What is a hip labral tear?
by Meghan Griech, PT, DPT, cert MDT, CKTP
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Hip impingement, more specifically, Femoral acetabular impingement (FAI) can develop for many different reasons; however, the exact cause is often unknown. There are two specific types of FAI that can occur, one due to the shape of the femoral head and the movement within the acetabulum (joint socket), and the other from an overgrowth of the anterior (front) hip tissues causing a pinching of the tissues during certain movements… but more about that later.
The hip joint is a ball-and-socket joint that attaches the femur (long leg bone top end) to the pelvis. The hip is one of the most mobile joints in the human body, with abilities to move forward, backward, rotate, and a combination of movements. The movement of the femoral head and the acetabulum (pelvis socket) need to be congruent in shape and the tissue needs to be structurally strong otherwise adverse movements or pinching can occur.
There are two main types of Femoral Acetabular Impingement (FAI), CAM or Pincer, yet you can have a combination of these also. A CAM Impingement is caused by a deformity of the femoral head (ball). In this type of impingement, the ball has a more oval than round appearance which creates friction when the ball hits the edge of the acetabulum.
For many people, the abnormal shape is thought to have been present since birth. It is also possible to develop this abnormal shape over time and is seen more frequently in young athletes that participate in sports involving a lot of twisting of the hip and squatting. Pincer is the second type of impingement that occurs when the acetabulum is abnormally shaped. The acetabulum may cover the head of the femur too much, creating friction when the edge of the acetabulum hits the head/neck of the femur. Oftentimes, bending the hip greater than 90*, knee higher than the hip causes an increase in pain in the front of the hip.
Most patients with FAI experience pain or stiffness in the groin or front of the thigh.
While the CAM style of impingement pain most often occurs due to repeated irritation of the tissue in certain positions, it is also most prevalent in middle-aged women. The pincer type of impingement most often occurs during a child’s development where extra bone growth in the hip socket.
Normally, the ball glides smoothly within the socket, but a problem with the ball or socket rim can interfere with smooth motion. Trauma from repetitive hip flexion damages the cartilage of the socket, leading to hip impingement or femoral acetabular impingement (FAI). It is believed to be a major cause of early osteoarthritis of the hip, particularly in those under age 40.
Hip impingement can lead to loss of rotation of the hip, especially internal (rolling your leg in). That triggers pain in the groin area during or after flexing the hip, such as when you sit for long periods of time, run or jump. Over time, impingement of the hip may tear the labrum, the fibrous ring of cartilage surrounding the hip socket that acts as a suction cup to maintain the femoral head into the acetabulum.
Hip impingement also may damage the protective cartilage that covers the ends of the bones in the joint, called articular cartilage. That can wear down the cartilage over time and eventually make it deteriorate completely leading to osteoarthritis.
Those with hip pain and concerned about the loss of motion of their hip should focus on maintaining their current motion while trying to move in ways that doesn’t increase their pain.
What you can do
Maintaining mobility while reducing irritation to the hip is key. Modifying your daily, job-related, and sports activities will be beneficial to reduce tissue inflammation, tissue stress, and progressive pain. Reducing the amount of time sitting in one position will alleviate tissue pain from compression forces. Walking with short steps to reduce stride length will reduce front hip tissue pressure and possible pinching.
Activities focused on improving lower-extremity muscle flexibility and joint movement will be beneficial. Stretching tight muscles around the hip will reduce abnormal forces that cause pain with motion, while stretching other joints, especially those related to walking (knee, ankle, foot), may decrease stress at the hip.
Improving the strength of your lower extremities and trunk will help to reduce added stress and overworked muscles around the hip. Strengthening the hips and trunk can reduce abnormal forces on the already injured joint.
*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result. This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional. No guarantees of specific results are expressly made or implied with this article.