Hip Labral Tear Recovery Timeline: Treatment Breakdown

hip labral tear hip pain torn labrum hip

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.

hip labral tear torn labrum hip hip bursitis

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.

Torn Labrum Hip Bursitis Hip Stretches Surgery

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.

Physical Therapy Labral Hip Tear Hip Pain Surgery Upright Bike

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.

Torn Labrum Hip Physical Therapy Surgery Hip Pain Post op

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.

Get to Know Your PT: Cami Hatch, DPT

Denver Physical Therapy Cami Hatch

Therapydia Denver physical therapist Cami Hatch takes some time to talk pelvic health PT, the importance of being a good listener and changing up her workout routine.

“It’s important to challenge the body in different ways. Try new things and be adventurous!”

When did you know that you wanted to be a physical therapist?

I took some time off after I graduated from undergraduate and got a job working as a PT aide. I really enjoyed the environment and working with people and I liked that I could stay active throughout the day while still challenging my mind.

What is the biggest challenge involved in being a PT?

I would probably say dealing with the healthcare system. It’s challenging to have to consider how the patient’s insurance will affect their treatment.

How do you like to stay active?

A little bit of everything; running, yoga, hiking, weights. I recently started biking a little more too. I like snow sports in the winter. I snowboard mostly but I am trying to get into cross country skiing.

What’s your favorite song to get you motivated?

I could never pick just one, it varies monthly. Right now I have a lot of 90s hip hop on my running playlists. I’m also a big fan of the 60s and 70s.

What surprised you the most about the physical therapy profession?

The plethora of different theories and beliefs that PTs have. There are so many different treatment options and programs that sometimes it can get a little overwhelming. I try to learn from all the different approaches and take what I can from each one.

Are you currently pursuing any further education/certifications?

I try to take continuing education courses as often as I can. I think eventually I will consider getting a women’s health certification.

What do you wish everyone knew about PT?

From a women’s health/pelvic floor perspective, I wish people knew more about what Pelvic Floor PT is in general. People are often told that medication or surgery is the only option when in fact there are other things we can try. I also wish more women would come in after childbirth. I think people assume that since the female body is designed to give birth, everything will be fine but in reality it is a trauma and it’s important to make sure the muscles and tissues recover fully to regain strength and function.

What is the most important personality trait that a PT must have?

I think it’s really important to be a good listener. Listening to how a patient feels and what their thoughts are about their pain/recovery helps to determine how to approach treatment. I think this is especially important with my women’s health/pelvic floor patients because their pain/issues may have more of an impact on their psychosocial health and personal relationships. It’s important to consider the patient as a whole person rather than just an injury/diagnosis.

What’s your go-to breakfast?

Sprouted wheat bagel with peanut butter and coffee.

What do you do to de-stress/unwind?

It depends on the day. Sometimes I like to go for a run, it helps to organize my thoughts and get out my energy. Other times I enjoy reading, yoga and meditation.

Finish this sentence: On Saturday mornings, you can usually find me…

Well every other Saturday I am working. Otherwise probably sleeping in and trying to convince my boyfriend to go trail running with me.

What is your favorite piece of wellness advice?

Change it up. I think it’s easy to get into a specific routine and to do the same things all the time but it’s important to challenge the body in different ways. Try new things and be adventurous!

Click here to learn more about Cami and the other physical therapists at Therapydia Denver.

FEEL BETTER FASTER: QUICK LINKS TO COMMONLY SUGGESTED ITEMS

 

At Therapydia Denver we strive to help our patients feel better as quickly as possible.  In some cases, regular treatment sessions and a solid home exercise program are not all that is necessary for a speedy recovery.

Here is a list of items the Therapydia PTs often suggest for patients to purchase for home use:

KT Tape

KTtape

KT tape is a specific brand of tape that is used to promote healing, manage swelling and enhance your body’s control of muscles and joints while not limiting range of motion.  It can be worn for 3-4 days at a time and rarely causes skin issues.  With instruction from a Therapydia PT, most people are able to apply the tape in a safe and effective manner.

We like KT Tape specifically because the strips are pre-cut and rounded, ready for application right out of the box.

KT Tape is most commonly suggested for patients with: shoulder pain, golfers elbow, tennis elbow, knee pain, plantar fasciitis

Lumbar Support

lumbarsupport

Many low back, neck and even shoulder issues can be exacerbated by poor Lumbar Support during prolonged sitting.  If the curve in your low back is allowed to flatten out, it essentially starts a chain reaction which can adversely affect structures above and below your spine.

We like this particular lumbar support because it is affordable, portable and durable.

Lumbar Support is most commonly suggested for patients with: low back pain, sciatica, shoulder pain, neck pain, headaches

Stabilizer

stabilizer

Numerous studies show that low back pain is accompanied by absent, poor or incorrect activation of important core muscles.  The Stabilizer  gives the patient immediate and accurate feedback, letting them know if they are doing their prescribed exercises properly.  It essentially increases the quality of core exercises at home.

A standard blood pressure cuff can be used for the same purpose, but they are often too sensitive to give useful feedback.  We like this particular stabilizer because it is durable and just sensitive enough to give the patient only the information they need.

A Stabilizer is most commonly suggested for patients with: low back pain, sciatica, sacroiliac joint (SI joint) pain, hip pain

Foam Roller

foamroller

The Foam Roller has been suggested by healthcare professionals for years and for good reason.  They are extremely helpful for loosening up tight muscles and fascia between sessions with your Therapydia PT.  After careful instruction, they are also effective at loosening up tight spinal joints that make achieving proper posture difficult.

We prefer the 36 inch round roller as it can be used for the widest variety of exercises and activities.  This particular roller is affordable, extremely durable and more dense than others on the market.

A Foam Roller is most commonly suggested for patients with: knee pain, hip pain, upper back pain, shoulder pain, neck pain

Roller Stick

rollerstick

The Roller Stick is essentially used for the same purpose as a foam roller.  The main difference is that this hand-held tool allows the patient to control the amount of pressure, whereas a foam roller usually incorporates body weight.

We like this roller stick because it is much more portable than a foam roller and allows the patient to reach some areas that may be tough to address with a foam roller.

The Roller Stick is most commonly suggested for patients that travel frequently and suffer from: knee pain, hip pain, calf pain, achilles tendon pain, plantar fasciitis

Metatarsal Pad

metpad

A number of aches and pains in the foot may arise from a fallen transverse (or forefoot) arch. A Metatarsal Pad is used to brace this portion of the foot, thus restoring the natural shape of the forefoot and dissipating compressive forces.

We like these particular metatarsal pads because they are affordable, durable and self adhesive.  When applied between the insole and the shoe they tend to stay in position during most activities.

Metatarsal Pads are most commonly suggested for patients with: metatarsalgia, morton’s neuroma, forefoot callus

Heel Lift

heellift

A Heel Lift can be used to treat a leg length discrepancy as well as a variety of achilles tendon issues.  When properly applied, a heel lift can essentially level out a patient’s pelvis which can provide rapid alleviation of hip, knee and lumbar spine pain.  A heel lift can also alter the amount of tension on the achilles tendon to allow for proper healing after an injury.  

We like this particular heel lift because it is affordable and adjustable.  This allows for proper fit and progressive increases in tension to the achilles tendon as healing continues.

A Heel Lift is most commonly suggested for patients with: leg length discrepancy, hip pain, sacroiliac joint (SI joint) pain, achilles tendonitis, achilles tendon rupture

 

Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:

ACJointSeperation-pic2©

A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

File_000(note: this is not Blake Bortles)

A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.

 

With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston

 

Fantasy Football Injury Of The Week

New for the 2015-2016 NFL season:  

Each week, the Therapydia Denver PTs will analyze and discuss the NFL injury with the most serious implications for your fantasy football team.  In this analysis and discussion, we will include a description of the injury, the most likely treatment options for the injury and a prediction as to when the injured player will be back on the field.  

We will explore all available information outlets, then employ our extensive training and experience in orthopedic and sports physical therapy to give you an informative yet concise evaluation of the injury of the week.  

We will give you all the information you need to make an informed decision.  The rest is up to you.  Start, bench, trade or hop on the waiver wire.  

 

Sciatica: What Is It and How Can Physical Therapy Fix It?

Medical man with back ache

Sciatica is one of the most common diagnoses that we see in physical therapy.  But what exactly is sciatica and how do PTs treat this complex diagnosis?  Well the simple answer is the treatment is all dictated by the source.

Generally, sciatica is a term that is commonly used to describe pain, weakness, numbness, or tingling that radiates down the back of the leg. Typically, the symptoms follow the distribution of the sciatic nerve but there can be some confusion as to the source of the pain especially when the patients symptoms are found to be referred.  Our job as PTs is to determine what the source of the nerve irritation or referral origin is and treat it accordingly.  This can often be accomplished with a thorough musculoskeletal exam and typically without the need for costly medical imaging.   Below are the most common causes of sciatica seen in PT and how we typically treat them.

DISC HERNIATION

 

HERNIA OF THE DISC - SLIPPED DISCThe most common source of sciatica is pressure on the sciatic nerve from a herniation or protrusion of a spinal disc.  This pressure on the nerve can create an irritation and inflammatory response causing symptoms to radiate down the leg following the path of the nerve that is compressed.

What can physical therapy do to help patients with sciatica caused by a disc herniation?

Studies have shown that patients respond well to repetitive lumbar range of motion in improving sciatica symptoms related to lumbar disc herniation.  Typically the direction that most patients report relief of their symptoms is lumbar extension.  However, a thorough physical therapy assessment will help decide a patient’s specific “directional preference”.

Core stabilization exercises in conjunction with lumbar range of motion are also effective at reducing sciatica symptoms.  PTs tend to focus on strengthening the transversus abdominis and gluteal muscles in both static and dynamic activities.

Patient education is probably the most important component of the rehab of disc herniation.  Patients are educated on proper sitting and standing postures as well as proper body mechanics with lifting activities to avoid causing further disc herniation.

STENOSIS

 Denver Physical Therapy Stenosis

Narrowing of the space where the spinal cord or nerve roots exit the spinal canal is called stenosis.  If the space is narrowed, that can create pressure on the cord or the nerves causing pain to radiate down the leg.

Stenosis is typically seen in a condition called degenerative disc disease.  Our discs are located between the bony vertebrates and over time they can start to lose some of their height.  This loss of height causes the narrowing of space seen in stenosis.

Another cause of stenosis is tiny little bone spurs called osteophytes that can form in the spinal cord or nerve root space.

What can physical therapy do to help patients with sciatica caused by stenosis?

Our goal in PT is typically to help improve ROM in the lumbar spine to help open up the narrowed space.  Patients with stenosis often respond well to lumbar flexion or bending exercises, which is in contrast to the lumbar extension exercises often seen in disc herniation.  However, a thorough physical therapy exam will help determine the appropriate stretches/range of motion exercises.

As with disc herniation, core stabilization and posture/movement retraining are important for patients with sciatica caused by stenosis.

Functional dry needling (i.e. Trigger point dry needling) is also very effective for patients with lumbar stenosis.  Photo Oct 27, 9 29 32 AMBy using tiny, hair thin needles, we can quickly decrease the muscle tightness of spinal muscles, resulting in decreased compression of the lumbar vertebrae.  We will discuss dry needling more in the last section

 

PIRIFORMIS SYNDROME

Deep in your buttock/gluts is a muscle that runs diagonally from the outside of your hip to the lowest part of your spine.  This muscle, called the piriformis, can get short and tight or even be in spasm. In 85% of the population, the sciatic nerve runs just beneath the piriformis and in the other 15% it runs through the muscle.  The sciatic nerve can become compressed and irritated when the piriformis is taught or in spasm creating symptoms of sciatica down the back of the leg.

piriformis_anatomy02Image credit: http://www.methodistorthopedics.com/piriformis-syndrome

What can physical therapy do to help patients with sciatica caused by piriformis syndrome?

Typically, a physical therapist will prescribe a thorough home exercise program that includes stretches for the piriformis, hamstrings, and glute muscles (see linked video for example of a piriformis stretch).

Sciatic nerve glides/flossing can be effective at getting the sciatic nerve moving again if it is trapped by the piriformis, especially in conjunction with the stretches above (see linked video for example of a sciatic nerve glide).

A common theme with all of the causes of sciatica is core stabilization.  Core and glute strengthening exercises will help to reduce the demands put on the piriformis muscle with daily and recreational activities (see linked video for an example of a core exercise).

Trigger point dry needling has also been found to be very effective at quickly reducing the tension of the piriformis.

 

TRIGGER POINT REFERRAL PAIN

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Image credit:  http://www.partnersinhealthclinic.com/conditions-treated-with-tdn

Trigger points are tender knots in skeletal muscles that often cause radiating or referral pain.  In the case of sciatica, trigger points in the gluteus minimus, gluteus medius, and piriformis muscles are common sources of radiating pain into the back of the leg.  Trigger points are located in almost all muscles in the body but usually lay dormant without referring pain.  Dysfunction of movement patterns, compensation for weaknesses, or postural deficits, among many other things, can cause the trigger points in the dysfunctional muscle to become active and painful.

What can physical therapy do to help patients with sciatica caused by trigger points?

Physical therapists can assess movement patterns to determine if the trigger point is the source of sciatica symptoms and correct any movement dysfunction that they find.

Joint mobilization, massage therapy, and myofascial release are common techniques to release or inhibit an active trigger point.

Trigger point dry needling (also known as TDN, functional dry needling or intramuscular manual therapy) is becoming a very popular treatment for a variety of musculoskeletal issues but especially sciatica.  As mentioned above, TDN involves the insertion of a tiny filiform needle into the trigger point.  When the needle reaches the trigger point it creates a twitch response which feels like a cramp.  The muscle relaxes and the trigger point becomes inhibited, alleviating the symptoms of sciatica.

We’re open!

therapydia denver physical therapy

Therapydia Denver is excited to join the Therapydia network! We opened our doors at the beginning of March at 800 Lincoln Street, conveniently located in central Denver (can’t find us? we’re located within the Vital Strength and Fitness facility). Therapydia is a national network of Physical Therapy clinics that emphasize ongoing wellness programs like Yoga, Pilates, and TRX. We strive to create an environment that is conducive to wellness with clinics that are well-appointed, well-equipped and well-staffed.

Led by expert Clinic Director, Casey McNitt, Therapydia Denver offers a range of physical therapy and personal wellness services.  Therapydia picks top physical therapists in each city through a selctive screening process. We look for PTs who have extensive clinic experience, studied at top schools and who continually expand their knowledge base through evidence based continuing education. Our PTs have unparallelled experience in specialized areas of treatment and are highly trained in cutting-edge wellness practices.

Most importantly, Therapydia clinics use state of the art technology to improve patient satisfaction and outcomes. Our clinics take patient satisfaction very seriously, in fact, Therapydia clinics have an average national satisfaction score of 9.7. With our proprietary patient relationship management software, ReferralJETSM, we are able to track satisfaction and assure we are providing the best quality of care possible.

Want to learn more or schedule an appointment? We’d love to hear from you! Send us a message and we will be in touch shortly.