Hip stability is critical for runners. It helps enforce proper biomechanics as you repeatedly land on a single leg, is regained, therapy will progress to throughout your lower body. And the labrum, a ring of strong fibrocartilage that lines the socket of the hip joint, helps to protect the hip during the thousands of steps taken on the run. When it is healthy, the labrum plays an important role in cushioning the joint and distributing load as you stride.
Although traumatic injury is responsible for some labrum tears, repetitive use and activity can also cause damage to the cartilage ring. These tears are commonly associated with sports like soccer, hockey, and golf, but the repetitive motions in running means labral tears can affect us too—especially if you already have any irregularities in your hip structure.
All About 75 Hard weaknesses in muscles around the hip is enough to get you back to your weekly mileage. However, with multiple other structures in the hip and with pain symptoms similar to other conditions, it can take time to both diagnose and treat a hip labral tear injury.
Here’s what you need to know about labral tears—the causes, symptoms, and treatment options—to get you on the right path to running pain-free again.
Causes of a Hip Labral Tear
Most labral tears are caused by an underlying structural variation. That includes hip impingement, when bones bump into each other in flexed positions, or hip dysplasia, when the socket part of the joint is either too small or not in the right position creating instability, says Chad Mather, M.D., an orthopaedic surgeon dealing exclusively with hip injuries and hip arthroscopies and associate professor of orthopaedic surgery at Duke University School of Medicine in Durham, North Carolina.
“[The labrum] can either be pinched and torn by impingement or it can be stretched trying to stabilize the joint in hip dysplasia,” he explains.
Join Runner's World+ for unlimited access to the best training tips for runners
How Weak Glutes Can Affect the Pelvic Floor strength of the muscles around the hip joint can further influence the impact of these structural imperfections. “If your hip abductors are weak or they fatigue too quick, that puts a lot of strain on your hip. And so that can contribute to another part of the stability equation being abnormal—a structural problem and a muscle problem. That’s how, oftentimes, you can experience an issue,” Dr. Mather tells Runner’s World.
Also, just because you have one of these structural variations does not always mean it will cause you problems. According to Dr. Mather, 30 to 50 percent of the population may have dysplasia or impingement with no symptoms. “I always like to say there are three contributors to whether you have symptoms from [structural issues]: You have the underlying structure, the way that your body moves, and then what you choose to do with it,” he adds.
Because runners may work the hip more vigorously than the average person, you may begin to exhibit symptoms earlier than someone less active.
Symptoms of a Hip Labral Tear
Nutrition - Weight Loss your hip, weaknesses in muscles tendonitis, bursitis, or even muscle strains and can vary from individual to individual. This makes it tricky to determine the problem and the most effective treatment—0ne of the reasons labral tears are frustrating to runners anxious to get back to their regular training plans.
“Hip pain can take many forms. Most commonly it hurts in the groin, but it can be a C-sign distribution, where you’re grabbing your hip and it kind of hurts everywhere. It can Should You Keep Running If You Have Pain, it can hurt along the side [of the hip], it can hurt in the groin. Sometimes it can actually be referred up to the low back—that’s not uncommon at all, especially in runners,“ Dr. Mather explains.
If you do a have a tear, turning, twisting, or squatting may cause sharp pain or you may have a more constant dull ache. Patients with labral tears may also notice clicking, catching, or other mechanical sensations.
Even elite distance runner Taylor Ward, who regularly works with a massage The Best Exercises for a Hip Labral Tear muscle strain. Just a few weeks after finishing 29th at the U.S. Olympic Marathon Trials, Ward, a 2:30 marathoner, felt a sharp pain in her hip on a hilly run. When the tightness in her hip didn’t go away after eight weeks of rest, cross-training and various forms of therapeutic care, she sought additional medical advice and imaging to try to correctly diagnose and treat her pain.
“We were treating it as a psoas strain, working with my massage physio to relax, calm down, let it heal. We were treating it as such, but then I was starting to have really bad problems with my adductors and it just seemed like no matter how much work we did on it—whether it was dry needling or massage, stretching, rolling out, all those things—it would not respond like it should have,” Ward tells Runner’s World. “It would still get so intensely tight no matter what work we did. So that’s when we started to feel like it was a protective mechanism...we were having issues with those other muscles, but more so because they were protecting the joint.”
How a Hip Labral Tear Typically Gets Diagnosed
Everything You Need to Know About Hip Pain rest and activity modifications, your physician may order medical images, like an MRI, to better view the area and identify damage to the labrum. Sometimes doctors will inject a dye into the joint to provide greater detail in the images, called an MRI arthrogram.
Dr. Mather also notes that diagnostic injections (different than the injection used for the arthrogram) can also be a very valuable tool for physicians. Injecting a numbing medication into your hip joint will reduce symptoms and allow the doctor to better understand if the pain is coming from your hip, or somewhere else.
Also, even if you suspect a soft tissue injury, an X-rays can be helpful, as it shows the variations in your hip shape that might cause the actual labrum tear. “There are specific types of views that can better show and quantify things like the amount of dysplasia or the amount of arthritis that you have or the amount of bony impingement that might show up,” Miho Tanaka, M.D., orthopaedic sports medicine surgeon, founding director of the Women’s Sports Medicine Program at Massachusetts General Hospital, and faculty member in the Department of Orthopaedic Surgery at Harvard Medical School, tells Runner’s World.
However, it’s important to remember that MRIs and X-rays are only part of the equation and need to be considered alongside the patient’s symptoms. In Ward’s case, both her X-rays and MRI arthrogram showed a cam impingement—a bump on the femoral head, or ball of the hip joint, that grinds the labrum—but not hurt in the buttock.
Fortunately, she trusted her body enough to recognize something else might be at the root of her pain. “And as it continued to not progress and not get better, I did start to have those doubts that something more is going on. It’s more than just a strain, it’s more than just the impingement,” says Ward.
Dr. Tanaka adds, “I would say the one area that people always forget is the physical exam. Because it seems so old school and we rely so much on MRIs. They give us all of this data, but really the MRIs give us too much information… The real crux of treating any kind of hip pain is figuring out where the pain in coming from and that doesn’t always correlate to a structural problem that we see [or don’t see] on an MRI.”
Seeing a physician who specializes in the hip or sports medicine may also help achieve the correct diagnosis, and treatment, sooner.
How to Treat Hip Labral Tears
Treatment options for labral tears include surgical and non-surgical measures. For many, beginning with non-invasive options like physical therapy From physical therapy to surgery, learn how to deal with this pain in the hip.
While physical therapy won’t heal the labrum, it can strengthen the muscles A Hip Thrust Workout for Stronger Glutes.
“Doing some conservative care with physical therapy, working on the surrounding musculature and the joint mobility and things like that, can be very effective for people and there are people that can avoid having surgery,” Jessica Douglas, M.S.P.T., O.C.S., a physical therapist with a specialty certification in orthopedics and director of clinical operations at Joint Ventures Physical Therapy in Boston tells Runner’s World.
A physical therapy program should be catered to the individual, but in general will first seek to restore mobility in the joint with some stretching How Weak Glutes Can Affect the Pelvic Floor mobility is regained, therapy will progress to basic strengthening. strengthen the muscles side planks, sidelying leg lifts, and clamshells to strengthen the muscles in and around the hip.
What to Know About TFL Pain in Runners squats. “Once all of these exercises can be completed with appropriate form and without pain, then the patient can start working on plyometrics [like] hopping, jumping and skipping to load the joint in the way it will be loaded with running. With all of these activities, correct form is most important, and the therapist shouldn’t progress to the next step until the patient has the full range of motion, with good alignment/control, and without pain,” says Douglas, a runner and triathlete who has also had a labrum tear herself.
In general, Douglas suggests giving physical therapy a try for about two months to see if the changes in strength and motion alleviate your symptoms. However, the therapist should continually reassess your progress and you should consider revisiting your doctor if your symptoms are not improving as expected.
Even if you find that physical therapy is not getting you back to pain-free running, the strength and mobility gained from the process is still beneficial, including better preparing your body for surgery, if you make that choice. Physical therapy can reduce inflammation as well as reengage muscles that might take stress off the hip joint, says Dr. Tanaka, improving surgical outcomes and providing a foundation for recovery later on.
If you’re considering surgery, it’s important to weigh the costs and benefits including the overall safety of the procedure, the likelihood it will help you return to the level of function you are seeking, and your ability to invest your time and effort in the proper rehab.
Most importantly, Dr. Mather advises the surgery should align with the cause of the problem—not just repairing the torn labrum. “In the hip we have two major operations—we have arthroscopy and we have osteotomy. Osteotomies change the position of the bone. And arthroscopy is very good at removing bone, but it cannot change the position of the bone,” he explains. “So if the [cause of hurt in the buttock] is hip dysplasia, arthroscopy is probably not going to help that, especially if it’s more severe. If the [cause] is exclusively impingement, then arthroscopy is very likely to work.”
What Recovery from Labral Tear Surgery Looks Like
Getting back to running is highly likely after many labrum repair surgeries, especially if you follow a return-to-running program prescribed by a knowledgeable physical therapist. Although runners may be excited to hit the pavement again, taking your recovery step by step will ensure you do not undo the work the surgery aimed to correct.
Post-operative physical therapy follows the same progression as in treatment, but accounts for the pain and mobility restrictions resulting from the surgery. It will typically start with pain and mobility management and progress to strengthening and motor control.
Douglas says she usually doesn’t have patients running until their activities of daily living are completely pain-free and unrestricted. “And they need to have really good strength in the muscles that support the hip, glutes, hamstring, quadriceps, and the rotational muscles of the hips,” she says. They also need to be able “to tolerate some more dynamic exercises—that includes plyometrics—before we’re going to start into doing a running program,” she adds. “I like to be conservative with that because I want people to be successful.”
Much like the symptoms, recovery time is affected by multiple factors including injury severity and the type of procedure. After a long process to diagnosis and treatment, it can be disappointing if recovery goes slower than planned.
Ward was finally able to start running about six months after her surgery. Although the wait was frustrating, she took comfort in knowing she made informed decisions and did everything she could to treat her hip labral tear injury. She stayed positive by trusting her body was strong enough to recover. “After the surgery, it was really tough, it was really painful. And I just kept telling myself…I made this decision. And it’s a long process. I’m going to get back to being able to run and compete at the level that I want to,” says Ward.
