In February, I started experiencing pain in my right hip. I am a 45 year old male. 6’-2” 195lbs. I am not a long distance runner. I do a lot of high intensity training (uphill sprints, burpees, air squats, etc.). I don’t lift heavy weights, mostly body weight exercises. The pain wasn’t too intense but it has gotten worse. It was a dull throbbing deep in my groin, especially when I cross my legs. I also had pain in the front and outside of my hip. I kept training through the pain and ended up developing pain in my left knee (opposite side). This made me slow down and I went to see Dr. John Salvo at the Rothman Institute in Philadelphia. My x-rays looked good so he sent me for an MRI with a dye injection and a CT scan. The MRI showed a large tear in the anterior labrum of my right hip. The CT scan showed NO impingement (FAI). Based on everything I’ve read, this is unusual. Most labral tears are caused by impingement. Dr. Salvo recommended 6 weeks of PT to see if my conditions improve. The PT tested me and said my glut, core and hip strength is very good, so he gave me some stretches. Here’s my question: is there any reason to go through the 6 weeks of PT instead of just scheduling my arthroscopy? I’ve become deeply depressed over my situation. I would very much appreciate any suggestions. Thanks.
I’m not saying don’t try the PT, but if you are set on wanting the procedure, why not schedule it ASAP. Will the doc only do it after he sees if PT alleviates the pain?
I had mine done in July of 2012 and after two shoulder surgeries, it was a piece of cake. Back at work in a week, walking (crutchless) in like 10 days and started running progressions (alter G) and riding again a couple months post op.
First of all, sorry to hear about your disposition. I tore the labrum in my right hip back in late Aug 2013 and visited Dr. Adickes in Houston, who is a pioneer of the labrum repair surgery. I went through a similar diagnosis: x-ray, x-ray with dye and then full-on MRI. Both the x-rays and the MRI confirmed the tear with no impingement. Dr. Adickes asked me what was more important, getting better now or getting better later. I opted for now and went through the surgery, and cannot be happier with the results. Along with the surgery, I did 3 months of physical therapy which basically strengthens the surrounding tissues and gets rid of your bad habits (which caused the injury). So to me, surgery and 3 months of PT > 6 months of PT. I as able to return to work in a week and was walking with a brace in 2 weeks. After 3 months of PT, I was released to begin training again. There is still mild pain associated with the injury but I am 99% and competing in Olympic distances again.
Hope this helps.
First of all, sorry to hear about your disposition. I tore the labrum in my right hip back in late Aug 2013 and visited Dr. Adickes in Houston, who is a pioneer of the labrum repair surgery. I went through a similar diagnosis: x-ray, x-ray with dye and then full-on MRI. Both the x-rays and the MRI confirmed the tear with no impingement. Dr. Adickes asked me what was more important, getting better now or getting better later. I opted for now and went through the surgery, and cannot be happier with the results. Along with the surgery, I did 3 months of physical therapy which basically strengthens the surrounding tissues and gets rid of your bad habits (which caused the injury). So to me, surgery and 3 months of PT > 6 months of PT. I as able to return to work in a week and was walking with a brace in 2 weeks. After 3 months of PT, I was released to begin training again. There is still mild pain associated with the injury but I am 99% and competing in Olympic distances again.
Hope this helps.
Sounds very similar to my results. I’ve been slow to amp the run mileage, but been biking over 100+ miles a week since like November (4 months post op). I was scared because it was the hip, but I lose a whole season last year dealing with the same issue…x-rays, MRI, etc. and electing surgery feels like throwing in the towel, but my only regret was not doing it sooner.
Thanks LSUfan, what you wrote is very encouraging. I’m not sure if my doc will refuse surgery until after PT. My last appointment was on Tuesday 15th. That’s when he told me to do 6 weeks of PT. I scheduled another appointment on Tuesday 29th to discuss the things I mentioned in my first post. Not sure what I’ll do if he says absolutely “NO” until 6 weeks of PT.
Did you have impingement (FAI)? If so, was it repaired (bone shaved) during your surgery? 10 day and beginning activity again is awesome!
Klbel, I couldn’t agree more with your attitude. I want to get better now. I don’t want to wait and wait only to end up having the surgery. Why not do it while my muscles are still strong. Stopping all activity and only stretching will result in muscle loss.
BTW, what do you think about the claims of unrepaired torn labrums leading to arthritis?
Based on what you said about impingement, Dr. Adickes didn’t do anything to your bones, correct?
The surgical vs conservative treatment approach is largely based on symptoms. Many times the pre-surgical PT is ordered to attempt strengthening of involved structures for pre-hab (to optimize surgical outcome and recovery) or to see if they can make some progress. And sometimes the insurance companies wont authorize until a “bout” of PT is tried.
Regardless, a bad PT wont do anything but slow the entire process. A good PT will be able to offer you more than simply stretching. I’m sure you do have good strength for a 1 rep manual muscle test on most of your muscles but thats not going to help identify weaknesses. Find a good rehab specialist who is going to look at your injury in a wide scope to identify true areas that can be addressed to help the situation.
I have treated many post-op hip scopes (athletes and non-athletes) and there are good results. Some people will always set the curve apart and return to activity quicker than others. But surgery is surgery and some may have lingering post-surgical complications. No rhyme or reason sometimes. So this is ALWAYS something to consider when going the surgical route. The capsule will be tighter and the psoas/rectus tendons are at risk for overuse if they are overused too soon after.
Depending on the extent of the injury and your symptoms, there is also a chance you can heal without surgery if you find a real good rehab specialist. My coach is a DPT and has a labral tear after a bike crash couple of years ago. He has been training and racing since without issue. To some, this is the dividing line.
Sometimes the 6 weeks isnt “prolonging the inevitable” as much as it is testing the waters to see if some real progress can be made to prevent a major procedure. A good rehab plan should be able to find results in a few visits and see if the results are lasting over a few weeks, so 6 weeks isnt really a magic number.
Everyones situation is different and I say do some research and try to find a solid rehab plan, one that focuses on more than just “stretching” You should be working on much more than that IMO to find any results.
There is some merit to the increased risk of joint degeneration with instability.
Best of luck
From what I have been told, there is an extremely high propensity for arthritis if the labrum is left unrepaired. Correct, I did not need any bone shaving to fix my issues. They repaired the labrum tear with sutures and then stretched the iliopsoas by shaving down the soft tissue underneath it. This is also a fairly common procedure once the doc is in with the scope. They called it “cleaning out the cobwebs.”
I have a labral tear in my left hip, saw 3 surgeons, pt etc. My insurance carrier (Anthem) won’t cover the surgery until after 6 months anyways. That is why surgeons wouldn’t touch me until the 6 months had passed. I found out all of my pain was due to having two inguinal hernias right over the left hip. Once I recovered from that surgery to repair the hernias this past December, I had zero pain in my hip…so far. I just completed a 70.3 this month with zero hip pain…mind you I did only walk/jog the run course. I didn’t try running until this race… but now i’m thinking I need to start running and see what happens. Good luck. I am waiting on the whole hip surgery thing for now.
The pre-op PT for a hip labral tear should be all about building stability and not compromising that stability by stretching.
Please note that garden-variety PT prior to surgery hasn’t really been shown to be beneficial. Many surgeons feel more comfortable asking for PT to do be done as it covers off the conservative management bit. Always choose a PT who is highly experienced with labral tears. A bad PT can cause a devastating aggravation of the hip injury. I’m living proof. My PT decided I wasn’t extending my hip enough and did a proprioceptive neuromuscular facilitation (PNF) modality that tore my hip apart and left me crippled and unable to work.
I am awaiting surgery which is four months away here in Canada. I have a small mixed FAI and one huge anterior tear and one smaller posterior tear that will need to be fixed along with whatever they find inside when they open me up.
I’ll include a great article on hip PT for labral tears post-op which has some great background information too. The initial phase exercises might be alright to try as they’re very conservative and won’t compromise the tear if you are careful. Go easy and make sure that you feel no pain during the exercise or up to a day after. http://www.ncbi.nlm.nih.gov/...articles/PMC3325633/
Thanks everyone for your well thought out responses. I just got back from PT and I had a talk with the therapist about my concerns. He understands and explained that he just wanted me to do some stretches and core strength exercises to start. Today, he added 5 more exercises (clam, knee to chest, etc.). I felt better about this but my I’m still struggling with the fact that PT is just delaying the inevitable. Am I incorrect? Someone please set me straight. I have been unable to find anything online documenting long term recover from labral tears without surgery. Maybe I’m just not looking in the right places.
I have tears in both hips, and have been managing mine with PT only for several years. Do I have zero pain all the time? No. But it is certainly manageable. Honestly, even the better hip surgeons around here have warned me against surgery, except as a last resort. Which is sort of how I am treating it. I am fine with letting someone saw my femur in half and put me back together, but I am avoiding a hip scope like the plague. 
That’s a great story. I appreciate your honesty. I don’t want surgery. I wish I knew, for sure, if this labral tear is going to increase my chances of arthritis and eventual hip replacement. I know that’s probably a bit extreme, but that seems to be what others are saying.
Did someone saw your femur in half???
That’s a great story. I appreciate your honesty. I don’t want surgery.** I wish I knew, for sure, if this labral tear is going to increase my chances of arthritis and eventual hip replacement**. I know that’s probably a bit extreme, but that seems to be what others are saying.
Did someone saw your femur in half???
There is definitely science pointing in that direction, but even if it was proved to be true and accurate, it doesn’t necessarily mean it would apply to every individual as well.
The decision for me was do I try and manage something that causes pain and (according to my doctor and many other experts in the field) not fix a condition which leads me to earlier arthritis and hip replacement without any real sense of reassurance that my efforts would actually work and prevent surgery, or just delay it.
OR
have the surgery and be back to myself by the next season. Sure, surgery has it’s complications, but some of these guys are doing 40, 70, 100 hip scopes a year now and for a trialthete with deep water running, alter G, bike trainers, etc., we can be active again in a matter of weeks post op.
Of course, I am biased but I am a doer and would rather regret the decision I made now, than delay making one and miss out. Doesn’t mean I am right by any means.
How bad was your pain before the surgery? Was it debilitating or just a dull ache?
Got to the point of debilitating before we hit it with cortisone.
Long car rides, more than an hour or so sitting at my desk. It wasn’t a pain as a throbbing fatigued sensation. The pain really only came from running, BUT mine was impinged so slightly different.
mcmric,
Its very hard to compare your injury to others. Each injury has a unique presentation and will limit each person differently. I know you are looking for answers to help you make you decision but it really comes down to your own personal struggles from the injury.
Pain is always the #1 limiting factor and usually pushes people towards treatment options. The posters above with anecdotal experience may or may not have had the same levels of pain you have and the same physical limitations. So their decisions were made based upon their individual situation.
As far as complications: surgical options always pose inherent risks from the anasthesia to the physical procedure itself. And is not a guarantee. Conservative options also have the possibility of minimal gains and continued symptoms. High success rates with surgery. High Success rates with PT.
I always determine my patient’s goals and treatment is generally prescribed with them in mind. If I’m treating a patient and I’m not seeing some sort of result in the first 2-3 visits then I re-assess and change my approach. If I’m confident in the rehab and we’re not seeing LASTING results after 3-4 weeks consistent with them reaching their goals then I usually take a step back and we have a different talk.
How bad is your pain, meaning, how much does it limit your everyday function? Then how much does it limit your complex activities/training/etc. Have you given it an honest and true chance to rest/heal (many of us do not)?
If you think about it, 4-6 weeks is really not a long time considering long-term outcomes. I’m talking more about the fear of joint degeneration you mentioned. In terms of training and triathlon, sure you may throw a kink into your season. But sacrificing one season if it means a true chance to avoid surgery, may be worth it. There can always be more seasons.
Yes there is a risk of joint degeneration with instability but the same can be said for all joints. Knee instability as a result of ACL injury has been shown to increase articular cartilage degeneration but stability does not come from ligaments alone. In another thread I mentioned professional athletes who are ACL deficient and they perform very well because of their quad strength. The muscles act as secondary stabilizers and provide the necessary strength for the knee to function properly without malalignment and extra wear and tear.
I’m a PT and have a slight bias towards conservative treatment. My father is an Orthopedic/sports med surgeon so I have a nice view from the other side of the fence too. There are certainly benefits to both options but my father has always said avoiding surgery is a much better option if the person can maintain their goals. Even the most least invasive procedures have risks and present an entirely different healing process.
I hope you can weed through all of the info and at least get a better handle on the options. It seems like you’re very stressed from the situation and decision to be made, and understandably. Get multiple opinions and a thorough evaluation of your current baseline. Hope this helps sort through the fog.
Thanks Yepper. After much consideration, your comments and a visit to another orthopedic doctor, I am going to stay the course with PT.
You’re right; I need to avoid surgery at all costs. My x-rays and CT scan show no sign of impingement. I’ve made a decision to work towards eliminating the pain and to stop focusing on the fact that the tear may never heal.
My pain is moderate to mild. I am not working out at all because I want to get better as fast as possible. This is really creating a mental struggle for me.
From your experience how long does it take most people with labral tears to become asymptomatic?
I have a young runner who has a labral tear, she also has a hip impingement, she is planning to have surgery and her ortho has advised her not to run. Her pain is manageable but the doctor said with a tear the fluid leaks out which could cause cartilage damage and that won’t be able to be repaired should it wear away. Any thoughts on that, she really wants to run?
I don’t know about the increased risk of arthritis - for what its worth I lived with a 3rd degree labral tear and FAI that was painful every single day for 15 years before I had it repaired. I now have a tear in the other hip, but its not hurting every day, so I am leaving it alone. The operated hip/leg have new problems since the surgery - weak glutes, IT band tightness/pain, and decreased ROM and capsule stiffness that I have to constantly work on. Was it worth it? Yes -but it was trading one problem for a different one. You have to decide for yourself. No harm in waiting 6 weeks, or 6 months for that matter IMO.