The ‘irritable hip’

I was fortunate enough to attend the “The irritable Hip” course back in November 2013, presented by Physiotherapist Nichole Hamilton and developed in accordance with Dr Michael O’Sullivan. The course went into great detail regarding Surgical and Conservative management (of the hip); Incorporating the Lumbar spine and Pelvis. It was an extremely informative day where many questions were addressed and it has opened my eyes to new techniques and overall patient care/management. I thought I would provide some information about what are specifically labral tears and their causes and potentially help some of you out there experiencing an irritable hip.

The acetabular labrum is a fibrous rim of cartilage (think of it like a calamari ring) around the hip socket that is important in normal function of the hip. It helps keep the head of the femur (thigh bone) inside the acetabulum (hip socket) and provides stability to the joint.

The mechanism of injury for Acetabular labral tears (labral tears) tend to fall into two groups, the first being that of significant acute trauma involving hip rotation, perhaps whilst playing sport or post fall. The second group can present with a gradual onset of symptoms (without trauma) which may be as the result of a structural problem in the hip (such as an over-coverage of the acetabulum around the femoral head or hip dysplasia) or a biomechanical overload, potentially causing repetitive micro trauma to the labrum.

Labral tears can cause pain, stiffness, and other disabling symptoms of the hip joint. The pain can occur if the labrum is torn, frayed, or damaged. “Clinical presentation of patients with tears of the Acetabular Labrum” a retrospective study that was referenced, found that patients –
• 92% presented with groin pain
• 86% describe sharp pain, 80% dull pain
• 71% were female
• 61% insidious onset
• 89% describe mechanical locking (clicking sensation)
• 91% describe activity related pain (pivoting, walking )
• 92% tears anterior, ant-sup or ant-sup-lat
Stephen, Burnett, Della, Rocca et al (2006)

I often have patients present to the practice complaining of hip/groin pain that gradually has come on over a period of time and is getting progressively worse. Not all hip/groin pain is a labral tear however having a thorough assessment early on is extremely important so that we can make sure that any possible dysfunction occurring at the hip is corrected and a management plan is formulated. In conservative treatment of labral tears it is imperative we identify postural malpractices and educate patients early on so that they can change them. A thorough physical examination will be performed and other contributing factors to muscle imbalances will be addressed. WHY our patient presents with longstanding hip pain/issues is often a more important question than WHAT is giving them pain. In our sessions we will listen to a patient’s history of symptoms and will target their main problem activity whilst addressing their primary concerns and beliefs. We will provide a tailored exercise rehabilitation program and perform manual therapy techniques to assist with releasing tight structures around the hip and improve mechanical function. If you should have any other questions or would like further information, or have been experiencing any hip/groin pain please do not hesitate to book in and have one of our physiotherapists assess and help you.

Written by Kelly Parbery, Physiotherapist, Physico City Physiotherapy.

Ganz R.Parvvizi J, Beck M et al (2003) Femoralactebular impingment: a cause for osteoarthritis in the hip. Clin orthp 417:112-120
R. Stephen J. Burnett, Gregory J. Della Rocca, Heidi Prather, Madelyn Curry, William J. Maloney and John C. Clohisy. Clinical Presentation of Patients with Tears of the Acetabular Labrum J. Bone Joint Surg. Am. 88:1448-1457, 2006. doi:10.2106/JBJS.D.02806
“The Irritable hip- Surgical and conservative management incorporating the lumbar spine and pelvis”- Dr Micheal O’Sullivan- NOSMC, Physiotherpist Nichole Hamilton- Synergy Physio. Copyright Nichole Hamilton 2013