Hips Hurting? How Deep Twists Can Tear Your Cartilage

If you’re a younger or middle-aged adult bothered by hip pain, your first thought is likely not about hip surgery. But you may need it — many young, athletic people are having hip surgery after finding out that a deep cartilage tear is causing their mysterious, nagging pain.

Orthopedic surgeon James Rosneck, MD, answers our questions, detailing what you need to know about identifying and treating these painful labral tears.

Q: What is a labral tear?

A: It is a tear in the ring of cartilage (labrum) in your hip that cushions and seals the joint.

Q: What causes it?

A: Trauma (from a car accident, for instance) can cause a labral tear. But we see it more frequently among athletes whose activities flex the hip while twisting. We see this in all kinds of sports — even activities like yoga and Pilates.

A variation of normal anatomy can cause a labral tear as well. Often this is hip impingement, where the shape of the hip causes abnormal contact between the ball and socket of the joint. The most common root cause of a labral tear is onset over time due to physical activity combined with a bony abnormality.

Q: Are certain groups more likely to have a labral tear?

A: Yes. There’s about a 2-1 ratio of women to men and it often happens in younger, active patients.

Q: What are the symptoms?

A: Many people can have a tear and not have any symptoms at all.

If you do notice a symptom, though, it’s typically pain deep in the hip joint that doesn’t get worse when you push on the area. It often comes with certain activities (movement in a particular direction, for instance).

Q: How do doctors diagnose a labral tear?

A: We can get most of the information we need from a health history, examination and a good set of X-rays. An MRI will likely also be done to confirm the diagnosis.

Q: What are the treatment options?

A: There are a few conservative treatments that are a first line of defense in treating a labral tear. We typically try them for three to six months to see if we can alleviate the pain.

These options include:

• Taking a break from activities that cause the pain.
• Using anti-inflammatory medication.
• Receiving a guided injection of cortisone into the hip joint.
• Using physical therapy which unloads some of the pressure from the hip joint.
• Modifying activities to a lower, less painful level.

Q: What if conservative treatment doesn’t help?

A: If these things aren’t working, we can do an MRI to get a better idea of the pathology of the injury. This shows whether there is cartilage damage, arthritis in the joint or injury to other muscles that might cause problems.

Depending on the patience of the patient and how severe the symptoms are, your doctor might recommend surgery to fix it.

Q: What should a patient know about surgery?

A: This is an arthroscopic outpatient surgery that lasts one to two hours. Though it’s relatively quick and uses small incisions, it is not really minimally invasive.

The surgeon fixes the tear, but the most important part is treating the abnormality in the bone to keep it from happening again. Because of this, we have to distract the hip socket, which causes a longer recovery.

A general recovery timeline looks like this:

1. Physical therapy usually starts the day after surgery (to help prevent scar tissue from forming).
2. You will probably use crutches for about three weeks after surgery.
3. You will wear a brace that limits motion for about two weeks.
4. It usually takes about three weeks before you can begin driving again if the surgery is on the right leg.
5. After about six weeks, you should comfortably resume your normal daily activities.
6. After about six weeks, you can get on an exercise bike or elliptical trainer and possibly do some swimming.
7. Depending on your age, pain and activity level, it takes about three to six months to return to your sport.

If you are having hip pain deep in the joint that lasts for more than a month and occurs with particular movements, check with your doctor to see if you might have a labral tear.

The sooner you pinpoint and address the problem, the sooner you can get back to your normal activities with less pain.