Just the sound of a tear sounds painful but maybe not?
First of all, what is a “labral tear”? The hip socket is like a small cave with a labrum or cartilage/connective tissue lining the inner rim, which is called the acetabulum. The top of the leg, which consists of the femoral head (top of the femur) fits within that little cave and sits next to that acetabulum’s labrum.
There are many patients who complain of hip pain to their physicians, who may then send those patients to receive hip Xrays or MRIs. If a hip joint labral tear is diagnosed by MRI and the patient still has pain, then it is not uncommon to be referred to an orthopedic surgeon who does surgery for labral tears. However, not all patients get better from surgery.
The reality is there are many people with hip joint labral tears but not all of them have pain:
A May 2015 study revealed that of 70 young adult volunteers who had NO pain in their hips, 27 of them (38.6%) had labral tears by MRI findings. There was an isolated finding in 16 (22.9%) and other joint diagnoses in 11 (15.7%). The message here is that there should be confirmation that the history and physical lines up with an MRI finding. MRI findings alone may not be the reason for pain. Thus, assuming that a “tear” means it should be fixed by surgery is not always true nor is the diagnosis-to-pain connection that simple. (1)
The above study was not the first of its kind. In 2012, a study with 45 volunteers of a wider age range (15-66 years old) with NO history of hip pain, injury, or surgery were evaluated with MRIs as well. Labral tears were found in 69% of hips. Multiple other diagnoses were found in others as well. The older the patients were the more cartilage degeneration such as cartilage defects and subchondral cysts. Again, NONE of these volunteers had pain. (2)
An August 2015 study revealed that of 208 patients WITH hip pain who were older than 50 years old and underwent hip Xrays and MRIs, 93% of them had labral abnormalities (73.1% labral tearing, 20.2% labral fraying or degeneration). If they had moderate to severe osteoarthritis changes, then 100% of them had labral abnormalities (73.1% labral tearing, 26.9% labral fraying or degeneration). It is suggested that only those patients with chronic hip pain who are good surgery candidates and have Xray evidence of a good distance between the femur (upper leg bone) and the tibia (lower leg bone), should get an MRI study. Otherwise, labral tears will be overdiagnosed by these MRIs and suggest that they are the source of pain leading to potentially unnecessary or unhelpful surgeries. (3)
So, what should people do who have hip pain without a strong reason to get an MRI or have surgery? A small single-subject research study addressed 4 patients who had known acetabular labral tears with hip pain on the side and to the back of the hip region. Soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae were done over 6-8 weeks. All 4 patients experienced statistically and clinically significant improvement in hip pain and function. Three of those patients also experienced hip pain relief toward the front of the hip, not just the side and to the back of that hip region. Although this is a small study, it is worth noting. These patients did not receive surgery and became better. (4)
What’s the take-home message?
There is more to hip pain than just labral tears and degenerative changes. The problem may not be where the pain is perceived. Many therapists of various kinds offer alternatives other than surgeries. They may address strength, flexibility, stability, proprioception, and a balance of many factors. There is no doubt that multiple factors and parts of the body contribute to the amazing human body system, which is suspended and operated in a very intricate and coordinated manner.
If you have a labral tear, it may not be the cause of your pain, but it could be the effect of other issues, which may be leading to your pain. Not all therapist or body assistants are the same. It may take some hunting, but considering a practical and logical approach with lower risk options is sound advice.
(1) Lee AJJ et al. The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. Bone Joint J. May 2015, 97-B(5), 623-627. doi: 10.1302/0301-620X.97B5.35166.
(2) Register et al. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012 Dec;40(12):2720-4. doi:10.1177/0363546512462124.
(3) Jayakar R et al. Magnetic Resonance Arthrography and the Prevalence of Acetabular Labral Tears in Patients 50 Years of Age and Older: Is It Really Indicated? Orthopaedic J of Sports Medicine. August 3, 2015 3(2) suppl. doi:10.1177/2325967115S00085.
(4) Cashman GE et al. Myofascial Treatment for Patients with Acetabular Labral Tears: A Single-Subject Research Design Study. J Ortho Sports Phys Ther. 2014, 44(8): 604-614. doi: 10.2519/jospt.2014.5095.