HIP LABRUM TEAR MYTHS
Finding out you have a hip labral tear can be a pretty unsettling experience. Consult with Dr. Google and you'll find a wide variety of opinions on what your future holds, from doomsday 'you'll never be the same' to toxically positive 'you're totally fine, lots of people have them!'
The most helpful and factual advice probably lies somewhere in between - this can be a tough injury to recover from, but it is possible to manage and return to a pain-free, active life without surgical intervention.
As someone with a labral tear in each hip who continues to run marathons and someone who regularly works with runners with a history of or currently struggling with a labral tear, I want to share some myths about them:
Let's get into each of these in more depth:
1. Myth: You need surgery.
Fact: Many people do well with conservative treatment - even getting back to all the activities they love (running, cycling, squatting heavy, CrossFit) without pain. It turns out that asymptomatic labral tears are pretty common - meaning there are many people out there living life with labral tears that don't cause them pain. It's been suggested that labrum pathology seen in routine imaging may in some cases “represent an incidental finding rather than the underlying cause of the patient’s pain” (see references below for more info!).
With that said, some of us do have pain caused by the labral tear, but we don't necessarily need to have it surgically repaired for us to heal & recover. Not many studies exist comparing outcomes of surgical to nonsurgical management, but the studies that have been done have not found surgery superior to conservative treatment at 2 year follow-up. Our bodies are incredibly adaptable and a logical, progressive rehab program can be just as, if not more effective than surgery in getting you back to your life.
2. Myth: You should limit deep squatting, cycling & intense running forever.
Fact: Your body is capable of healing & adapting back to whatever movement patterns and exercises have been aggravating in the past. Many people with symptomatic labral tears have gotten back to running marathons, CrossFit, heavy weightlifting, Ironmans and more!
3. Myth: Pain is a sign of more damage.
Fact: When I was in the middle of recovery, I was convinced that still having some low to moderate levels of pain meant I would never be able to run again - but I was wrong! Pain doesn't mean that you're causing more damage or a bigger tear - think of it as a sign of stress or sensitivity versus harm. Oftentimes it's actually helpful to work through low levels of discomfort to help your body re-adapt to various activities, and typically pain starts to decrease as you continue each activity provided you progress gradually.
Lee, A. J. J., Armour, P., Thind, D., Coates, M. H., & Kang, A. C. L. (2015). The prevalence of acetabular labral tears and associated pathology in a young asymptomatic population. The Bone & Joint Journal, 97(5), 623-627.
Schmitz, M. R., Campbell, S. E., Fajardo, R. S., & Kadrmas, W. R. (2012). Identification of acetabular labral pathological changes in asymptomatic volunteers using optimized, noncontrast 1.5-T magnetic resonance imaging. The American journal of sports medicine, 40(6), 1337-1341.
Tresch, F., Dietrich, T. J., Pfirrmann, C. W., & Sutter, R. (2017). Hip MRI: prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. Journal of Magnetic Resonance Imaging, 46(2), 440-451.
Mansell, N. S., Rhon, D. I., Meyer, J., Slevin, J. M., & Marchant, B. G. (2018). Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. The American journal of sports medicine, 46(6), 1306-1314.