Not So Tragically Hip, The Labral Tear. By Pam Ferguson
What’s more frustrating for an athlete than a nagging injury that just won’t go away? It usually starts out as a little ache or twinge, with the hope that a few days rest or some manual treatment like massage or physiotherapy will help speed the recovery process, but when that ache in your hip has you hobbling and stiff each time you get up from your desk, forcing you to skip your morning run or lie awake all night with a dull throbbing pain in your groin, it’s definitely time to see your friendly neighbourhood sports medicine doc and investigate whether or not you’ve got a labral tear.
A hip labral tear involves the ring of cartilage (labrum) that follows the outside rim of the hip socket. In addition to cushioning the hip joint, the labrum acts like a seal to hold the ball at the top of your femur securely within your hip socket. Labral tears are also common shoulder injuries.
I was diagnosed with a labral tear a few years ago. I had been an avid soccer player for 35 years, playing multiple games a week, and had already suffered one major injury, followed by knee surgery back in 2000. I had gone through nine months of full-time comprehensive Pilates teacher training and when the constant clicking and dull ache in my right hip started to interfere with my workouts. Things reached a crisis point when a well-meaning personal trainer pushed me into an end range stretch that sounded as bad as it felt, and shortly afterwards I broke my foot trying to protect my hip doing an advanced reformer exercise. It took months to get a proper diagnosis (through an MRI), and when I finally got into see a surgeon, he told me point blank that I was too old for the surgery that could repair the tear--40 was the cut-off, and I was considered geriatric!
While my soccer career had to be put on hold, Pilates has been an invaluable resource for rehabilitation. Besides me, we’ve encountered several clients at CoreWorks who’ve been diagnosed with hip labral tears, including a yoga instructor who suffered an injury during childbirth, and a former elite hockey player, who suffered tears in both hips and had a surgical repair on one. Like any surgical procedure, this one can be invasive and not everyone is a candidate (even when they aren’t 42), so many people look for more conservative treatment options. Developing more core strength, improving functional movement, and identifying a healthy range of motion in the hip, are just some of the ways that Pilates-based conditioning or active Physio Pilates can foster a return to regular activity and help decrease pain and discomfort related to the injury. By looking at the actions or activity that preceded the injury, and assessing the body’s strengths, challenges, and habitual movement patterns, Pilates can also play a vital role in rebalancing things like slow to fire glutes or limitations in spinal rotation, etc.
A hip labral tear, especially if left undiagnosed or untreated, can lead to the development of osteoarthritis in that joint in the future--even with a diagnosis, the prospect of long-term damage is stressful. Take it from one of our clients, Tiffany Merritt, Registered Psychotherapist (Qualifying), Art Therapist & Yoga Teacher: “Finding out at age 41 that I had a labral tear in one hip plus arthritis in both was scary. I felt overwhelmed about how I could keep moving my body safely without making things worse, and angry about the likelihood that I would need a hip replacement at a much younger age than I had ever imagined. Being able to strengthen my glutes while tending to my "grippy hip flexors” and honouring my more limited mobility with the guidance and care of the Pilates teachers at Coreworks over the last year has been a game changer for me. I’ve now transitioned from slower therapeutic work back to getting a good workout for my entire body, while of course always being mindful of my hips’ safe limits. I'm determined to do all that I can to keep from having any procedures done to my hip until absolutely necessary, and my regular classes at Coreworks are a key part of that plan. I feel safe at Coreworks. And when you have a chronic injury--that is at the root of what is important.” Staying active through Pilates can help people regain and maintain strength, stability and mobility in the hip joint, and in many cases, facilitate the return to their favourite sports and activities. Pilates allows someone recovering from a hip labral tear to progress from non weight bearing exercises to gradual weight bearing, or closed to open chain exercises, in a variety of orientations (supine, side lying, prone, quadruped, kneeling standing, etc.), at the same time providing challenges for stability and balance, all key to returning to form.
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