Running and Hiking With a Hip Labral Tear

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show is for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. Today, I'm going to be covering the topic of labral tears of the hip, and we're going to be covering a few different varieties of it.

I will first give you the disclaimer that I'm not going to be talking about substantial injuries here. This is going to be in active populations such as runners, hikers, and those of you who play recreational sports on courts and fields, etc. You're all going to get benefit from this. So, labral tears, I first should tell you what a labrum is. It's almost like a socket, a cartilaginous socket within the socket of the hip joint. So, it's almost like an O-ring or a gasket. It helps keep the hip joint generally in its proper place, and everybody does have a labrum. The shoulder also has a labrum, too.

The reason why it's brought up so many times with hip injuries is because when someone eventually has some hip pain, especially in the front side of the hip, the groin, we call it, they'll eventually get an image done. And for those of you who have gotten x-rays done, x-rays really don't show any soft tissues. They don't show any muscles, tendons, ligaments. They won't show any cartilages. They'll show joint spaces, fractures, and things of that nature. But they really won't show cartilages, which is what this is, but MRIs will. So, MRIs generally start with a low-level MRI, which is going to be one that doesn't have any dye contrast.

And it's not really the best at looking at labrums. A arthrogram is better, but most people don't really need an arthrogram, especially in the lower levels of things. We can tell with history and an examination, figure out how much of the problem this really is. I should give some context first that we are not going to be covering the big labral tears in here. And you'll know that you'll have something similar to that because it'll actually physically lock in place. And it'll be a painful click or pop that when repositioned, you'll feel no symptoms whatsoever. I met people like this, and usually those are ones that are much harder cases for rehabilitation and strength training and tissue work, etc.

Like we call it conservative care. We've seen a lot of our people with labral tears actually on telehealth as well, and they've managed really well. But if you have one of these locked in place and you have to physically move it out into a different position and it's a painful click and lock or pop, then those are much harder and those are going to be outside the context of this podcast. I will answer a couple questions here too. I've gotten some questions from some of the listeners, and I'm going to cover three a little bit later today. Now, symptom-wise, again, you'll feel it in the front part of the hip, mainly with bringing your knee up towards your chest and a little bit across your body, almost like you're trying to stretch your piriformis.

And some people do this figure four stretch or they'll do like a pigeon pose, and it bothers the crease of their hip, and it doesn't really feel super stretchy in the backside of their hip. It's like the front crease of the hip is what stops them the most. In the lower-level stages of this, it's generally almost like a form of hip impingement. I've covered hip impingement on another podcast before, which is a type of case that responds really, really well to rehabilitation and strategic exercise suggestions. But also, labral tears can too. I wish I had context for this statement, but there was a paper that they did back in the day.

I want to say I read it about, I want to say 10 years ago, and it was looking at figuring out how many people had no symptoms but still had labral tears. And I want to say it was like, I don't remember the exact number, but I want to say a third or like half of them, maybe a 66%. It was a pretty good substantial number of people that had MRI confirmation of labral tears absolutely had no pain whatsoever. And so usually we, as a culture, look at these images when we're in pain. So the relationship of having a labral tear, although it may be asymptomatic and not even the cause of your pain, but it presents itself because you're looking at it at the same timeline of having hip or groin pain is kind of, it's, it's, it's hard to differentiate those two because it happens so closely together.

I mean, shoot, if, if you shoot an image and I have a normal abnormality, but I'm doing it when I'm in pain, I would probably blame that normal abnormality. So for a lot of people that we see here at Performance Place with even our, some of our telehealth, like we coach them through how to manage this really well with decreasing their symptoms just by changing some of their movement patterns and giving them simple stretches and exercises to do. Now, everybody has their different root cause. I can't stress this enough. Some people, we noticed that they have more groin pain, either due to hip impingement or a labral tear associated to putting more load into that one side.

And for example, we see people all the time who have an old knee injury, say on the left side, like an old ACL injury that happened like 20 years ago. And then they end up having right hip groin pain and they get told it's a labral tear. And when you look at them move, they have enough movement compensation where their body's still trying to get away from that old injury because they've never really trusted the knee again. They never did strength training on the knee. The quad is substantially smaller. There's laxity in the knee, in the opposite side knee. And so this other side takes a big old hit with load.

And so it ends up creating some of the positive orthopedic tests that we see with our hip impingement as well as our labral tears. Now, the major difference between the two that I'm kind of alluding to is that, so labral tears have a more of a clicking type of scenario. Like there's a more of a physical internal joint obstruction. A lot of times with people who don't have big ones or they have frays, like there is like a feeling or a grinding or not necessarily grinding. Grinding is more arthritic. I apologize. But it's more of like a sound within the joint. People with hip impingement really don't necessarily have that.

Now, let me answer some of these questions that I have. I think you'll get good information from this, especially if you're trying to get back into activity. So number one question. My MRI shows a labral tear, but my doctor says it might not be causing my pain. How do I know if the tear is actually what's hurting me or not? So, again, you have to go back into the history. People who have traumatic labral tears, those are the ones where it's like, I felt a pop. I couldn't move my hip really well. And it started locking in place. Like that's a big one. It's timed associated to the onset. And that would also be seen probably on an MRI, but certainly an arthrogram.

An x-ray wouldn't cut it in this case. Now, for people who don't really have an incident and they have more of like a buildup type of process, in my experience, many times their pain is not associated to the actual labral tear itself, but it will be in some positions that they go into. For example, when they start challenging like knee across body and then up into their face, or they're trying to stretch out the back of their hip. And so they challenge the front side of their hip with more compression, or they're crossing their legs and stuff like that. Like usually this is like in the deep ranges.

Yeah, that's going to be more labral pinching or you're challenging the labrum, if you will. And just to note, we rarely see anybody with posterior hip pain with a labral pathology. It's not super, super common. I don't think I've ever seen it over the years. So a lot of the pain that people experience, I think, is actually more associated to compensation. Like they're compensating around either the labrum or altered movement within the hip, which probably created the labrum in the first place, or the old injury on the opposite side of the body. I've seen it over and over again with people with arthritic change.

They have these reports where they're like, well, I felt really good today. And then the next day, or sorry, yes, but yesterday I felt terrible, but I decided to sit for a little bit and then the hip got better. And then so I went on about my day. You see that their symptoms change, but they have a hard time relating that their arthritis did not change. Their labral tear did not change, but their symptoms did based upon load, position, etc. So there's ways to manipulate it. So a lot of times we will find that people who have growing pain with running, they'll find it when they're running downhill.

They'll find it more when they're in a fatigue state or towards the latter mileage. They won't have it in the very beginning other than just warm-up stiffness. And this is because the body starts going into movement patterns associated to fatigue, like the knee crosses midline. They go into an anterior tilt, which creates more of a pressure point in the front part of the hip. So I think it's the compensation that usually creates more of the symptoms. And it's simply managed. Number one is you can just discontinue the activity, which is what most people don't want to hear. But you can temporarily discontinue it.

I usually don't have people do it, but that is probably the simplest answer. By the way, this is not a podcast for medical information. It is reeducational only. Or the other option is we can make the hip or the leg or the human more resilient against the forces associated to the onset, such as sitting, walking, running, X amount of mileage, running downhill, etc. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar, and you've been dealing with some ache, pain, or stiffness that keeps coming back, no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Question number two is can I keep running and hiking with a labral tear, or do I have to stop until it's completely fixed? So, number one, I think we have to consider what the meaning of fixed means. If we're talking about it actually getting back to, quote, normal, the hip labrum will never be, quote, normal again. It won't be back to its state that you were when you were 15. It won't be back to the state that it was a year ago. It's just different. And that's completely fine. And I know when people hear me say this, they're like, it's like depressing.

I'm not going to feel better ever again. That's not what I said. I said, will it actually physically be the same anymore? The answer is no. Like, your skin is not the same anymore, but you survive and you're fine. Arthritis is there. It's not the same anymore, but you survive and you're fine. You have scars on your skin. You have old tears and frays and different muscles and tendons. It's completely fine. To a point, it's okay to have these things. If it's completely detached or if it's really severe, then yeah, it's going to be harder to survive despite having that unless you have it surgically repaired or some more advanced type of intervention.

But so if we redefine the word fixed and turn that into is it okay to be active, run and hike despite it not completely feeling better, not fixed, then I think the answer is yes. Like, most people are allowed to run, hike through about, we say, like a 2 out of 10 pain. And it needs to actually start to mend itself as they start to move. We notice a lot of times people with hip or groin pain, they end up having problems associated to maybe like the first 10 minutes of walking or hiking or running, but then it starts to really get better. Or if they do a structured warmup, they'll start to feel better too.

So usually if it starts to ramp up, then no, this is a red light activity. Do not do it. And then we need to give the person some suggestions of exercise or stretches to make them more tolerant of that before they actually start continuing it. But it's not realistic for most people to say, you know, I'm not going to walk ever again until this labrum is actually feeling better or this hip is feeling better. Like you have to function. And there's actually a baseline of what we call ADLs. Like you have to do, you have to walk here to there. You have to get up out of bed and go to the restroom. It's like doing nothing is not going to help, but doing too much and being reckless isn't going to help either.

So there's a sweet spot in here. And most of it comes down to not letting the pain ramp up necessarily, knowing that or observing that actually cools down as you start to warm up. But then observing, if you go past 10 miles, then it starts to ramp up again. So there's a threshold sometimes in there as your fatigue starts to set in. But also recognizing that there's things you can do to decrease the amount of pain that you're having despite it not really being fully repaired. Like we see people all the time who end up having a good amount of physical activity that we have them do, but we give them parameters or guide rails for it.

We say, hey, you can go for a hike and a run as long as you don't feel any problems. By the way, you want to do a warm up prior to it. Here's the warmth that we gave you with these specific exercises and stretches. Or as I'll tell a lot of my sport athletes, if you show up to the game and if you played a game, I know I played baseball. And so let's just say you showed up to a baseball game in high school or college. How early do you arrive to the game to warm up? And then high school athletes will say an hour. One of my buddies that played college baseball, he said three hours. And then when you talk to a recreational athlete, sometimes they'll say, warm up?

What are you talking about? And like it's super prevalent in my area, at least for recreational softball. Like you show up and like they want to pack as many games as they can after work hours. And then you show up and then you don't have any field access. You're just on the sidelines. And then your game's an hour and you just, you know, people just show up and start playing. Like going from a dead, going to a dead sprint from doing nothing and no warm up is not a good idea either. So, and other people that I've met, they say, well, I don't warm up really anymore because I'm too tired to play the actual game.

So I'm going to save it for the game. Or if you don't feel good, so I don't warm up and I want to save it for the game. That's not a good idea either. So I think we have to be realistic with our expectations. If you don't warm up, don't expect to feel good. I may be biased when it comes to running jogging, but a warmup, unless you're in severe pain, is doing it slower. Like a warmup for baseball is jogging. And all of a sudden, when you talk to a jogger sometimes, what is a warmup for jogging? It's calf raises, you know, it's like just, I would just jog slower and then eventually get your body warmed up.

And as I'm recording this podcast, I'm looking at my car, a thermostat, and it's at 188 degrees. But when I started, it was 80. So expect your body to operate better when your temperature is a little up from your warmup. And the third question we have is, my surgeon's recommending labral repair surgery. How do I know if I actually need it or not? And can I get better without it? I can say that, again, going back to what I talked about in the beginning of this podcast, if you are somebody where it's like physically locked in place and it's, you're actually finding your way to creatively get around this physical obstruction, you stand up and you're like, oh, I feel better now.

Like it's like clears it quickly. It's like taking your hand out of a door. It just feels better almost automatically. Then there's a chance that surgery might be a better option for you. But it's not to say I wouldn't try conservative care first. We always have the saying here at Performance Place that unless under special circumstances, you have to earn your surgery, you have to show that conservative care does not help. You have to check all your boxes to help your body repair itself despite having an ailment that's hard to overcome. That's okay to be frustrated with it. That's why you have coaches and medical staff to help you make good decisions as a team to be able to give your body the best chance of recovering on its own.

Now, if it can't do that and you've given yourself a good amount of time, I'd say about three months and you have no success whatsoever, usually then I would send people to get a second opinion. If they hadn't had any imaging at that point, a lot of times that'd be a good time to do so. Generally, one year images or older are kind of old and stale and we got to send them out for a new one. And then we ask for a surgical console. I like to get three surgical opinions, especially for cases that are not slam dunks as surgical cases, because you kind of like number one, and this goes for all the doctors you go to.

It's like you ask for what I would ask. What would you do if you were in my what would you do if you were in my shoes? And you'd be surprised the answers that you get, you know, like I would, I would, I operate a little bit differently than somebody else based upon my risk profile. Like I'm not worried about hurting myself, so I'll do certain things. So I think you just ask them candidly, what would you do if you're in my shoes? And say, what would, what would I do? What would happen if I didn't do anything for the next month, the next year? Like what, what would things look like? And is there any risk of waiting to give yourself a little bit more time to address it conservatively?

And you need to make sure that you've done everything that you actually can and done it well. Give yourself a chance to earn that surgery, get your hip and your legs stronger without having to do the surgery just yet. And then you will probably repair faster. I've talked to a few people who have surgeries done who were super, super strong. And they, they said that their surgery basically congratulated them and said, I've, I've never seen somebody respond so fast to surgery and actually get back to activity so fast. It must've been because you're so strong and so active. So you do have to check those physical activity boxes if you can, but if you're in so much pain, you can't physically move and no one's able to help you.

That's a whole different story. Yeah.