Should I choose PT or surgery for my hip impingement or labral tear?
The labrum is a dense connective and fibrocartilage tissue lining the socket of the hip joint. It functions to deepen the hip socket and improve stability and weight bearing during functional activities. The labrum is highly innervated on top and front portions of the joint and often refers to the front of the hip when symptomatic. Labral tear diagnosis is on the rise due to more surgeons being trained in hip arthroscopic surgery and increased utilization of MRI scans. Experts note caution is warranted when interpreting these findings because up to 68% of pain free individuals will have a labral tear after MRI testing.
Hip labral tears and femoral acetabular impingement are common diagnoses among < 40 year old patients especially those involved in rotational sports such as hockey and tennis. As stated previously, many of the positive MRI findings are also present in pain free athletes. Researchers are still determining which of these findings indicate pathology vs. a natural adaptation to the sport similar to what we see in pitcher's shoulders.
Physical Therapy treatments including manual therapy and exercise are very effective for both hip impingement and labral tears. Goals of treatment include pain reduction and improving patient function including return to sport and activity. Interventions are designed to increase space and avoid abnormal contact at the hip joint. Most importantly, patients are trained to re establish hip strength and coordination to allow a safe return to sport without the classic hip pinch or catch. Two studies have compared the effectiveness of Physical Therapy to surgical interventions and both have found significant patient improvement, but no significant differences between groups. Thus, patients are encouraged to utilize Physical Therapy first for their hip symptoms. Early Physical Therapy may also help identify patients who require surgical intervention after conservative treatment.