Managing Hip Labral Tears in Runners
A labral tear in the hip is an injury to the labrum, a ring of cartilage that surrounds the rim of the hip socket (acetabulum). The labrum helps stabilize the hip joint, provides a seal for the joint fluid, and assists with smooth, efficient motion. A tear can occur from acute trauma (like a fall or sudden twist) or repetitive stress, which is common in runners, especially those with tight hips, poor mechanics, or hip impingement. But surgery isn’t always the answer.
A research study from 2012 found that, on MRI, 69% of asymptomatic subjects had a labral tear. This is important because hip labral tears are common in active populations. Not all labral tears contribute to pain, and not all hip pain is caused by a labral tear.
What runners should know if they suspect a labral tear:
• Symptoms: Pain in the front or side of the hip, clicking, catching, or a feeling of instability. Pain may worsen with prolonged running, pivoting, or deep hip flexion, like prolonged sitting.
• Impact on running: Labral tears can limit hip range of motion and decrease force transfer, making running less efficient and potentially increasing injury risk elsewhere (like knees or lower back).
For mild tears, conservative treatment is usually the way to go, but every body is different. Here are a couple things I do, and help my patients do, to maintain happy hips:
Don’t aggressively stretch the hip flexors - The presence of a labral tear may cause a tighter anterior hip due to the joint instability. Aggressively trying to improve hip extension range can often flare things up.
Regularly strengthen gluteus medius and rotational hip muscles - according to the NCBI, 64% of patients with a hip labral tear have hip abductor weakness, due to inhibition. And poor pelvic stability can further stress the hip joint.
Keep feet strong and stable - since the feet are the only part of the body that touch the ground when we walk and run, their ability to dissipate impact forces determines the stress the rest of the kinetic chain receives.
Avoid prolonged sitting - hips and low back may not tolerate sitting for long periods of time, and it could exacerbate the tightness in the front of the hip. The more movement and lubrication you can get through your joints on the daily, the better.
Walk around in shoes with minimal cushioning - because of the inherent instability, the body may craves stability. The proprioception you get from walking around barefoot or in minimalist shoes can keep your body happy.
Labral tear pain that does not respond to conservative treatment may warrant a surgical referral. But labral repair surgery does not always help alleviate the pain, probably because there are other factors contributing. If you’re dealing with labral tear pain, consult with your doctor about your next steps.
