My Injury: Hip Labral Tear & How I Moved On
Everyone has gotten injuries throughout their life, and all are along the spectrum of no big deal to life changing. People seem to hold on to injuries, as a physio I am always surprised how grown clients will bring up injuries that happened 20+ years previously. While some past injuries are not relevant or long lasting, some injuries can cause lasting or life long effects. The trick is to minimise those and work to make your body now as "strong" as possible.
I was in high school 2008-2012 where I ran indoor track for 2 years (attempted basketball but found I was better at track), and outdoor track for 4 years. My events were sprinting and jumping focused - as the devoted MBM members will know my journey from sprinting to distance running i.e anything over 200m has been a tough but enjoyable one in my adulthood.
The story of how is short and pretty boring, but in my senior year during the regional (or championship can't quite remember) meet of all places during a long jump I ran down the track and slammed my take off foot down - as you do - and immediately felt my leg compress. It was almost as though my leg was like one of those camera tripod legs and was shortening. It was followed by immediate sharp pain into my groin and I fell spectacularly into the sand pit. To be honest it makes me laugh now because of how silly it probably looked to everyone else, such a fail!
I wasn't able to lift my leg so dragged it behind me like some sort of sporty rag doll. Something important to note at this juncture is that at 18 I was extremely competitive and my next event was coming up, a 50 metre dash. There was no way I wasn't running, I was meant to be in lane 3 in a pretty high heat - lane 3 is the lane that has the best time. So, you can tell what is coming... I ran. Or attempted to run, I basically hobbled to the end which looking back was far more embarrassing & uncool!
I rested for the next couple weeks, luckily for me this was the final meet of the season so I wasn't missing out. And to be honest I rested and got back to moving well. I had a HUGE bruise in my groin and down my leg - for me, especially since I don't bruise easily I knew it was a bigger injury. Overall, besides some mild pain into my groin intermittently I was fine because I was in the middle of sporting seasons. I rested and in a couple months when spring track came around I felt pretty confident with no issues and ran with no issues. As I said some intermittent groin pain but nothing at that time I couldn't push through.
Eventually the season ended and since it had been a couple months of intermittent hip pain I went to a physical therapist in Bangor, Maine. Now that I am a Physiotherapist myself I realise how that her assessment and techniques were TERRIBLE. Unpersonalised sheet of exercises to complete, quick assessment done by another assistant which she barely reviewed before coming to do some manual therapy techniques. Now this is the part that makes me mad because I had been having low pain up until this point, but she felt I needed my leg manipulated and she PULLED my leg down (a hip manipulation technique with no evidence base) and the moment she had done that I felt horrible groin pain, 10/10. I left dragging my leg behind me almost in tears. I didn't understand the gravity of this at the time because my mom had told me sometimes physio is painful sometimes so I had to be brave, but what she meant of course is they need to move your limbs around and ask you to functionally move which can be painful. Not like this... But of course I didn't realise and so I didn't say anything assuming it would get better. ]
SHOCKER - it didn't. It got worse, & I couldn't understand why. It was intermittant & very painful. I couldn't walk for more than 30 minutes without pain radiating from. my groin down my thigh, moving my leg into certain positions was caused extremity sharp pain.
I unknowingly did exactly what a good physio would have told me to do and did strength training, in ranges I could avoiding the pain. Overtime the pain improved... but I still had no idea what was going on and why. When I graduated University in 2016 the pain had come back with a vigor, I can't remember why or any reason but I did know it was back. My mom got me in with an Orthopaedic Surgeon (the one who had done her hip replacement), he did an Xray showing my issues with my bone but of course soft tissue can't be seen without MRI. This is the first time I was diagnosed with a Labral tear.
What is a labral tear? According to the Mayo Clinic - A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of the hip joint socket. Besides cushioning the hip joint, the labrum acts like a rubber seal or gasket to help hold the ball at the top of the thighbone securely within the hip socket.
From here upon his advice, I continued/ got back into my strength training until I could come back for an MRI to confirm. During this part of my life I had was about to move to the England to start my Masters in Physiotherapy. So, with continued strength training the pain improved, although it never went. I continued having extreme thigh pain and groin pain following walking longer than 30-45 minutes or going into external and internal rotation. I was frustrated to say the least and through my research, I was in PT school after all - I found the options for labral tear included:
- Progressive Strength Training
- Anaesthesia Injection
- Surgical Repair (as you can see in the image above). The labrum has poor to no blood supply which means once torn it will not repair naturally and if conservative measures such as physiotherapy and pain medications then this surgery is indicated.
HOWEVER - Not only does surgery mean increased risk of infection, bleeding, nerve injury and recurrent symptoms if the repair doesn't heal properly... Now lets back track, as I said I was completing my PT Masters. I was lucky enough to do a placement at Live Vital Physical Therapy and Performance - I learned so much about evidence based practice, anatomical knowledge and therapeutic movement. During this time they introduced me to the understanding that not every surgery is successful or has a high success rate. Sadly, the surgical repair has a low chance of success, meaning the pain doesn't always go away. So for me the surgical risks & higher chance the pain.
So... Guess I was stuck... trying to keep my pain low with strength training. To be fair it worked mostly but keeping up with it or else was something I found stressful and disappointing. We all want a cure after all, instead of a management plan. Alas, sometimes that is how life goes... but I will say this, I have been lucky enough to meet some great physio mentors and in my final placement I met a physio who taught me about the complexities of pain - which yes I had learned about before - but it was put in context with my own pain and let me tell you it changed my world. He showed me how while my injury was very real my pain had become top down - my perception of my pain, and my mind were expanding the pain sensations making everything worse.
When I understood pain better my pain levels went down, I had more acceptance and found a much better quality of life. Do I sometimes get pain? Yes, but can I go on a 6+ hour hike without pain? Yes?
Life will still be filled with management but I'm much happier, in less pain and functionally fit.
What's my management strength and conditioning plan? We will put a hip labral tear strength video on Made By Movement Clinic soon! x
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