In this video, I'm going to tell you everything that you need to know about hip labrum tears.
I'm going to talk about the symptoms that causes how to diagnose it on yourself,
as well as the treatment options that you've got. My name is Dr. David Middaugh, I'm a specialist
physical therapist at El Paso manual physical therapy. And this channel is dedicated to helping
people stay healthy, active and mobile. While avoiding unnecessary surgery, injections and
pain medications. Please consider subscribing to our channel so that you don't miss out on
any of the helpful videos we post every week. So let's get right to it the number one symptom
that someone with a hip labrum tear is going to feel his pain on the front of the hip right in
here. That's when it hurts. That's where people will get a hip labrum tear pain right where the
leg folds on the body where the leg meets the body and you have a fold right there. When you bend
your hip. That's the most common place to get the pinching sensation, the achy sensation, you can
get pain in other areas, but it's usually related to muscles spasming or nerves that are achy.
In other parts of the hip like the outside of the hip, you could also have back pain,
or sacroiliac, joint pain, SI joint pain, which is a form of back pain as well. And another
definitive symptom is joint locking. If you've had the experience where you're moving and all of a
sudden your hip gets stuck like it you're walking in, it bends like this, and you can't fully
straighten it out and wants to stay kind of bent. And it's painful to move it's that's what we would
consider hip joint locking. And the theory with that is that if the hip labrum is torn,
then you're going to get a flap of the labrum or a chunk of it's just not going to move properly.
And you can pinch it or get it stuck in the joint. And to give you a picture of what this looks like.
I put my artistic skills to the test here. This is what a hip labrum tear would be like here,
if you've got a hip joint here, there's the ball. And there's the socket, the red right there.
The pink is the labrum. It's a chunk of cartilage that surrounds the socket. So on this side over
here, it's not on the inside of the socket, it's on the outside of the socket. And it typically
gets affected in one area right on the front of the hip right where I was showing you where the
leg meets the body and where your hip folds. That's the most common sites for a hip labrum
tear, you can also get stiffness in addition to the joint locking. So what that means if
you've been sitting for a while you may not lock up necessarily, but you might
feel stiff in your hip. Like it takes you some a few steps to warm up your walking your hip,
and then it loosens up and you can begin to walk a bit more normal. You might wake up
stiff in the morning as well and need to free up your hip, maybe twist it around, move it around.
And after several steps, then you might normalize in your hip and get on with walking
normally again. Now let's talk about the causes. There are several causes to hip labrum tears,
the more obvious causes are going to be traumatic injuries, like if you've been in a car accident,
if you had some sports accident or had a bicycle or motorcycle accidents. And as you sustained
injuries from that and if you have hip pain, it is possible that you can have a hip labrum
tear that was a result of that traumatic injury. There are also structural causes to hip labrum
tears. And that's something that you are typically born with or have developed over a long time.
The main one that people are born with is hip dysplasia, which means that the ball and socket
joint to the hip just didn't form normally during development. And it's the people have trouble with
that afterwards. A lot of people can function and do quite a bit of things with hip dysplasia,
but they do tend to run in to little problems here and there. Eventually arthritis as they get older.
If you've got hip dysplasia, then it's kind of just a matter of time before you end up getting
some other hip injury like a hip labrum tear. Another structural problem that's relatively
newer in the medical field that we're learning about is something called femoral acetabular
impingement. And all that means is femoral means the thigh bone so it's we're talking
about this bone right here the femur, femoral and then Assa tabula is the socket.
So the inside of the socket right here, so femoral acetabular impingement. So big fancy words for hip
impingement. But what they're finding out is that there are some cases of bony changes where the
edge of the soccer right here grows outward, kind of like a bone spur. And then you can also have
another change where the neck of the femur so the ball connects to the long bone of the femur,
you can get some thickening on that area, and they call this a cam and pincer deformity.
In case you have that and you're wondering, that's another reason why you might get a hip
labrum tear. But the most common reason that we see people with hip labrum tears
is for no reason. They come in and they say, you know what, I've been active my whole life. I've
always tried to exercise. I've been involved in walking. I've gone to the gym. I've never had
any severe accident. I've had hip pain here and there, but nothing that really stops me in my
tracks. Then my hip pain got worse enough for me to go see the doctor. And then that's when
they told me that I had a hip labrum tear. That's the most common presentation that
we see here in the clinic. And people in those situations are just worried and afraid, because
they've torn cartilage in their hip. And they're thinking that they probably need surgery. In fact,
doctors are usually telling them that you're going to need surgery, eventually, you're going to get
arthritis, and eventually a hip replacement is going to be what's on the table for you.
But let me give you my perspective on why hip labrum tears happen. It's a muscle imbalance,
there's muscles on one side of the joint that are too strong or dominance. And there's muscles on
the other side of the joint that are too weak or not dominance. And it's changing
the way that that ball moves on the socket. So to be more specific, here, I'm talking about
the glute muscles in the back, those are usually very weak in somebody who's got a hip labrum tear,
because of that weakness, the muscles of the glute, they attached to the edge of this bone
right here and on the tailbone all through here, there's a bunch of deeper glute muscles as well,
and the outcome here and attach on the outside of the thigh bone of the femur.
And when they're strong enough, they can pull the bone in this direction, moving the joint
in this direction. If they end up getting weak, then you end up going in the opposite direction,
the bone tends to go this way. Because if this is relatively weak, then the hip flexors,
the bones that are the muscles that are attaching on the front of the hip joint,
the ones that are responsible for picking up your hip like this, now become dominant or strong,
and they're in a better position to pull that socket, remove the elbow out of the way,
they pull the ball forward on the socket. And the most common place where people suffer
hip labrum tears is right in here right on the front, top part of the labrum. And it's
because you're getting this motion, we call this hip anterior glide medial rotation syndrome,
in my specialty in manual therapy, and what that means is the because of that imbalance, the hip
joint, the ball socket has gone anteriorly. And then it's rotated medial, it's inward, rotated
and drifted forward, and it's compressing the front edge of the joint here, the ball and socket.
And so that's what's breaking down that hip labrum. And if you end up getting a torn labrum,
and you continue, you can eventually get arthritis. And let's talk about diagnosing
yourself. But number one thing that you probably already have done is go back and look at all
those symptoms that I talked about pain in the front of the hip, right where the thigh meets
the rest of the body where the leg folds on the body, that joint locking that I talked about the
stiffness that you might have, you can go back and listen to all those symptoms that I listed.
But let me give you a test that you can do at home right now to more definitively diagnosis in your
own hip. Because of the location of where the hip labrum usually tears, you can further pinch that
area using a simple motion that I'm going to show you and compare it to your other side. As long as
you don't have any hip problems on the other side, you can get an accurate diagnosis off this test.
So all you need to do is sit down somewhere where you can access your leg like this.
And what you're going to end up doing is bringing your knee up and in and your foot outwards like
this, you need to do this passively. In other words, you need to guide it with your hands
and minimally use your muscles so that you don't influence the joint position with your muscles.
So you going to grab your knee, pull it up, just like so you might do this on your
side, that's good right now just to make sure you know what's happening and what to expect.
And if you already feel that problem in the in the front of the hip right here, you're done,
don't force more on this test, you've probably confirmed it. But if you want to go further,
if you can tolerate it, and you know you're going to be okay, then what you would do next
is push the foot outwards like this, so that you're twisting the hip joint inwards like
that. So on the skeleton, what you're doing is you're pushing your knee up like this.
So that's going to slightly compress the front of the hip socket right here with the labrum that
and then you're going to rotate your foot outwards. And I can't do much more on the skeleton
because the bones already compressed right here they're meeting they're hitting each other.
But most people should have a bit more motion than what my skeleton has here.
So you would do it on each side, bring your knee up, and force your foot outwards like that gently,
don't hurt yourself and compare it to the other side knee up, push your foot outwards like that.
If you have pain on just one side and the other side feels good, then you've likely got a torn hip
labrum. But some of you might realize that this is a lot like hip arthritis, these symptoms and
his presentation. In fact, this test that I just did, is going to be a lot like what hip arthritis
would feel like how you would differentiate the two is with hip arthritis, you tend to have
a more consistent stiffness. In other words, you're almost always stiff in your hip joint.
And you could also have a hip labrum tear an old one and have hip arthritis on top of that,
if that's the case of priority. for you would be to treat the hip arthritis. And by the way,
we've got a bunch of videos on hip arthritis, just go down into the playlist below here
and find a link for a playlist on hip arthritis videos, you can learn more about that there.
The other defining factor is the locking. If you have the locking, then that's more a hip
labrum problem. If you don't really have hip locking, just stiffness and a loss of motion.
That's more arthritis problems. Usually, hip labrum tears don't have a loss of motion.
They can in some cases, but it's not always it's not as consistent with hip labrum tears
as it is with arthritis, to have a loss of hip motion. And what I mean by that
is how far you can bring your knees to your chest. Also how far you can turn your foot outwards, like
this and inwards like this. And then how far you can move your leg backward on your body like that.
Compared to the other side, you would compare all those motions side by side.
And if you've got a limitation on one side that's consistent, it's happening every day. It's been
like that for weeks or longer months, then that's going to be weighted more towards hip arthritis.
Now let's talk treatment options for a hip labrum tear. The number one thing that your
doctor is going to recommend to you is pain medication, specifically anti inflammatory
pain medications. So you're looking at medications like ibuprofen, naproxen,
other NSAIDs, as well as injections, your doctor may recommend an injection for your hip,
the most common one being a cortisone injection. Cortisone is an anti inflammatory and pain
medication that is supposed to help calm down the inflamed tissues in the area.
Both of these treatments, oral medications, and injected medications, like the cortisone
are only designed to give you short term relief. And doctors are quick to do this. And it helps
a lot of patients out with the pain relief, but it's not giving them the long term
fix so that they're not making the tear worse and developing arthritis over time, those medications,
the injected medications and oral medications are just supposed to get you through the
day so that you can sleep better at night. And so they can walk a little better throughout
the day, without being in as much pain, a doctor might recommend sending you to physical therapy.
And if that's the case, that's an excellent move. Physical therapy should help out tremendously with
this, you just got to be careful which physical therapist you're going to which clinic, you're
going to you ideally want to see a specialist that helps out people with avoiding surgery.
And most clinics, they won't tell you what they specialize in. But if you walk in and
look around the place, and there's a lot of people that had had surgery there, if you
talk to a few people there, they'll probably tell you, yeah, had the surgery had that surgery,
then they specialize in treating people after surgery, and they're probably not
going to be the best. And helping somebody avoid a surgery. clinics like that tend to
be kind of group therapy clinics where they treat a lot of the same conditions all simultaneously.
And they'll have an open layout with a bunch of machines. And they just kind of move people from
machine to machine. And that's an excellent thing for somebody that's just had surgery.
But for somebody who's dealing with a hip labrum tear, it's probably going to make things worse
to push you like that this takes some extra care and you've got to pay close attention.
And you've got to look at how the joints are moving within the hip as well as other joints
around like in the back the SI joints, even down into the knee and the ankle and foot.
If physical therapy does not end up working out for you and you go back to your doctor,
what they'll be recommending to you at that point is going to be a hip labrum repair surgery.
And there's different kinds that are out there and in the research are leaning more away
from hip labrum excisions, which means you're taking out a chunk of cartilage and then trying
to preserve as much cartilage as possible in that hip labrum. Because you're finding
that it has a better outcome for the hip later on that people are less likely to get
pain afterwards in arthritis, the more cartilage they can preserve.
So they'll do a repair instead where they sew together anything that's torn, or they cleaned
it up. They breed it to make sure that the joint and the cartilage there is as congruent or shapely
as possible for optimal motion for the joint to move the best. So my hope in making this
video is to fill in the gaps that you might have after visit visiting your doctor if you've been
searching online for information on a torn hip labrum and you're not quite finding what you need.
I hope that this was thorough for you. If you found it to be thorough, please give
it a thumbs up please share it with somebody else that you know that's going through this problem or
might have this problem because they're going to need to see this and we've got a ton of videos
here on this channel for hip problems. You can find the link to the playlist
for just our videos in the description below. I hope to see you guys in the next video. bye