Many of our LYT Prime regulars and certified LYT Yoga Teachers who’ve taken my Sequencing Lab Modules are well acquainted with my husband, Tim. He’s the 6’2” 210 lb super yogi who could always be found sweating his butt off next to me in Lara’s classes, heard grunting and panting off camera while I taught my 6:00 am T/Th class virtually, or seen practicing as my student in the Labs! Ever since I started teaching (and made him come with me to my first class so at least ONE person showed up), he fell head over heels in love with LYT Yoga and rarely missed class. Then roughly three years ago, we went to another studio while on vacation and the teacher took us into Lizard lunge in the first 10 minutes of class. I remember at the time thinking yikes, this is really early to be going into such a relatively deep pose. Tim felt and heard a pop in his right hip. Over the years, the pain has come and gone, and progressively gotten worse. He hasn’t been able to tolerate a class since February 2021 and a recent MRI revealed a tear of the anterior labrum and advanced arthritis.
Although previously thought to be a relatively uncommon injury, acetabular labral tears are being diagnosed with increased frequency due to improvements in diagnostic imaging. The prevalence of labral tears in people with anterior hip or groin pain is thought to be between 22-55%. The labrum is a rim of cartilage that outlines the socket of the hip joint, called the acetabulum. The thickness of the labrum varies between 2-3 mm thick. It is wider and thinner in the anterior portion and thicker posteriorly. It functions as a shock absorber, joint lubricator, and pressure distributor in the hip joint. It also provides stability to the hip by deepening the acetabulum by 21% and increasing the surface area of the acetabulum by 28%. This helps to distribute the load across the joint surfaces. Creating a seal for the joint, it helps keep the head of the femur (the ball of the joint) away from the acetabulum by maintaining the synovial joint fluid pressure within the joint. Not surprisingly, a compromise of the labrum has been associated with early joint degeneration. A study by McCarthy et al. found that 73% of patients with fraying or tearing of the acetabulum had damage to the joint cartilage and it was greater in those with the tears. They also found that in 94% of these patients, the joint damage was in the same area as the labral tear. They suggested that the risk of joint damage roughly doubles in the presence of a labral lesion.
More than 90% of people diagnosed with a hip labral tear complain of anterior hip or groin pain. Pain is also reported in the lateral region or deep in the posterior buttocks, albeit less often. People often describe a constant dull pain with intermittent episodes of sharp pain that worsens with activity. Walking, pivoting, bending over, prolonged sitting, and impact activities like running can aggravate symptoms. People often present with a limp, need a banister to climb stairs, and cannot walk long distances due to pain and weakness. Finally, the presence of clicking, locking, catching, or giving way is common as well.
The most consistently positive finding in people with a labral tear is a positive Anterior Hip-Impingement Test. This test is performed with the person on their back and the hip and knee flexed to 90 degrees. The hip is internally rotated and adducted. The test is considered positive if the pain is reproduced in the anterolateral hip or groin.
Although tears have been reported in all regions of the labrum, most tears found in the United States occurred in the anterior portion. Mintz et al. found 94% of the labral tears in their study were anterior. McCarthy et al. found 86% were anterior in theirs. Different reasons for the high prevalence of anterior tears have been suggested, including a relatively poor blood supply anteriorly as compared to the other regions and the fact that it’s thinner and therefore weaker. More than likely it’s also due to the fact that in Western civilization, this area is subjected to higher forces and greater stress during regular daily activities. Interestingly, in Japan the majority of tears occur in the posterior labrum, likely due to the frequent practice of squatting and sitting on the floor, which places more strain across the posterior region.
Whether labral tears have the potential for healing is controversial. Some articles report no potential and others report some potential for healing. In my clinical experience, improving joint capsular range of motion with manual therapy and limiting painful movement patterns that increase forces across the labrum, particularly the anterior labrum, have been beneficial. I’ve created a 4 video LYT Yoga Hip Pathology Series for LYTⓇ Daily which modifies our traditional practice to accommodate just this. I have been interviewing my husband and former patients and friends who’ve had hip joint issues including labral tears to determine just what bothers them and what seems to help. So if you suffer from hip joint pain/pathologies or know someone who does, go give it a try! Until then, I’ll see you on the mat!