Physical Therapy for Hip Labral Tear
What Are the Best Hip Labral Tear Exercises?
A Guide to Treating Hip Labral Tears and Hip Impingement, by Expert Orthopedic Physical Therapists
Hip labral tear is a common injury we treat. So, why do hip labral tears occur? And how do we treat clients with hip labral tears? We’ll show you exactly how we help you fix hip pain when you have a labral tear!
What is a Hip Labral Tear?
A hip labral tear is a tear to the cartilage that lines the acetabulum (the hip socket where the head of the thigh bone sits).
Hip Labral Tear
Patients with hip labral tears may experience lateral (outer) hip pain in a “c-sign” distribution, indicating that the underlying cause is within the hip joint.
C-Sign
Why do Hip Labral Tears Occur?
According to research, a hip labral tear usually occurs over time as a result of excess strain placed on the labrum. Mechanical impingement and/or instability of the hip joint are believed to be common causes of hip labral tears.
What does hip morphology have to do with hip impingement?
There are 2 primary types of hip impingement aka femoroacetabular impingement (FAI)
CAM impingement
Excess bone development on the femoral head-neck junction (upper portion of the thigh bone)
Pincer impingement
Excess bone development on the acetabulum (socket of the hip bone)
Pincer & Cam Hip Impingement
Excess bone at the hip joint may cause early bone contact during hip motions such as flexion, adduction, and internal rotation, potentially leading to mechanical impingement and a painful hip.
Clinical signs of FAI were shown to be present in up to 95% of patients with a hip labral tear.
According to this study, the anterior superior (front and upper) region of the hip joint is the most common location for a labral tear and research suggests the patient symptoms are typically provoked by combined the motions of hip internal rotation, adduction, and flexion.
FADIR Test
Altered Biomechanics are Associated with Hip Labral Tears
Abnormal movement patterns are commonly seen during single leg tests such as a step down or single leg squat. Here are some of the common findings:
Uncontrolled or excessive trunk movement
Lateral or forward lean
Pelvic drop or rotation
Pelvic drop is when the opposite side pelvis drops instead of remaining level
Pelvic rotation is when the pelvis rotates away from the stance leg
Valgus collapse of the hip into adduction or internal rotation
Excessive knee valgus or unsteadiness
Knee valgus is when the knee cap turns inward toward midline instead of tracking straight over the toes
Decreased depth of movement
Inability to tap the heel to the ground with the step down test
Loss of balance
Excessive anterior pelvic rotation
This is when the pelvis tilts forward too much, which closes the space available in the hip joint
According to research these altered biomechanics may result from strength deficits, joint mobility deficits, motor control deficits, and pain or inhibition. They may also be movement strategies patients use to decrease hip impingement positions.
Research found that improved movement control on the step down and single leg squat test is associated with improved self-reported pain and function in patients with hip labral tears.
Which Clinical Impairments are Associated with Hip Labral Tears?
We categorize nonarthritic hip pain into the following groups based on clinical exam: Femoroacetabular Impingement, microinstability, or both.
FAI
Pain and decreased tolerance to end-range motions that create bony impingement
Decreased muscle length
Hip flexors
Quadriceps
Hip muscle weakness
Abductor muscles
Rotator muscles
Lumbopelvic muscle weakness
Poor motor control with weight bearing single leg tasks
Microinstability
Symptoms increased with activities that strain capsuloligamentous joint structures
Often weight bearing external rotation and forceful extension (anterior microinstability)
May see global joint laxity (too much joint motion)
Hip muscle weakness (similar to FAI)
Abductor muscles
Rotator muscles
How does a physical therapist treat hip labral tears?
Treatment is based on clinical findings and the category of nonarthritic hip pain: FAI, microinstability, or both.
FAI
Patient education/activity modification to avoid or decrease excessive or repetitive hip flexion
Ergonomic considerations
Chair height adjustment: avoid low chairs
Driving adjustments: push chair back and/or change angle of torso to be less upright
Postural considerations at work to avoid excessive anterior pelvic tilt
Fitness & activities of daily living
Limit squat depth
Limit deep kneeling
Limit inclines or stair running
Sport-specific considerations or participation modifications. Speak with your PT about this.
Muscle flexibility exercises
If indicated, address hip flexors or quad tightness to minimize effect on pelvic tilt
Joint distraction and mobilization techniques to decrease pain and improve tolerance to movement in painful ranges of motion
Long-axis distraction
Lateral distraction using a mobilization belt
Inferior glide
Muscle strengthening exercises
Emphasize hip abductor and rotator muscles
Resisted clamshell
Resisted sidestep
Single leg bridge, etc.
Progress to weight bearing, combine movements emphasizing mobility in one plane while stabilizing in other planes of movement
Pelvis on femur rotation
Single leg resisted weight bearing external rotation
Trunk on pelvis rotation
Medicine ball throw
Task-specific exercises for strength, endurance, and neuromuscular control
Stepdown
Single leg squat variations
Lumbopelvic muscle strength and endurance exercises
Isometric stabilization (plank variations)
Dynamic stabilization with limb movement (resisted torso twist)
Microinstability
Patient education/activity modification to avoid repetitive end-range motions that stress passive stabilizers (hip extension and external rotation)
Exercise and sport modifications or limitations
Running stride (avoid aggressive terminal hip extension)
May need to avoid pivoting movements
Avoid forceful hip extension movements
Sport specific considerations or participation modifications (speak with your PT)
Consider performing exercises in joint mid-range until patient is asymptomatic and exhibits appropriate control at end-range
Muscle strengthening exercises (see FAI exercises above)
Temporarily modified activity and range of motion (ROM) are made initially to offload and protect the irritable hip joint until symptoms are stable and strength, flexibility, and movement control have been addressed. Depending on the patient’s fitness/activity goals, a gradual increase of motion and return to activity should be implemented as tolerated.
Here Are What We Believe to Be the Best Hip Labral Tear Exercises
Forward Plank
Strength and endurance in the abdominals will help to stabilize us in the sagittal plane and prevent excessive anterior pelvic tilt, a motion that makes hip impingement worse.
Progress from sets of 15 seconds, to 30 seconds, 45 seconds, 60 seconds, etc.
Progress further by adding a side step component
If too difficult initially, perform with knees on the ground or from an elevated surface
Side Plank
Strength and endurance in the obliques and lateral hip muscles will help stabilize us in the frontal plane and prevent valgus collapse and pelvic drop.
Progress by adding a clamshell or hip abduction
Start with short lever variations and progress to longer lever variations
Copenhagen Plank
Strength and endurance in the obliques and inner hip muscles to stabilize us in the frontal plane at the trunk, hip, and knee
Start with short lever variations and progress to longer lever variations
If too difficult initially, start with an adductor isometric (ball squeeze between inner thighs)
Single Leg Bridge
Strengthening the glutes will help us decrease excessive anterior pelvic tilt
Progress to single leg bridge with arms in the air to increaser stability demands
Progress to single leg hip thrust and progress further by adding weight
If too difficult initially, start with double leg bridge and progress to eccentric (up on 2 legs, down on 1)
Lateral Step Down
This will strengthen the glutes, quads, balance, and movement control in single leg all at the same time
If balance is a limiting factor, hold on to a wall or dowel
Focus on building strength with this exercise
Start with a 4 inch step and progress to 6 inch, 8 inch before adding weight
Progress to single leg squats
If too difficult initially, perform with less hip hinge and more knee bend. This will load the knee more and the hip less for now until loading the hip is better tolerated
Runner Up Exercise
Single Leg Deadlift
This one can overload the system
Work on hinge mechanics on both legs first before attempting single leg
Start with partial ROM into hip flexion
Gradually progress deeper into hip flexion if tolerated well (no increase in hip pain during, immediately after, and 24 hours after exercise)
Progress by adding weight
If balance is a limiting factor, hold on to a wall or dowel
Closing Remarks
These are general exercise recommendations based on the impairments commonly found in patients with hip labral tears. We hope you found this article helpful. As always, consult with an expert in this field so they can advise and guide you.
If you would like to work with us to resolve your hip pain, contact us below to speak with a physical therapist.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy