I see a lot of people with hip pain at the clinic here in Boronia as well as at the other clinic I work at in Ashburton. The focus on hip pain has increased dramatically over the last 15 years due to a few reasons:
- Better quality and cheaper MRI scans that can identify smaller structural problems
- The 'discovery' of a condition (FAI or Femoroacetabular Impingement) that 20-30% of the population has but had not been documented until around 2003
- The advent of 'simple' arthroscopic (keyhole) surgery for the hip - previously the only option was 'open' surgery - traumatic and with a very long recovery time.
Hip joint anatomy.
Picture courtesy www.methodistorthopaedics.com
So what is the labrum? The word is from the Latin word for 'lip'. It is a piece of fibrocartilage that lines the hip joint, like a suction cup or washer. I often describe it to patients as a 'calamari ring' like structure.
If you have a scan confirming a labral tear, it needs to be interpreted with caution. Are you certain this is causing your symptoms?
A great study out of the USA from 2012 proved why we need to interpret the MRI findings with caution. The study gathered a group of ~32 year old males who had NEVER ad hip pain prior. On MRI - 83% of them had labral tears/changes. This really proves that labral tears are often symptom free!
Schematic representation of labral tear.
Image courtesy www.aafp.org
So what do we do if a labral tear is causing pain or disability? We can't discount this condition. Particuarly one paper from 2001 hypothesised that labral tears do 'fast track' wear (or osteoarthritis) of the hip joint. This certainly hasn't been categorically proven but it is something to keep in mind.
There are a few options, however none so far have a lot of evidence that they work:
- Physiotherapy: often aimed at strength/control exercises and addressing hip posture particularly with sitting
- Injection therapy (most often cortisone (corticosteroid)
- Surgery
Certainly the take away from this is that labral tears often do not cause pain and are often pain free. A thorough examination of the hip (and the story preceding the hip becoming sore!) are very important in accurate diagnosis and treatment.
Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. Aidan has an interest in Sports Medicine conditions, particularly those involving the hip, groin, or tendon injuries. The clinic is located close to Ringwood East, Bayswater and Heathmont. Aidan currently works at the clinic on Tuesdays and Thursdays. Find out more about Aidan on his website aidanrich.com.au or on our practitioners page