Coping with Hip Labral Tears

A hip labral tear occurs when the cartilage that lines the rim of the hip socket becomes torn, frayed, or detached.

Hip labral tears are usually secondary to another hip condition that stresses the labrum, such as repetitive stresses from physical activities or sports, or sudden trauma to the hip.¹Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J (Engl). 2019;132(2):211-219. doi:10.1097/CM9.0000000000000020^,2Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine. 2023;90(1):105465. doi:10.1016/j.jbspin.2022.105465

This article explains how the hip labrum can tear, what a torn labrum feels like, and ways to diagnose and manage labral pain in the hip.

What Is the Hip Labrum?

The hip labrum is a ring of tough cartilage that lines the hip socket (acetabulum).

The labrum serves to:

• Hold the ball (femur) and socket (acetabulum) parts of the hip joint together
• Deepen the hip socket and limit extreme range of motion in the hip
• Seal the hip joint and prevent leaking of the joint fluid
• Allow free movement between the hip socket and thigh bone
• Serve as a shock absorber for the hip joint and lower body

The labrum is made up of cartilage that is the strongest type – called fibrocartilage – and contains woven layers of collagen fibers, making it strong enough to withstand the stressors and demands on the hip and provide a significant range of motion and flexibility.

If the labrum becomes weak, damaged, or torn, it loses its ability to retain the sealing effect around the hip joint, causing leaking of the joint fluid. Over time, increased friction between the joint surfaces leads to thinning of the joint cartilage, joint instability, and the development of hip osteoarthritis.

Read about Hip Osteoarthritis on Arthritis-health.com

How Does the Labrum Tear?

Hip labral tears develop from one of two mechanisms:

1. Chronic microtrauma to the hip
2. Sudden, acute injury to the hip

Labral tears from chronic microtrauma are more common and occur when the labrum is constantly irritated and/or inflamed from conditions such as hip impingement or stressors from sports, which make the labral cartilage weak, thin, and unable to bear additional stresses.

Sudden tears occur when a forceful impact on the hip, (such as in contact sports or traumatic injuries), causes separation between the joint's ball and socket components, resulting in the tearing or detachment of the labrum from the hip bone.

See 6 Activities to Avoid with a Hip Labral Tear

Types of Labral Tears

There are 3 types of hip labral tears based on their location:

1. Anterior labral tears, located at the front of the hip. These tears are more common because:
   1. The labrum is thinner in the front of the hip joint
   2. There is poor blood supply in the front part of the labrum, making it more susceptible to wear and tear³Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105-117. doi:10.1007/s12178-009-9052-9
2. Posterior labral tears, located at the back of the hip
3. Combined anterior and posterior tears, where both the front and back portions of the cartilage tear or completely detach from the bone

Anterior labral tears occur when there’s increased stress on the front of the hip joint, such as walking, running, and pivoting.

Posterior tears are less common and occur when there’s increased stress on the back of the hip joint, such as frequent squatting or sudden trauma from an accident or fall.

Combined tears are rare and occur when the hip sustains extreme force during a fall or accident.

Hip labral tears are also called acetabular labral tears.

How a Torn Labrum Causes Pain

An injured hip labrum causes pain due to¹Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J (Engl). 2019;132(2):211-219. doi:10.1097/CM9.0000000000000020^,2Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine. 2023;90(1):105465. doi:10.1016/j.jbspin.2022.105465:

• Joint inflammation from lack of adequate cushioning between the joint surfaces
• Joint instability from increased pressure on the damaged part of the labrum

Hip labrum pain is typically felt in the front part of the hip and/or the inner side of the thigh (groin) and is more common while lying down, causing disturbed sleep. Pain flare-ups occur while walking, running, or prolonged sitting.¹Su T, Chen GX, Yang L. Diagnosis and treatment of labral tear. Chin Med J (Engl). 2019;132(2):211-219. doi:10.1097/CM9.0000000000000020^,2Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine. 2023;90(1):105465. doi:10.1016/j.jbspin.2022.105465

The Course of Hip Labral Tears

A torn labrum is not always painful. Up to 50% of people with hip pain from various causes also have a torn labrum, and it is unclear if the labral tear contributes to the pain.²Berthelot JM, Brulefert K, Arnolfo P, Le Goff B, Darrieutort-Laffite C. Update on contribution of hip labral tears to hip pain: A narrative review. Joint Bone Spine. 2023;90(1):105465. doi:10.1016/j.jbspin.2022.105465 When a labral tear causes pain, the symptoms worsen over time, and medical treatment is required to manage the symptoms.

How does hip labral pain start?

For most people, labral injuries occur due to chronic microtrauma, leading to a gradual onset of labral pain without any apparent cause. This discomfort may be accompanied by sensations of clicking, popping, or locking within the hip joint.

If labral tear pain starts suddenly, it’s likely due to a recent acute trauma, such as stepping onto uneven ground and twisting the hip at the same time or being hit near the hip with extreme force, and sometimes, patients hear an audible pop when this type of hip labral injury occurs.

See Hip Labral Tear Risk Factors and Causes

How does hip labral pain progress?

In the initial stages, the pain is not severe or bothersome, leading individuals to overlook it for several weeks or months. However, over time, it often becomes more troublesome.⁴O’Connor FG, Wilder RP, Nirschl R, eds. Running Medicine. Second edition. Healthy Learning; 2014.

A longer duration of symptoms without proper evaluation can lead to a more severe labral tear.⁵Cho YJ, Rhyu KH, Chun YS, Kim MS. Patterns of labral tears and cartilage injury are different in femoroacetabular impingement and dysplasia. J Hip Preserv Surg. 2022;9(3):151-157. Published 2022 Jun 30. doi:10.1093/jhps/hnac026

Can a torn labrum in the hip heal itself?

Due to the poor blood supply, labral tears do not heal on their own, but they can heal with non-surgical treatment or be surgically repaired.

Targeted physical therapy is the most common treatment for a hip labral tear. It focuses on stretching and strengthening the muscles around the hip, buttock, and thigh, reducing stress on the labrum and allowing it to heal. Treatments to reduce inflammation, such as anti-inflammatory medications, steroid joint injections, and regenerative medicine (for example, platelet-rich plasma), also relieve pain and create a better healing environment.

See 5 Best Stretches and Exercises for Hip Labral Tears

Some types of hip labral tears require surgery to repair the damage and cannot be treated with non-surgical methods.

See Hip Labral Reconstruction Surgery

What happens if a labral tear in the hip is left untreated?

Delayed treatment of a labral tear is associated with poor outcomes.

If left untreated, a hip labral tear continues to worsen and weakens the hip joint by reducing shock absorption and leaking joint fluid. Over time, the joint’s articular cartilage (cartilage that lines the joint surfaces) begins to wear out, increasing the risk of hip osteoarthritis.

Read about Hip Osteoarthritis Causes and Risk Factors on Arthritis-health.com

Serious Symptoms and Signs Mimicking Hip Labral Tears

Certain symptoms and signs of a hip labral tear may mimic a serious medical condition, such as cauda equina syndrome, infection, or pelvic tumors. These symptoms include but are not limited to:

• Severe groin pain and/or numbness: Sharp, burning, or shooting pain and/or a feeling of numbness in the groin, which makes it difficult to sit
• Pain in the pelvic area: A dull ache or sharp pain in the pelvic region and/or lower abdomen that is constant or worsens with movement
• Pain during sex: Discomfort or deep pelvic pain during sex

Additionally, hip, back, or groin pain that started after a motor vehicle accident or trauma or hip pain with fever or unexplained weight loss also warrants prompt medical evaluation.

Hip labral tears are diagnosed and treated by physiatrists, sports medicine specialists, physical therapists, and orthopedic surgeons.