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A hip labral tear is a mechanically induced pathology that could predispose one to develop osteoarthritis at the joint. The goals for physical therapy management is specifically designed in accordance to individual patient symptoms. Patients should avoid weight training of quadriceps femoris and hamstring muscles and avoid any exercises causing hip hyperextension. Patients should avoid active straight leg raises or any type of trunk curl with the hip in flexion greater than 90° to avoid undue compression of the anterior labrum. The appropriate physical therapy intervention for a patient with an acetabular labral tear has yet to be established.
A rehabilitation protocol for nonsurgical treatment of acetabular labrum tear by Yazbek et al. Phase 1 of the protocol consisted of pain control, education in trunk stabilization, and correction of abnormal movement. Phase 2 focused on muscle strengthening, recovery of normal range of motion, and initiation of sensory motor training. Phase 3 emphasized on advanced sensory motor training, with sport-specific functional progression. Most prevalent impairments after an arthroscopy includes inflammation, pain, swelling, decreased joint mobility, altered muscle extensibility, impaired muscle strength, altered proprioception, and decreased muscular endurance.
Gentle stretching and flexibility exercises of hip muscle groups including piriformis, psoas, quadriceps, and hamstring muscles should begin with passive range of motion exercises, respecting the patient's pain threshold and by abiding to physician dictated precautions.


Strengthening exercises for the hip adductors, abductors, and extensors are introduced at first isometrically with the operated limb in a neutral position, and advanced as tolerated and with regard to weight-bearing status. Gait training may be necessary to restore normal movement patterns as the individual transitions from using an assistive device to ambulating independently. Balance and proprioception exercises are introduced as hip strength returns, and as weight bearing status allows. The use of electrophysical modalities in the management of hip labral tear is intended to minimize inflammation by decreasing pain and swelling around the injury and by increasing circulation to the joint. The appropriate physical therapy intervention including the use of modalities for a patient with an acetabular labral tear has yet to be established. Joint abnormalities or excessive forces at the joint from sudden or repetitive twisting and pivoting motions are known to cause a labral tear. A pad may be placed under the ischial tuberosities to correct the problem of increased pressure on the femurs. Any exercises requiring hip extension beyond neutral, such as prone hip extension exercises or lunges, in which the hip on the stance side is hyperextended, also should be avoided. However, several studies have shown that physical therapy can be beneficial when used appropriately. Strengthening exercises should include core stabilization activities to improve trunk strength in addition to hip muscle strength. Knowledge on the tissue healing process is required to apply these modalities appropriately.


Since there is little evidence in the current literature to support rehabilitative procedures performed on labral tear patients, the best approach of treatment is adapted based on the physical therapist's clinical experience on what was shown to be beneficial to the patient population. Patients often present with hip or groin pain but differential diagnosis is necessary to confirm the presence of a labral tear. Patients who are overweight and who have large thighs should be encouraged to lose weight to avoid the altered alignment of the femur in sitting.
The goals of physical therapy should focus on reducing forces on the hip by addressing the patterns of recruitment of muscles that control hip motion, by correcting the movement patterns during exercises and during gait, and by instruction in the avoidance of pivoting motions in which the acetabulum rotates on the femur, particularly under load. This protocol addresses the potential impairments from a labral tear in three phases over a period of 12 weeks.
Physical therapists should note the location and size of the labral tear, and also the phase of tissue healing to guide the intervention strategies. Weight bearing restrictions indicated by the physician should be followed to allow healing to occur without re-injury. Conservative management can be beneficial for some patients while arthroscopic surgery might be indicated for others to repair or remove the torn labrum.



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