Labral tears

Hip labral tears are a condition that can sometimes accompany sacroiliac joint dysfunction.

 The labrum is a ring of cartilage found within the hip socket.  Its main purpose is to absorb shock, as well as to help make sure your leg bone fits snugly inside the hip socket.

Cartilage is generally pretty tough, but sometimes it can become injured.

There are many different potential causes, according to the American Physical Therapy Association:

Labral injuries can be the result of trauma, such as a fall or a car accident, but are most commonly caused by repetitive trauma to the hip joint. Individuals who participate in sports that require extremes of motion, such as figure skating, repetitive twisting and ‘cutting,’ like hockey or soccer, or long-distance running are most often diagnosed with labral tears.

Basically, if you subject the labrum to forces it wasn’t intended to bear, for long enough, you can create a tear.

As Vicki Sims explains in the video above, labral tears can be a result of SI joint dysfunction.  When the ilium (hip bone) is rotated out of position, this means the hip socket is not where it is supposed to be.  As a result, the thigh bone (femur) sits abnormally in the hip socket.  Like anything in the body, when things are not lined up the way they are intended to be, this is when you run into problems.  Having the femur in an abnormal position can put stress on the labrum in a way it was not intended to bear.

According to the Mayo Clinic, it is possible for labral tears not to cause any symptoms.  However, possible symptoms include:

  • A locking, clicking or catching sensation in your hip joint
  • Pain in your hip or groin
  • Stiffness or limited range of motion in your hip joint.

The difference for you to be aware of, as a patient, is that the SI joint and the hip socket are located in two very different places.  It can definitely be confusing, since we often use the word “hip” to refer to the pelvis in general, or to the SI joints.

However, the actual hip socket is located in the front of your pelvis.  It is where your legs attack to your body.  (The official name for the hip socket is the acetabulum):

acetabulum_03_anterior_view

The acetabulum

Meanwhile, the SI joint is towards the back.  It is where the pelvis and spine connect.

auricular_surface_of_ilium_02_anterior_view

The SI joints

Since some of the symptoms of a labral tear and SI joint dysfjunction can sound the same, it is very important for a physician or PT figure out where your pain is coming from.

However, they are at completely different places in the body, so don’t let this post scare you!  Chances are you don’t have a labral tear!  As Vicki Sims explains in the video above, SI joint dysfunction is only likely to cause a labral year if it goes on for years.

***

In my personal experience, the question of a labral tear ended up taking up quite a lot of time while I was trying to find a physical therapist to help me with my SI joints.  (Luckily I didn’t end up having one, but I wish this part of the story could have been avoided).

After the exercises my first PT gave me made me consistently worse, I went elsewhere for a second opinion.  However, I was limping so much during my appointment, and found it too painful to stand on one leg at a time, that she ended up saying she wasn’t comfortable treating my SI joints until I saw a physician to rule out a labral tear.

I was really frustrated and annoyed by this at the time.  I had to wait 3 weeks to get an appointment with a doctor, who ended up telling me I of course didn’t have one.

I told her that I felt the PT making me wait for this appointment had been a waste of time because my pain was clearly coming from the area of my SI joint.

She gave me a knowing look, and said, “You know, there are a lot of trends that come and go in physical therapy.  It has to do with what everyone is receiving trainings on at a particular moment in time.  I have also noticed that everyone seems to be talking about labral tears.”

And with that, the question of a labral tear was dropped.

***

I was really angry at being sent on this wild goose chase at the time.

It’s only now that I look back, especially after watching Vicki Sims’ video above, that the PT’s insistence makes a little more sense to me.

The fact is that the question of a labral tear should be taken seriously.  However, at the same time,  I wouldn’t freak out just because someone suggests you have one.  Although they can be common, it does appear that they are also a somewhat “trendy” topic among physical therapists at this time.

You can avoid my mistake and save time by bringing up the topic of a labral tear at your first appointment with a physician.

***

For me, what ultimately ended up happening is that I realized land-based physical therapy was never going to help me in my current state.  My movement patterns were too altered, in a way that I couldn’t just “push through” — you can’t push through when your SI joint is stuck.

And my muscles were so tight, and so weak.  Some of them were overworked, and some of them were underworked, but again– with my SI joints locked up, all of the land-based exercises I was given only seemed to make things worse.

Aquatic therapy was my way around this– a way to let my tight hip flexors loosen up and get stronger at the same time, along with all of my other tight muscles.

***

One thought I want to leave you with is just to be aware that there are trends that can come and go in physical therapy.  Listen to yourself if something doesn’t make sense, and go and get a second opinion.

When you hit a roadblock, there probably are ways around it (in my case, switching to pool therapy).

Let me know if you have any questions!

**Hip socket and SI joint pictures both courtesy of BodyParts 3D, via Wikipedia.**

2 thoughts on “Labral tears

  1. Diana Ellis Noviasky says:

    Thank you for your insight. I have been going to a chiropractor and doing yoga with no relief in sight. I have begun water exercise and still have pain. First, my pain seems to also stem from the crest of my hip bone. Second, who do I see as a doctor? Orthopedics just want to do surgery. I need to know what’s going on first! The initial scan indicates, arthritis, small labrum tear, slight bulging of L 4 and 5. I also have had terrible tailbone pain, which has finally subsided, after I stopped running. Please provide your thoughts and ideas of doctors to visit. This has been going on almost 2 years. Many thanks.

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    • sunlight in winter says:

      Hi Diana, I’m sorry to hear about what you’re doing through, and I’m so glad my blog has been helpful. As you know, I’m not a medical professional, but hopefully I can provide some useful feedback:

      Pain at the crest of the hip bone– the most likely causes that come to mind are referred pain from the SI joint or the lumbar spine, or muscular pain. You have a major muscle there (the quadratus lumborum) which attaches to the crest of the hip bone, and it if tightens up, it can definitely create pain in that area.

      Here’s a really informative video that provides an overview of the various causes of lower back pain– you might find it helpful: https://sijointsaga.com/2017/07/14/low-back-pain-part-1/

      As for what type of doctor to see, the kind of specialist I most recommend is a physiatrist. The name is kind of odd-sounding– their specialty is Physical Medicine and Rehabilitation. Basically, they specialize in everything else you can do to improve a person’s pain other than surgery. Unfortunately not all physiatrists are familiar with the SI joint– the first one I saw was not. However, from there I went on to see two others who were much more familiar with it. You will probably have to do some research to find the right person, but it sounds like it’s worth getting another opinion before surgery.

      Here’s a later video in that same series where a physiatrist talks in more detail about the SI joint. This should give you an idea of some of the non-surgical treatment options that are out there, and ideally the level of knowledge you’re looking for in a doctor. https://sijointsaga.com/2017/07/24/physiatrist-si-dysfunction/

      And here are my posts about the second two physiatrists I saw:
      https://sijointsaga.com/2017/06/13/what-i-learned-from-seeing-my-second-physiatrist/
      https://sijointsaga.com/2017/03/11/prolotherapy/

      As you probably know, I swear by aquatic physical therapy, if your doctor clears you to try that. I personally would recommend that over yoga– I think there is significant evidence to suggest that yoga can actually be hard on the SI joints. I know it has a great reputation, but I don’t think it’s always deserved:
      https://www.yogajournal.com/teach/protect-the-sacroiliac-joints

      Okay, that’s a lot of information so I think I better stop myself there. Hope this is helpful– let me know if you have any more questions!

      Like

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