Labral Tears of the Hip

            "To keep the body in good health is a duty... " - Buddha

               The joints in our bodies are protected by two types of cartilage.  Hyaline cartilage covers the surface of the bones and protects them from the friction damage that would occur if the bony surfaces rubbed against each other.  White fibrous cartilage can be found in joints that are subjected to frequent stress.  This type of cartilage helps keep joints intact and acts as a shock absorber.

            Movements that are repeated over and over again will gradually start to wear away cartilage just as a stream will erode the surface of a rock over time.  When joints are placed in unnatural positions, such as a turned out position, the body’s weight cannot be distributed normally over the joint, and undue stress is placed upon it.  Unnatural joint positions also occur when the dancer's body is misaligned or the dancer has a muscular imbalance.  When this stress is combined with repetitive movements, tiny tears begin to occur in the cartilage.  After a while these tears increase and result in bigger tears.  Additionally, jumps, leaps, pivots, and turns create enough force to cause cartilage damage on their own.  It is not surprising then that those who participate in ice hockey, soccer, football, golf, and ballet are at a greater risk for developing tears in the cartilage of the hip joint.

The labrum is a ring of white fibrous cartilage that can be found along the edge of the acetabulum, or the socket in the pelvis where the femur sits.  Its job is to hold the femoral head in place by increasing the depth of the hip socket. 

            The labrum often tears away from the acetabulum due to overuse and small injuries that may occur during twisting or pivoting movements and accumulate over time.  Dancers who experience a labral tear may complain of pain in the front of the hip, feel a “catch” in the joint when moving, experience stiffness in the hip, and/or have a limited range of motion at the joint.  These feelings may get worse after a long walk, or after staying in one position for a long time.  As the tear grows, the pain may radiate down the leg, to the side of the hip, or toward the lower back, and may become constant enough and severe enough to cause the dancer to avoid certain exercises and/or lessen the amount of time spent in class or rehearsals.

            If left untreated, a torn labrum can cause a shift in the way the femoral head sits in the acetabulum and increase the stress on the joint, predisposing the dancer to arthritis.

            Labral tears are diagnosed through an MRI scan of the hip.  More and more frequently, medical professionals are trying to avoid surgery and work instead with physical therapists to help dancers with this injury.  Anti-inflammatories will help with pain management, and physical therapists can work with dancers to eliminate any muscular imbalances they may have and to strengthen the muscles of the hip.  If the pain continues, cortisone shots can also help.  Because the inner side of the labral cartilage has no blood vessels, it has no way to repair and/or heal itself as do other soft tissues like muscles and tendons.

            If physical therapy does not work, or if the tear is too severe, surgery may be required.  During the surgery, any pieces of cartilage that have completely torn off can be removed, and the surgeon will trim the torn edge of the labrum and re-attach it to the edge of the acetabulum.  The recovery time for this type of surgery is a long one – 4-6 months with physical therapy for rehabilitation.

            The good news is that, although labral tears have been very common among ballet dancers, dance medicine specialists believe that education can play a key role in decreasing the risk.  Providing both dance educators and dancers with information about proper anatomical training, the dangers of muscular imbalances, the dangers of fatigue and overuse of the body, and the benefits of cross-training can help produce healthier dancers who can dance longer, stronger and happier without this type of injury.