As a physical therapist and certified Pilates instructor, I specialize in helping patients return to their normal activities after suffering from hip pain. I have found that hip labral tears are one of the major sources of hip pain.
Hip labral tears are receiving increasingly more attention in medical literature with advances in the understanding of their role in hip and groin pain. One recent study noted that when imaging was done using magnetic resonance arthrography (MRa), 22% of athletes with groin pain had labral tears.1 Labral tears can occur traumatically when people fall or land on their hip area. However, most hip labral tears form slowly over time due to repetitive forces. Hip labral tears are more common in women than men, but can affect both genders.2 They frequently affect athletes who pivot and externally rotate their hips, especially: ballet dancers, runners, soccer players, golfers and hockey players.3
The hip is a complex ball and socket joint and has twenty-one muscles that cross it. The socket of the hip joint has a ring of fibrocartilage and dense connective tissues which help to aid in hip stability by deepening the hip socket. The labrum can also assist to reduce stress on the hip joint by increasing contact area during impact activities.4
Labral tears often lead to pain while sitting, pain with rotational movements in the hip, pain with running, and limitations in positions where the hip is flexed such as squatting and pigeon pose in yoga.
Pilates training with a physical therapist can often alleviate the hip pain associated with labral tears.
A physical therapist is uniquely skilled to determine the nature of hip joint dysfunction and pinpoint what mechanical issues are putting pressure on the hip joint and the labrum. Once the specific issues are identified, Pilates training is an excellent way to teach proper movement to help regain control of the hip joint.
Some of the muscles which power the hip joint also attach to the lumbar spine. Being able to move the spine freely and also stabilize the spine is very important. Not only is Pilates is a great way to teach segmental movement and spinal flexibility, but it also promotes engagement of the core muscles with activity.
In my experience working with patients with painful hip labral tears, I often find they have tight hip flexor muscles, weak gluteal muscles, and poor hip muscle coordination and control.
These individuals often find it difficult to disassociate their hips from their lumbar spine and move each separately. They can benefit from leg circles in springs to encourage holding their spine steady and moving their hips fluidly. Standing reformer exercises can be a great way to train lateral hip strength with these patients. They often benefit from standing hip abduction and adduction exercises such as side split and “speedskater” movements.
Pilates exercises to promote hip extensor muscle strength can also be beneficial such as footwork in neutral, first position and second position. Ensuring good lumbar positioning and stability with these postures is important to teach proper muscle firing.
In many cases, training and rebalancing the hip joint with Pilates can alleviate the pressure on the labrum which is causing the pain.
REFERENCES:
Narvani AA, Tsiridis E, Kendall S, et al. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc . 2003;11 :403– 408.
Hase T, Ueo T. Acetabular labral tear: arthroscopic diagnosis and treatment. Arthroscopy . 1999;15:138– 141.
Binningsley D. Tear of the acetabular labrum in an elite athlete. Br J Sports Med . 2003;37 :84– 88.
Cara L Lewis, Shirley A Sahrmann; Acetabular Labral Tears, Physical Therapy, Volume 86, Issue 1, 1 January 2006, Pages 110–121.
ASK PILATES PT
Having difficulty finding the right position during exercises? Don’t understand a recent medical diagnosis? Want to know how to target a problem area? You have questions, WE have answers! Don’t hesitate to email askpilatespt@gmail.com!
With Love, Scrubs, and Sidekicks,
