“I’ve torn (fill in the blank), does this mean I need to have surgery?” It’s one of the most frequent questions I get. It’s also a common misconception. If you hear the word “ tear” it’s natural to think something is broken therefore it needs to be surgically repaired, but that’s not necessarily true.
I played competitive soccer my entire life- literally from age 4 onward. At the height, I was practicing 6 days a week, weight training on 3 of them, and having 2 matches. That type of training wears on the body over time. I didn’t start having intermittent hip pain until I was in physical therapy school and my main form of exercise was turning to the next page of my Musculoskeletal Lab notes while sitting for hours on end.
After 6 months of that, my body was craving exercise, but didn’t realize it wasn’t in the same shape. Either way, I decided to run in the Pittsburgh half marathon. Then all I did was run on the treadmill and study. Six miles into the race I started getting right anterior (where your thigh meets your pelvis) hip and groin pain. This got progressively worse over the next 7 miles, with the last 3 miles being a stabbing pain with each step. Being stubborn (ask any former patient, or my husband), I went against my better judgment and continued to run on it because I refused to walk any part of it. I literally had ‘just keep swimming’ from Dory in Finding Nemo playing on repeat in my head to keep a cadence running as my stride length got shorter and shorter. By the time I got to the finish line, saying I was limping is an understatement. I could barely put any weight on my right leg for the next 3-4 days because it felt like a knife going through my hip. Even bending over to tie my shoes was impossible. But looking back at it now, it was all too obvious that I have a labral tear in my right hip.
Labral tears in hips are common in people who do unilateral, repetitive motions like kicking, jumping, pivoting, or running (think dancers (particularly ballet), long distance runners, and soccer/basketball players). Your labrum is a cartilaginous ring that surrounds the lip of your acetabulum (the socket your hip bone sits in). Its primary function is to provide stability in ball and socket joints like your hip and shoulder. Now, when a piece of the labrum is torn either traumatically or by degenerative changes over time this causes the joint to become inherently less stable. Think of it like a golf ball sitting on a golf tee. In this case your labrum is like the lip of the golf tee and when intact, the ball sits on top of the tee and doesn’t move. However, when a piece of that tee is missing the ball starts wobbling around and can fall off. In terms of your hip, the ball of your femur starts moving around too much, typically forward, and causing inflammation around the frayed labrum.
Luckily the doctors at FPSPT have treated hundreds of these injuries. When you have a torn labrum, you have too much anterior (to the front) motion of your hip, causing the posterior (back portion) capsule to tighten up from lack of use. By stretching the posterior aspect with joint mobilizations, it helps the femur stay more aligned in its socket. In addition you have multiple muscles that attach into your femur whose sole purpose is to externally rotate your hip and pull the femur back into the socket as well. By strengthening these muscles, they take a lot of the daily forces off of the joint allowing for the inflammation to subside because the femoral head isn’t constantly whacking into a compromised structure. Now once your labrum is torn, it can’t heal back to how it was previously, but it technically doesn’t need to. That’s why the body is amazing. With the proper training and treatment I’m able to run, hike, jump, pivot, and cut with no symptoms because now my muscles know how to compensate for my change in anatomy.
Has stabbing or catching hip pain been stopping you from the activities you love? Call us at Forward Performance Sports Physical Therapy and let us help you get back to your active lifestyle. It’s only Forward from here!
