Athletes and people who do manual labor can develop painful hip labral tears. Some of these people may have been diagnosed with a painful hip labral tear after orthopedic tests and an MRI was performed by their doctor. The labrum, as described by the famed Mayo Clinic is a ring of cartilage surrounding the hip joint. The labrum helps stabilize the hip joint in the socket.
Painful hip labral tears are most common in athletes such as soccer players, hockey players, golfers as well as ballet dancers. What does a painful labral tear mean to your lifestyle and activity level? Trying to continue your activities as you did before the injury can be challenging when it hurts to move your hip.
Orthopedics and hospital systems have publicized the benefits of painful labral tear surgery. Current data shows that 17 percent of those having the surgery require another within two years of the initial surgery and there are other invasive options that are being developed to help repair or regrow tissue that may stabilize the hip. Other people feel much worse after the surgery and there is little consensus as to what a successful labral surgery is. Fewer doctors are now willing to perform these surgeries due to poor outcomes.
In extreme cases of painful hip labral tears, as I recently read in an article that was printed in popular science, a 39-year old opted for a hip replacement after two failed labral repairs on the same hip. He researched the current technologies being used and was convinced that the hip replacement and the materials used can easily last up to 30 years. Since he no longer has a hip joint or nerves in that area, he should be pain-free with an artificial hip. The newer materials used by today’s orthopedics he writes in his column for Popular Science Magazine wear better and integrate better in people’s bodies, improving outcomes. He also suggests that younger people are now considering this option although one should be skeptical about his claims since everybody’s situation is different due to body mechanics and the reasons for their hip pain.
Many of these medical hip labrum treatments or surgical failures respond well to chiropractic care. The question is, why did the patient fail to respond to a surgical repair? Our office has helped many of these patients by improving their overall body mechanics. The hip is only one part of the mechanism of walking and movement.
Understanding how we move, and how we walk is important to understand the mechanism of hip pain. The medical literature has many reports of asymptomatic patients who have herniated or degenerated discs in their backs as well as meniscus tears in their knees. It is not unreasonable to also assume that many people are walking around with asymptomatic labral tears as well.
Understanding gait and the forces that are placed through the hip socket.
Overpronation describes what happens on the ground when you take a step with your foot. Pronation is a normal part of how you walk. People with overpronation may have a foot that falls in and toes out such as is seen in this illustration.
When we take a step, the leg goes forward, and the heel contacts the ground. You then step forward to load the leg and approach mid-stance as your body moves forward to the next step. Gait is an unstable process but a strong core will make it function more appropriately and reduce the ground impact as it does so.
As we move toward toe-off, the foot needs to turn out slightly which allows the tibia (the lower leg bone) to rotate and allows the knee to flex as we take our next step. This process is known as screw home and is vital to knee stability and health. It is this author’s opinion that problems in the hip, ankle, foot or pelvis will affect the screw home mechanism and load the knee inappropriately, damaging it over time. This is ultimately why so many people develop knee problems that may be preventable with a thorough chiropractic evaluation.
With each step, you transfer force from the ground through the pelvis and upper body. If you overpronate, you will toe out too far just as you approach terminal stance causing the hip to drop. The myofascia, connective tissue that surrounds the muscles will tighten over time resulting in a loss of flexibility and overall mobility. The side opposite the side of overpronation will tighten along the lateral side in the lateral fascia of that leg, while the side of overpronation will tighten into the back of the leg. The result is a distorted core as you see in the diagram to the left. Ultimately, this altered way of walking can cause chronic stiffness and back pain as well as shoulder and other mechanical problems.
This type of body mechanics will not absorb shock due to the tight fascia causes discomfort in the groin and into the hip on that side. This type of adaptation can be painful over time and result in knee, foot and hip pain as well as lower back pain. The torsion will cause the pelvis to distort resulting in poor flexibility.
If the labrum becomes damaged in someone who has this as a mechanical gait problem, is repairing the labrum a solution when their body mechanics continue to impact the hip? This is likely why so many of these surgeries fail; the mechanism that caused the injury was never properly identified.
The Sports Chiropractic Approach may be the best first approach to care.
Chiropractic sports physicians have a unique holistic understanding of body mechanics and the musculoskeletal system that most medical providers do not. Resolving hip pain requires more than therapy or surgery; it requires understanding the patient and making the intervention fit the patient’s problem.
A thorough history and active evaluation are performed to observe how the patient moves and understand the mechanism behind the pain. Gait is observed as well as body symmetry.
An x-ray may be needed to assess the quality of the hip joints if the problem is chronic, as well as to evaluate spinal wear and tear. People with a chronic gait problem often have wear and tear in their spine and hips which is seen as osteoarthritis on x-ray. Other than pathology, degeneration as found on x-rays is a history of malfunction.
In the case of a painful labral tear, the overall stability of the joint is assessed as well. While many tissues help stabilize the hip, extreme hypermobility of the hip may require a referral. If the patient was diagnosed with having a painful labral tear medically, our evaluation will consider the diagnosis however, we will also look at the patient more holistically to get a complete understanding of why you hurt. Likely, the labral tear may not be why you hurt, and chiropractic conservative care can resolve or markedly improve the pain and the problem.
Treatment consists of spinal and extremity manipulation which can relieve hip pain. Poor motion in the foot and the surrounding musculature and fascia will cause hip and knee pain as well as back pain, which is often ignored medically, or you will be sent to multiple providers for multiple symptoms. Patients with gait asymmetries can have hip and back pain relieved by foot orthotics, both custom and off the shelf to level their hips and reduce the forces into the hip joints. Chiropractors regularly recommend and instruct patients on how to perform exercises to strengthen a region as well as myofascial release or instrument-assisted soft tissue methods to improve movement patterns in the hips and legs. As movement improves, the patient can do more with less or no pain. It is best to try a conservative chiropractic approach first, since invasive methods can cause irreversible damage, resulting in chronic intractable pain.
Chiropractors do this without drugs or surgeries and most people will feel better as they move better. Chiropractic approaches are effective and low risk.
Will the patient be able to return to their old activities with chiropractic care?
Athletes and regular folks rely on chiropractic care because they understand that better movement reduces pain and improves performance. Most patients will improve however, we may occasionally need to refer someone who has significant joint pathology. In some patients who have moderate to advanced hip degeneration, they can function without a hip replacement being done for many years with the proper care protocols done on a regular basis in our offices and at home.
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