♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
(Bob applauds)
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we're the most famous physical therapists
on the internet.
- In our opinion, of course, Bob (sighs).
- Hip labrum tear, how to assess and rehab at home.
We're gonna show you some steps that you can take to,
well we're gonna show you how you can even diagnose it
to some extent. - Sure.
- And then we're also gonna show you steps
that you can do to try to help maybe temper it a little bit.
- Right. - So that.
- Yeah, and I did see it on studies.
They thought that maybe you could get through
without having surgery and continue on
with life in a normal way.
So, we don't know that. - Yeah,
It's gonna all depend on some of the defects
that you might have in there
that you might have been born with like a shallow socket.
- Right.
Or how bad the labrums tore. - Right.
It could be a real severe tear
a real minor one, which all takes some time.
- If it's folded up on itself.
Well, we should probably show people
what some of these things are.
But before we do that. - There you go.
I see them too, Bob.
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- Yeah. - Let's just keep it simple.
- Okay, Bob. - All right.
- We're talking about the hip labrum,
which the hip is here, so we know that's it.
And it's right in here.
I'm gonna come up with the other skeleton.
We don't have a name for this one.
So you can see this.
Now I do wanna mention,
there was someone who made a few comments
over the last few months about doing this video.
And I kind of looked it over the first time.
Cause I thought we did one on the hip labrum
and I looked through our archives and we didn't.
- We did one on the shoulder labrum.
- Right, we did on the shoulder.
- Yeah. - Yep.
- So here we got the hip and we'll make it complete.
So if you look at the hip, the labrum...
We don't have a labrum on the skeleton,
'cause the labrum is a fibrous
cartilage. - Piece of cartilage.
- And it goes, you got that in Lonnie?
Right along this black line here is where the labrum is
and it goes all the way around.
Okay.
And what it does, it helps provide some shock absorption.
It helps keep the lubricant and lubricate the joint.
It also helps stabilize it. - Stabilize the joint.
- Right. - Yeah.
- So it's got a number of jobs and it's important to have
and it can be injured oftentimes through trauma.
Say an auto accident where your knee goes
into the dashboard.
- Sure.
- Repetitive motion where you go to an extreme.
Say like a gymnast or someone
where they're maybe abducting, repetitively.
- Sure. - That kind of thing
can relate to that.
- Well, I had a patient yesterday, Brad,
that she was born with a really shallow socket.
So you have the ball here. - Right.
- And you have the socket.
And if that's the case,
what happens is it can actually pinch on there.
- Ah yep.
- And also the shape of the socket
and all those things come into play.
- Sure. - Or the shape of the head
of the bone, the femur.
- Right, right. - So.
- So there we got the labrum.
How it can be damaged.
And often, the study did say
that more females actually have a labrum tear the males.
And they're sure that it's the shape of the pelvis.
I'm sure the pelvis and the the Q-angle of the knee
and such like that.
So can all play a role.
- So how do you know if you have a labrum tear?
Remember that time, about two years ago,
I had really bad hip pain? - Yeah.
- And you did treatment on it and I was using crutches,
it was so bad.
- Right. - For about two or three days.
Thought maybe it was a labrum tear
and the pain went away after about the third day.
And it hasn't bother me since,
so obviously it probably wasn't a labrum.
- It did seem like you were getting a little bit
of impingement there in your hip at that time.
- Sure.
- So you wanna show a test on me, Brad?
- Sure. Yeah.
Now you can do scans for labrum tear
and people oftentimes think if you get a MRA
or MRI that you're gonna know for sure
whether you have a tear.
- You would think you would.
- But it's not true.
- Right.
- They found studies up to 30 to 50%
of MRI's are false positives.
- Wow. - You know, and they found out
when they operate on it.
- They end up going in there
and they find out it's not torn.
- Right.
It's like, oh, well what are you gonna do?
- Yeah.
- Was the MRA a little more? - Right.
- Little more accurate than the MRI?
- The MRA, magnetic resident angiogram,
is more dependable for this particular structure.
- Okay. - So this is how.
This is what's considered to be the best test
for a manual test.
So you get the person's supine.
This is called 90-90 position.
- Right.
- I'm gonna grab the hip here
and I'm gonna internally rotate it.
That means go this direction, so the foot comes away
from the other leg.
And then I'm gonna air duct
and go towards the center line this way.
And if that creates pain, it's a positive sign.
- Yeah, and I just had a lady yesterday,
a young lady, who that was positive.
It also felt like a pinching to her.
- Sure. - So, which makes sense.
- Right. - So if you're on this one,
you're gonna turn it this way and go this way.
- Right.
- So the foot's gonna go out that way.
- Right.
- And it's gonna be good to test both
and compare one side to the other,
because again, it's not a hundred percent.
Just because that's positive doesn't mean you have
a torn labrum. - Right.
- It means it's in indicative of it.
- Right, it's one more reason to think you might.
- Right. - So the surgery then Brad
is usually arthroscopic usually.
- Yeah. - And, and.
- They'll go in with scopes
and they could cut you open and do it that way too.
And surgically stitch the labrum.
And to be honest, I didn't look into the research
on what they do most right now
'cause we're not interested as therapist's research.
We're more interested in preventing that surgery.
- Right, they might debreed it or repair it.
They might repair the bone even.
- Sure. - So there's lots
of different things, but.
So this is a nonsurgical therapy option now.
- Right. - It's what we're doing, so.
- So exercises.
I'm gonna use this for balance.
The first thing you're gonna try to do is just see
if you can balance.
Let's say this is gonna be my involved leg.
The leg that's painful.
Oh, did we talk about the location of the pain?
It is typically in anterior.
- In the groin area.
- Yeah. - Yep here or
in the groin area, that's where it normally is.
- Which interestingly, my patient, her pain,
a lot of it is out here,
which makes me think she's compensating
and that muscles are starting to hurt out here
because of this thing that's going on.
- Right. - So we're gonna try
to treat some of the muscles there
as opposed to treating the labrum muscle.
- Sure, and maybe it's not a labrum tear.
- Right. - Okay.
- Maybe it's not a labrum tear.
- So exercise, we're gonna start out with one leg balance.
Okay.
Can you balance on one leg?
Now if any of these are painful, they irritate the problem,
you're not gonna do them.
- That is the key.
It's gotta be pain free.
- Right, sure.
Now you don't have to have a stick.
You can have a chair in front of you or hold onto a tabletop
or a cupboard, but you're gonna see if you can balance
I'm gonna use this for balance.
You could use it in either hand, if it's the right leg
usually you have better balance in the left hand.
And we're gonna balance it.
And once you can get to the point, you know
you might need two hands.
And if that works good, 15 to 30 seconds, go to one hand.
You might start out with one hand right away.
And then you're gonna see if you can start
to balance like this.
And on the good leg, if you could,
most people can go 30 seconds that are younger and fit.
- Sure. - Without any problem.
You wanna do about the same with the involved leg.
Once you can, they're about equal without pain,
then we're gonna have to go to phase number two
which is get some muscles working around there
with some dynamic movement.
So what we're gonna do here
is we're gonna take a stretch band.
Now you can use any kind of stretch band
and tie some knots in it and try maybe tie it
to a leg of a table.
- Sure.
- We happen to have this device right here.
- It's called the wall anchor.
- The wall anchor.
Yep, it works really well.
And if you got a Velcro strap like this,
really it works the best.
Let me just get a foot in there.
- So again, yeah.
What Brad was saying is you can take actual tubing or a band
and tie it to something and tie it around your leg too.
And do the same things as before.
- Sure.
One way or another, we're gonna get this resistance here.
Now we're gonna go in four different directions.
The four primary planes of the hip out and back like this.
And we're gonna do good, smooth, controlled motion.
Not like. - And again.
- Not like this.
- And again, pain free.
- Good, good Bob.
- Yeah. - Thanks for reminding me
on that, because it is really important.
- And it's all straightforward.
- Yep. - Is what he's doing.
He's not turning it out as he goes forward.
Straightforward toward me.
- Right. - So it lined up
with his thighs.
- Like I was gonna kick him in the kneecap.
- Yeah. - But I won't do that, Bob.
- I'm glad you said kneecap Brad.
(Brad chuckles)
- There we go.
And 10 to 15 reps is adequate.
Then gonna turn 90 degrees.
- What's nice about this, it's a little bit of hassle
to set this up, but once it's set up,
you can do your strengthening in all four directions.
- Right, and it's all very convenient.
- It really is.
It's worthwhile to take the time to set it up correctly.
So now you see he's going back into,
this is getting the little bit of hamstring
and hip extension, right.
- Right. - The gluts.
So. - And again, don't get this.
We're not doing a pendulum swing.
We're doing controlled extension
and back to the neutral position.
Again, 10 to 15.
And if you need to touch your foot down for balance,
that's fine.
If you feel too easy,
you can start to do this type of a motion
which is a little more aggressive.
It's gonna work the hip a little more.
- And he's trying to keep the knee straight on this,
'cause - Correct.
- What they've found, Brad, a lot of times is
that the hamstring is over dominant on this and they
they don't want it to be, they want the glute
and the hamstring to work together.
- Right. - That's all.
- So don't do this.
- Yeah. Don't do that in other words, right?
- Sure. Good point, Bob.
- So.
- All right.
And then finally this one gets the fourth direction
hip abduction.
- Very important on this one quite often, weak
on these cases that and the hip flexion
those are the two that are often weak.
- Yep.
- And again he's pointing his toe straight forward
and again. - Not like this.
- And again, he's trying to do this pain free.
- Right.
- So, all right.
We need a chair for squats, Brad?
- Sure.
- I'll start getting that ready.
- All right.
We'll take this off.
There's another way we can do squats
with a little less resistance
if you have your wall anchor like this, which.
- Set up?
Yep. - Yep.
And I'm just gonna use the resistance from here
and I'm gonna slide down
and the resistance actually pulls you back up.
- I'll believe that.
- Obviously not all your weight,
but it takes enough off to make it a little easier for you.
And it's kind of nice to work that.
- It's a good way to start.
And then also the key, when you have possibly a torn labrum,
you don't wanna go too deep on these at all.
- Right.
It should be pain free. - Yeah, yeah.
If you start going deeper
you're gonna probably get some pinching.
- Right, don't even think about doing this.
- Yeah, yeah. - It's way too far.
'Cause when you get in that flex position
is where you're more likely to irritate it.
Good point.
All right.
So if you don't have anything like that
just standing here in good tall posture.
You're not gonna go over like this.
- And a good shallow squats again.
- Yeah. - Just trying
to get some movement, some strengthening.
- Or heave, or heave.
Heels and toes are gonna be flat on the floor
and it's gonna be like this.
Again, good posture.
10 of them is gonna be good enough.
- Right. - Okay.
All right.
- Now you want to do lunges Brad?
- Oh yes, lunges.
Now Bob, you like to use them with the wall.
Why don't you do them with that?
- Well, actually I was doing it with this one, Brad but...
- Oh the tall one?
Yeah.
Again, I like doing it with this just
because it gives you a little, it helps you
with your balance and makes it a little easier.
Again it's a good way to start.
So I got it hooked up to a wall anchor
a little higher up and I just go backward like this.
And I actually do a little bit of posture exercise too
because actually they talk about the core being weak.
You get a little bit of core workout
a little bit of balance workout, you know?
And so I'm going back
like this and this just works out really well.
As you can see, the knee is not going
in front of the foot.
- Right here.
- Brad, do you wanna point that out?
- Yep.
You can do it again.
Do with the other leg please.
- I was trying to do it slow and I
I actually lost my balance.
- So the knee is not, it's there.
Go forward and make it incorrect, Bob.
There, that would be too far forward.
That stresses the knee and more hip.
So don't go too deep on this.
Bob's going pretty deep there.
You may not go that.
- Yeah, you can just start off real shallow like this.
- Sure, whatever's pain free, again.
Okay.
And last but not least, we're gonna go once again
to do some lateral motion with some dynamics.
- And you can do that with a loop too, right Brad?
- Oh yeah, sure.
- Do we have a loop?
- And I'm gonna point this way
'cause I wanna go this direction.
- I don't know where our loops are, Brad.
Do you know?
Oh, there they are.
- Right there. - Right there.
- And actually the loops work a little bit better
and more efficient than this,
but this works too if you have it handy.
You go ahead and do this
and you're gonna do that on both legs.
If you go ahead and put the loop on Bob.
- Yeah, we got these listed in our products.
Below all the sanc band.
These worked out really nice.
We like the quality of these bands.
They hold up well.
Not that they won't eventually break,
but they hold up better than most other ones.
So what are you doing Brad?
You're doing.
- Right, just lunges out and back.
Out, and you're gonna do five to 10 of those.
Again, squat down, but not too far.
If you need something for balance,
again you can use a stick or have a chair in front of you.
- Sure. - And you know,
you're gonna go both directions too.
There you go.
- Kind of our old Karate moves here, Brad.
- Oh yeah, it all relates together, Bob.
- Gonna get Karate positions.
- Everything fits together in life.
All right. - All right.
- Remember to take that off before falling.
- Yeah, taking it off.
All right. - All right.
So once again, enjoy with these exercises.
I think they're gonna help you out with that labrum and.
- Thanks for watching.