A hip labral tear involves damage to the labrum, the ring of cartilage located on the outside rim of the socket of your hip joint. This is precisely where the thigh bone (femur) meets the pelvis (ilium). Tearing can be a result of repetitive twisting, cutting and pivoting movements, common among athletes who participate in sports like hockey, soccer, football, ballet or any other activities that require a lot of sudden movements and directional changes. A hip labral tear could also occur as a result of structural abnormalities that you’re born with, made worse by excessive wear and tear or a trauma that causes an injury or dislocation to the hip. However it occurs, if you’re experiencing a deep ache in the front of your hip or groin, pain that increases with prolonged sitting or walking, stiffness in the hip or symptoms such as clicking and locking, it’s possible that a hip labral tear is to blame.
Although the timeline for hip labral tear recovery varies depending on your specific injury, if you require surgery, you should expect about 4 months of one-on-one treatment with your physical therapist and roughly 6-9 months before you feel 100% again. It’s important to note that not all hip labral tears require surgery. Often times, physical therapy and exercises to stabilize the joint can help patients avoid surgery all together, even with the presence of a tear. If your condition does require surgery, the following timeline will give you some insight into what to expect during your physical therapy treatment process.
*Please note, the recovery times included in this timeline are general estimations and may not correlate with your specific situation.
0 Weeks: Prehab Prior to Surgery
So you’ve suffered a hip labral tear and you know that you need surgery. Did you know there are steps you can take prior to surgery to help expedite recovery? The amount of time you spend in prehab depends on a few different factors and is sometimes, unfortunately, dependent on your insurance plan. If you’re limited to 20 visits per year for instance, your physical therapist may have to save some of your PT sessions for post-op but if you have more visits available to you, prehab can take a bit longer. If you have comorbidities, or other limitations or disorders that could complicate the recovery process, this could also delay things.
When you begin prehab, your physical therapist will conduct a full body assessment to check for limitations in range of motion and strength to get an idea of what sort of plan of care your condition requires. If weakness is the main issue, you may be OK with just a few sessions to educate yourself on the post-op rehab process and to get a good idea of what lies ahead. You and your physical therapist will work together to create a prehab program to make sure that you’re entering surgery as strong as possible. Pain management strategies will be discussed as well as methods to strengthen weakened muscles, especially in the glutes, core and legs. This will help you maintain better strength with functional activities.
0-4 Weeks: Post-Surgery Baby Steps
The amount of time after your surgery that you must wait before beginning any sort of physical therapy treatment is dependent on your surgeon’s specific protocol. Once your physical therapist and surgeon have come up with a good time to begin rehabbing your hip labral tear, your PT will ease you into an initial treatment plan that aims to reduce any swelling and pain, improve mobility with precautions/limitations and restore normal gait patterns. The progress you make during this period is dependent on your overall comfort level during mobility exercises and stretches. Because you’re still recovering from surgery, most activities should be avoided during this stage. To protect the repair limitations that are put on the hip, it’s important that certain movements are abstained from. Some physicians may ask you to use crutches with partial weight-bearing to reduce stress and load on the hip / repaired structures.
Your physical therapist will work on your soft tissue and muscles to improve tone and reduce pain. They’ll also prescribe range of motion exercises to help with mobility. It’s common to ease into exercising by riding an upright stationary bike to assist with range of motion. Your PT will guide you through initial exercises to ensure that you’re performing them correctly and with the right precautions. They’ll talk you through the best way to go about staying within range of motion restrictions as you go about daily activities as well. Manual therapy techniques will be utilized to help with passive range of motion through various movements. This helps to promote blood flow to the hip, decreasing swelling and inflammation within and around the joint.
The initial rehabilitation phase may be scary at first but your PT is there to help minimize your pain. It’s their responsibility to make your recovery as efficient as possible while working within your pain tolerance and not pushing you to the point of discomfort.
4-8 Weeks: Keeping it Moving
As you begin moving more comfortably, your physical therapist will work even more to restore full range of motion, improve your strength and stability, normalize your gait and begin focusing more on increasing leg strength. In this phase of rehab, you should see decreased pain and improvements in range of motion, strength and stability. You should also notice the ability to walk further without pain and see progress with the ease of going up and down the stairs. It may be common to experience fatigue when performing weight-bearing activities so any high impact movements should be avoided.
Appropriate activities during this phase of recovery include walking short distances (gradually building up to 1 mile). You can also continue with the upright bike and begin to add resistance about six weeks post-op. Swimming and elliptical training can usually begin around week 8 as long as there is not a lot of pain. Your PT will help you through exercises that focus on hip strength and stability and continue to work on strengthening your glutes, legs and core muscles. There will be more focus on balance and stability as well. If you’re still experiencing a significant amount of pain at the 8 week mark or recovery, your PT will help you modify your activities outside of physical therapy to get a hold on your current threshold to activity. Pain may be the result of weak musculature which would explain why if you’re too active, fatigue sets in and muscles and joints can start to compensate which may cause discomfort.
8-12 Weeks: Beginning Lower Extremity Workouts
2-3 months after your surgery, your goal is to continue building strength and endurance and to train your stability. You’ll know that you’re progressing well if you see an improved tolerance to weight-bearing activities and a decrease in your level of pain. High-impact activities, such as jumping, should still be avoided but walking and stationary biking should continue. Your physical therapy treatment will begin to introduce body weight squats and various other strengthening exercises. Double and single leg closed-chain exercises may be included such as step ups, step downs, lunges, and single leg balance training. Depending on your progress and pain level, your PT may include manual therapy techniques to stretch your muscles and mobilize your joints.
12-16 Weeks: Back to Jumping
If all is going well around 4 months post-op, you should begin dynamic drills to introduce jumping, agility and running into your plan of care. You’ll continue working on strength, endurance and balance training with the idea that your endurance shows improvement with all activities. It’s important to continue discussing with your physical therapist and surgeon the activities that you should avoid, as it will vary person to person. At this point in your physical therapy treatment, there should be less reliance on manual therapy techniques and more of an emphasis on exercises and self management of your recovery. Exercises included may focus on single limb strength and balance, non-loaded / loaded jumping, agility drills and a return to running program. As a patient, the best thing you can do is to stay compliant with your home exercise program so that you can maintain the gains you’ve achieved during your PT treatment.
4 Months+: Getting Back to Regular Life
Depending on your condition and unique body, it could take anywhere from 6-9 months before you feel 100% again. As mentioned above, staying compliant with the home exercises provided by your physical therapist is the best way to ensure the strength and mobility you’ve achieved continues. Consult your physical therapist if there is any doubt about returning to a certain activity or if you have questions with your home exercises.