness also in the hip flexors. I’m doing sons planks and stretching gently.
I have deep hip joints by the way, not like most dancers.
My surgery took over 4 hours so being in traction that long may have caused the numbness in the right which incidentally was the worse side though I had less pain there.
I can easily bend, tie my shoes, walk for maybe 30 minutes though not very fast
I see the surgeon in two weeks.
I want to dance again if only at a lower level.
Also want to return to Pilates after I’ve seen the doc.
Before the surgery I had very strong hips and legs and glutes from Pilates
Maybe that’s also helping my recovery.
Thanks for answering :)
I have never seen someone who had both hips done at the same time. I would totally err on the conservative side in terms of how you advance this. It is totally fine and expected to take several days per week off to let the muscles accommodate to the strengthening. I would not push the ballet stance with external rotation until at least 10-12 weeks from the op date. Age does have an effect on recovery, and the data for the forty and over crowd is not as great as the younger crowd, but it sounds like you take good care of yourself so I wouldn’t at all be concerned about the peri-menopausal thing.
Had my 2 week post op, was told took labrum out, as i knew. Allowed to put weight on both sides no rotating leg and have to use walker. They said because of the bone shaving my hip is weak right now. So my question is, does it just get stronger again between now and my six week appt? Not allowed to do pt until the 6 week point.
I see a lot of conflicting articles on google. What is the actual success rate of hip impingment surgery?
There just isn’t a huge amount of long-term outcomes data for this type of surgery given that it has really only been done for the last ten years or so. From personal experience, I think that the outcomes are decent, with most people reporting that they feel better off than before the surgery. I do think that this takes a good 6-12 months for solid improvement in at least hal fo these cases.
Hi Doc, thank you so much for taking time to answer questions, its so much appreciated
My surgeon wants to do a FAI scope, labral repair AND a iliopsoas partial release – the first 2 I am ok with but the idea of cutting healthy tendon and muscle seems ridiculous to me, I’ve told him no but he keeps pushing the option.
What is your opinion on this procedure? Thanks again
I think that psoas tendon releases used to be done quite a bit in the past, but not so much nowadays. I would definitely see another hip surgeon about this. Multiple opinions are always a good idea.
Hi, My daughter is 18 year old and had a labral tear repair along with a shaving of her femoral head, about 4 weeks ago. She has been going to PT and is doing good and has started walking slightly, however she still feels pain in her groin when she does some movements such as; slight twisting, bending more than 90 deg, laying on her side ect. She sometimes complains of it hurting on the outside (More of a bone pain). Is this type of pain normal to feel this late after surgery? Thank You so much for your expertise!
All sorts of pain is typically evident at 4 weeks post op. I would guess that this is normal and a function of weakness and swelling. A slow transition into walking is recommended.
Hi Dan. I am a 17 year old competitive soccer player. I was diagnosed in November of 2017 with FAI Impingement with a torn labrum. I ended up getting hip arthroscopy in early December. Three months after the surgery I experienced absolutely no pain and was doing better than expected. I then started running on the alter-g and was fine the first time at around 60%. However, I ran again about 2 days later at 65% and it did not feel right. It felt like the alter-g might not have been calibrated properly and it felt like I was putting a lot of force on my hip (more so than what I would have expected at 65%). I usually run on it for 10 minutes but I had to stop it short at roughly 5 minutes because it was becoming slightly painful and I didn’t want to push it. I continued to do the other exercises at PT, however, when I got home I had intense pain and iced to try to remedy this. That intense pain went away, but ever since (for about a month now), my hip has not felt as strong as it did prior to the event at PT and I now have strange aches and pains in my groin, the side of my hip, and near the hip bone. None of these pains are sharp, just achy and uncomfortable. Also, it seems that they get worse as the day wears on, and then become better after I wake up, and that cycle continues.
Since it has lasted for roughly a month, I decided to cool it with the PT and am waiting to get an MRI to see if there is anything wrong. I would appreciate your thoughts and insight on what might be going on. Additionally, how hard is it to re-tear the labrum as my surgeon and PT person have said that it is very hard. What would the symptoms be?
I would appreciate your help.
I do think that the MRI is a good idea. I would obviously have to see how you move etc., but lots of people who have FAI have a tendency for the head of the femur to translate forward in the socket because of a muscle imbalance. I would find a PT who has a lot of education in what we call “MSI” (Movement System Impairments) and get a fresh evaluation once this has all calmed down. Realize that you can’t really have this type of evaluation right after a surgery because the body is not moving normally and there is weakness in certain muscle groups etc.. PT is usually focused more on the doc’s protocol and getting basic strength back.
To answer your question it is difficult to re-tear a surgical anchor, but my guess is that it might be an underlying movement dysfunction that is causing the same type of irritation as before.