Reading 'labral tear' on your MRI can bring up strong emotions. It's common to experience satisfaction at having an answer to your pain, vindication at being 'right' about having a serious injury, grief at the thought of giving up things that you love, fear about possible treatments, and confusion about what to do next.
A labral tear of the hip doesn't necessarily mean you need surgery, have to give up your training or even that you have the answer to your hip pain.
What is a labral tear of the hip
The labrum of the hip (the shoulder has one too) is a fibro-cartilage rim that circles the acetabulum, the socket part of the hip joint. It helps provide extra stability and shock absorption to the hip.
The labrum can be torn and may result in pain, catching, locking and restriction.
The common misconception is that dancing or doing the splits causes labral tear. Luckily, this is not the case.
Flexibility training is unlikely to put you at greater risk of a labral tear
Studies have found no significant difference in the incidence of hip labral tears, confirmed by MRI between aged-matched professional ballet dancers and participants of other sports. (Mayes, 2016). It seems unlikely that training flexibility puts you at greater risk of a tear, but a tear may affect your training more than other activities. That said, the above study actually found no significant correlation between hip pain, function or range between hips with and without labral tears. Older age and cartilage defects were found to increase the risk of a tear.
Of course, this doesn't mean a green light to train exactly the same way when you have a torn labrum. But more about that next week.
What else increases the risk of labral tears
The usual mechanism for an acute labral tear is loaded rotation, with extension plus external rotation as the mechanism for the more common anterior labral tear. This generally co-occurs with subluxation or dislocation of the hip joint. Individuals with hip dysplasia or connective tissue disorders can be at greater risk due to the potential for reduced stability of this joint.
More commonly, labral tears result from wear, which is why prevalence increases with age and Femoroacetabular impingement (FAI), a condition in which extra bone grows around the joint line of the hip. Cam deformities, in particular, are associated with excess wear to the labrum.
While there are factors that increase the risk of Labral tears they are widespread in the general population.
How common are labral tears in the hip?
We know that labrum tears are common in those with hip pain. A study that considered the incidence of labral tears in hips with symptoms of FAI, including pain, found that 96-97% of these hips had a labrum tear. However, the same study found a labral tear in 43-46% of the pain-free hips. Only 9% of these hips became painful/symptomatic over two years of follow-up (Vahedi, 2019).
While the magnitude of the prevalence of labral tears in symptom-free hips varies from study to study, it demonstrates that not only are labral tears common, commonly, they are pain-free. Analysis of people with symptom-free hips (ave age 37.8) found labral tears in 69% of hips (Register, 2012). More recently, a prospective study that followed 20 elite rowers (18-35) with symptom-free hips found that 95% of the rowers had at least one labral tear and 75% of hips (each rower had two hips) had a labral tear. Follow-up found that only 50% of rowers experienced hip pain during their careers (Wedatilake, 2021).
This research is significant because it means that labral tears may not be the source of hip pain, even if they are present, and having a tear doesn't mean symptoms will develop over time. Historically, surgery has been recommended to repair labral tears, but in light of this research, Vahedi (2019) recommended that the decision to operate be considered cautiously.
Part 2 will consider different treatment options and considerations for managing a labral tear.
Concerned about hip pain? Book a Physio appointment here.
Mayes, Susan PT; Ferris, April-Rose PT; Smith, Peter MD; Garnham, Andrew MD; Cook, Jill PhD. Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants. Clinical Journal of Sport Medicine: July 2016 - Volume 26 - Issue 4 - p 307-313
Register, B., Pennock, A. T., Ho, C. P., Strickland, C. D., Lawand, A., & Philippon, M. J. (2012). Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. The American Journal of Sports Medicine, 40(12), 2720–2724.
Vahedi H, Aalirezaie A, Azboy I, Daryoush T, Shahi A, Parvizi J. Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement. Clin Orthop Relat Res. 2019 May;477(5):974-979.
Wedatilake T, Palmer A, Fernquest S, et alAssociation between hip joint impingement and lumbar disc disease in elite rowersBMJ Open Sport & Exercise Medicine 2021;7:e001063.