Hip pain due to an injury is often thought of as being in the hip area. But what about pain in the groin? Or that dull pain you sometimes get on the outside of the hip? 

The hip labrum is a circular band of cartilage that surrounds the inside of the hip joint. When there is an injury or a tear, this means the damage is to the labrum within the hip joint. The hip joint is where the femur (thigh bone) meets the ilium (pelvis). Visually, it looks like a ball and socket type joint which allows the hip to move in several directions. The labrum provides additional support to the hip joint. The labrum not only plays a significant role in maintaining hip pressure, fluid balance, and hip stability; but it also carries a collection of nerve fibers that can signal pain when there has been damage. 

Factors That Affect Healing

There are factors that can affect the healing process. Low blood supply is a reason that the labrum has a poor ability to heal. A torn muscle will actually heal faster than a torn labrum as a result of the low blood supply. 

What About The Pain

When it comes to a labral tear, most of the pain is felt in the groin and as a dull ache on the outside of the hip.

• The symptoms of a labral tear could be felt as one or many of the following:
• Popping, clicking, or catching of the hip joint.
• Groin pain.
• Throbbing on the outside of the hip.
• Deep ache in the buttock area.
• Weakness of outer hip muscles.
• Pelvic floor tightness on the same side as the hip pain.

Causes of The Hip Pain

The causes of the hip pain resulting from a labral tear vary. The following is a list of 6 possible and typical causes:

1. Poorly built office chairs are a possible cause, long periods of sitting in those cheap mesh chairs can result in pain from hip compression.
2. The overuse of the hip joints and muscles in athletes. Some sports require a lot of mobility – like soccer, running, jiu jitsu, wrestling, and skiing. Dancers and yogis can suffer this pain as a result of not properly warming or having overstretched hip rotator muscles and hamstrings.
3. Weightlifters who have over-pronated foot placement, along with poor breathing and bracing mechanics in their lifts can suffer from labral tears.
4. When sitting with children, sitting in a W can create too much internal rotation in the hips and can lead to poor hip development.
5. Old ankle sprains are another culprit. Having a loose or sloppy ankle joint will eventually work its way up to dysfunction in the knee or the hip.
6. Over pronation leading to rolled in feet will turn into internal rotation of the hips, creating compression in the labrum. 

Treatment Options

Treatments vary from person to person depending on the cause, location, and severity of the pain. At the Urban Wellness Clinic we help patients avoid surgery and medication with our approach to treatment with the intention of the patient becoming pain free so they can get back to doing what they love. Treating old injuries, looking into root causes, and understanding the anatomy of both is how we are able to put an end to further injuries. 

FAI (femoral acetabular impingement) and labral tears are often found to be a simultaneous problem. FAI is characterized as having either too much bone in the anatomy of the socket, or too much bone on the femur. Either way, this physiological condition causes increased pain with physical activity, a limited range of motion, and labral tears. The treatment options in this case are exercise, but are specific to those that will not aggravate the condition.  

Our treatment options in relation to labral tears and dysfunction include working on strengthening the muscles around the area, but also include the core and the glutes. 

We use ART (Active Release Therapy) for muscles that are too tight and are compressing the hip adductors, the hip flexors, and the deep 6 hip rotators. 

We use NKT (Neurokinetic Therapy) to check for core instability and weak areas. Typically there is weakness of the internal oblique on the same side as the injury, weakness in the external oblique on the opposite side, weakened QL muscles on the same side, and the gluteus maximus on the same side. The NKT additionally will be used to look for old scar involvement – this includes old scars from gall bladder surgery, c-sections, tummy tucks, appendectomy scars, and any scarring that could throw off the how stabilized the core should be. Soft tissue work is done to address the scar tissue that could be problematic. 

DNS (Dynamic Neuromuscular Stabilization) is used to retrain how the hip should sit in the socket. The main focus of this could be good core stability through movements like the 6 month supine, the deadbug, the beast to bear, the tripod, the DNS twist, and squats. 

Strength moves are performed to ensure the glutes, the core, and the hip muscles are working together. Typically, the movements here include the hardstyle plank, hip hinge to wall deadlift, the lunge, single leg deadlift and the squat. 

The gait anatomy can be retrained through movements particularly if there have been old ankle sprains, and if the patient is a runner, coaching to make their running form more efficient. 

If You Haven’t Gained The Results You Need There Are Other Options

If these approaches aren’t yielding the expected results, we will often refer a patient out for stem cell treatment or PRP as a more aggressive approach. We are connected with, and refer to Nick Beatty on the UES in Manhattan, or to Brian Shiple DO in Philadelphia. The stem cell treatment would include having stem cells injected into the hip to help restore and repair the damaged tissue. 

Urban Wellness Clinic is designed to ensure the most effective and least intrusive treatment be made available to our patients. With our combined expertise in the field of chiropractic work, and our desire to help our patients reach a new level of healing and restorative work, our only goal is for you to leave us feeling better than you have in a long time. If you want to get your hip pain assessed to see if a labral tear is the culprit, call us at 212-355-0445 or send us an email hello@urbanwellnessclinic.com

In Good Health,

Dr Emily Kiberd