How Exercise can help your Hip Labral Tear Pain and What You’ve Been Doing Wrong.Aug 22, 2021
So you’ve been told that the nagging chronic hip pain you’ve been feeling for months or years is from a hip labral tear. You’ve tried physical therapy (“PT”) and even looked for some hip exercises online but nothing seems to be reducing your pain symptoms.
And now you’re getting worried because the doctor said if PT doesn’t work, the next option is surgery. Can that be the answer? Are you so far gone with this annoying, frustrating hip pain that you need to go under the knife? Is there nothing left to try?
There is something left to try. Exercises that restore balance and function in YOUR body. The reason PT and other exercise programs don't work is because of how generic these interventions are.
For you to get out of hip labral tear pain through exercise you need to do exercises that your hips actually need. And because everybody experiences hip pain for different reasons, the strategy might be different for you than it is for me.
Why should you trust me? Well for starters, I’ve been where you are. In 2013, doctors diagnosed me with a hip labral tear and FAI. Luckily another corrective exercise specialist back then convinced me not to get surgery.
Boy, do I not regret it. Today, my hips feel better than they ever did. My own journey out of hip pain triggered a love for movement and corrective exercise. So not only was I able to get myself out of hip labral tear pain, I’m also proud to say that I’ve helped many others get out of hip pain and avoid getting surgery.
In this article, I’ll explain why most PT and traditional exercise methods fail. I’ll then provide a better way of choosing exercises and give you 6 of the best exercises I’ve found to help people in hip labral tear pain. I’ll then touch on whether there are any exercises or activities that should be avoided with hip labral tears.
Why do Physical Therapy Exercises for Hip Labral Tears Often Fail?
After an MRI confirms a hip labral tear, most doctors recommend PT as the first intervention. It’s low-risk and covered by insurance so hey, why not right?
As you might've found out, the exercises prescribed in PT offices are usually generic, low intensity and not customized to the individual patient. I’ll never forget when I went to my third PT office back in 2013 and one of the clinicians said “Oh, you got FAI and a hip labral tear. Only way to get rid of that is surgery.”
Why was I there then!? Looking back at that moment now, I realize it was not the PT’s fault. PT is an amazing resource we have in our society. The benefits far outweigh the cons and I’ve met many PTs I respect and trust.
But just because a modality is great for one thing does not mean it is great for another. For example, a strength coach who is a world-class bodybuilder will give you top-notch coaching on strength development. But it’s unlikely they’ll be able to give you the same level of coaching for endurance training.
There is a similar phenomenon going on in PT. PTs are excellent at helping individuals rehab certain injuries like broken bones or treat certain diseases like osteoporosis. The PT profession has been helping people improve these conditions for decades and have well established treatment protocols tested by clinical research.
The same cannot be said about hip labral tears. First of all, it’s very important to note that most individuals with hip labral tears don’t even experience hip pain. Countless studies examining the link between hip labral tears and hip pain fail to find any meaningful connection.
Here are a few examples:
- Register et al., 2012 - 45 volunteers with no history of hip pain underwent an MRI scan. 69% of these participants with no history of hip pain had hip labral tears.
- Schmitz et al., 2012 - 42 patients with no hip pain received MRIs. 36 or 85.7% of the patients with no hip pain had hip labral tears.
- Lee et al., in 2015 - 27 out of 70 young healthy volunteers with no history of hip pain had hip labral tears.
In other words, many people have hip labral tears but no hip pain. The opposite is also true. One can have hip pain and no hip labral tear. So if you receive a hip labral tear diagnosis, it does not mean that this is why you are in hip pain.
So any PT you see for hip labral tear pain will already be at a disadvantage. They’ll be treating your hip labral tear even if that may not be why you are in pain.
And what does the treatment look like? Researchers in the PT field recently adopted an exercise program called the “Personalized Hip Therapy” (“PHT”) protocol for anyone with femoral acetabular impingement (“FAI”) and related conditions like hip labral tears.
So these researchers created a standardized protocol to treat patients for a diagnosis that may not even be the cause of their pain. There are so many issues with the PHT protocol but this goes beyond the scope of this article.
It’s been a while since I’ve been in PT so I’m not sure how many PT offices are relying on the PHT protocol. But from my experience, PTs use some type of standardized protocol for hip labral tears. This is how it works for most diagnoses.
But how can a standardized protocol work if it is not addressing the actual cause of the pain? This is where doctors fall into the trap of treating the diagnosis and not the patient.
If you didn't do assessments analyzing your movement with your PT then I would not lose hope in exercise. If your PT didn't test your hip movements through a variety of assessments, then you cannot say that you gave exercise a fair try for your hip labral tear.
The Right Way to Choose Exercises to Improve Hip Labral Tear Pain
“So if the hip pain is not because of the hip labral tear, why am I hip pain?” you might ask. Well the answer is it doesn’t really matter. The goal is to feel better right? Not to get rid of the hip labral tear. That is why you need to choose exercises that will help you move and feel better as opposed to treating your hip labral tear.
One good way to start analyzing proper exercise selection is by looking at the 6 main hip movements. The 6 movements include:
- Hip Flexion
- Hip Extension
- Hip Abduction
- Hip Adduction
- Hip Internal Rotation
- Hip External Rotation
It's ok if learning all of these seems overwhelming at the moment. But you want to eventually figure out which of these you're weakest in. This will help you decide which exercises you should focus on.
Below, you’ll find some of my favorite exercises I give to clients in hip pain. To help you start getting familiar with the 6 movements, I'll provide one example for each. Try them out and pay attention to the ones that give you the most trouble. Those are the ones you should add to your training!
Hip Flexion - Hip Flexor Raises
Hip Extension - Lunge with Pelvic Tuck
Hip Abduction - Pissing Dog
Hip Adduction - Ballerina Squeezes
Hip Internal Rotation - Seated Hip IR
Hip External Rotation - Butterfly Pushdowns
Found some weaknesses? That’s a great thing! Now you know where to put your focus during your training. The more you can shift your attention to improving your movement versus fixing your hip labral tear, the sooner you’ll move and feel better!
Are there any Exercises to avoid if you have a hip labral tear?
I get this question a lot from clients so I thought it would be good to include it in this article. The way I always respond back is, would you avoid this exercise or activity if you labeled your discomfort as “hip pain” instead of a “hip labral tear.”
In other words, the question would be something like the following: “Should I avoid going for a hike if I have hip pain?” instead of “Should I avoid going for a hike if I have a hip labral tear?” Oftentimes, this shift alone makes it much easier for people to answer the question themselves.
Another helpful strategy I provide clients is to do the thing they want, mindfully. If the pain gets above a 6 or 7 during the activity or exercise, then slow it down and see if you can reduce the intensity.
The reason for this encouragement is because avoidance is a slippery slope. I see many people in a pattern of avoidance and fear which can make the pain even worse. This reinforces a feeling that you are broken or damaged because of your hip labral tear. And nothing can be further from the truth.
There are certain activities I get questions about more often. Below are some of the more common exercise modalities I get questions about.
Is walking OK with a hip labral tear?
I don’t know if there is a better activity for humans than walking. We evolved to walk. The mental and physical benefits obtained from walking are second to none. In my strong opinion, not only is walking OK with a hip labral tear but it is encouraged.
I would apply the two points of advice I provided earlier. Ask yourself the following question instead: “Is it OK to walk with hip pain?” And, can you do this activity with lower intensity and more mindfully. I’ll leave the rest to you.
What weightlifting exercises can I do with a hip labral tear?
Weightlifting with good form is one of the most effective ways of building a stronger body. But for those with chronic hip pain, there may be imbalances in the body that make weighted exercises uncomfortable.
If we cannot bend forward with function, does it make sense to do a loaded version of the movement, like a deadlift? Same thing with the squat. If doing a basic bodyweight squat is uncomfortable and painful, what will happen when we load it?
Hip pain is a sign that there might be some limitations in our movement. I see many people in hip pain perform traditional lower body lifts like squats and deadlifts with poor form.
It might be helpful to spend a few months doing corrective exercise and taking a small break from weightlifting. Once you get a better feel of what exercises bring you into better balance, you can start integrating weighted movements.
We need to play with the delicate balance of training smart and avoidance. We don't want to avoid safe and healthy movements. But we also don't want to put our bodies under heavy loads in positions that we cannot access with function yet.
Can I do Cardio Exercises with a Hip Labral Tear?
Let's reframe this question, shall we? Is it safe to do cardio exercise with hip pain? Most of you would probably say yes. It may be uncomfortable but that does not mean that you are doing something terribly wrong to your hip joint.
But pain during or after an activity is a sign that something is off. Our brain is interpreting the experience as a threat. Whether that interpretation is rational or irrational. There are two things I recommend you do.
The first is movement before and after your cardio sessions. I recently published a post demonstrating a warm-up and cool-down for runners. These workouts can be used before and after any other cardio workout as well. Check it out here.
The second tip is more mindfulness. Often times, we unknowingly create a fear pattern with certain activities. For example, we get hip pain after a few bike rides and now we fear it happening each time we get on our bike.
This catastrophizing is a risk factor for the pain becoming chronic. One thing you can start doing is to decrease the importance of these pain signals. Saying "whatever" to the pain signal instead of trying to figure out how to fix it or get rid of it.
I recognize this is easier said than done. But I am trying to give you something to try in this post. Creating a healthier relationship with our pain signals is one of the most important elements of recovery.
And it can be learned systematically just like movement! This is another skill I teach students in my Happy Hips course. If the above strategy works in your next cardio session, imagine what months of pain education can do for your symptoms.
Conclusion: Perform Exercises to Improve Hip Pain and not to Fix your Hip Labral Tear
If you take anything away from this article, let it be what you try to get out of exercise. Think about corrective exercise as a way of improving your hip pain. Not as a treatment for fixing your hip labral tear.
We don’t know why you are in pain. And to be honest, it does not matter. There are millions of people walking around with hip labral tears with no hip pain. Why can’t you be one of them?