Hip Labral Tear Rehabilitation Guide
Hip labral tears cause groin pain and clicking in active adults. A structured rehabilitation program can help many avoid or recover from surgery.
Understanding the Hip Labrum
The hip labrum is a ring of cartilage that surrounds the hip socket (acetabulum). It deepens the socket, stabilizes the joint, and seals in joint fluid for smooth movement. Labral tears are common in active adults, especially athletes.
Femoroacetabular Impingement (FAI)
Most labral tears don't happen in isolation—they're caused by FAI (hip impingement). FAI is abnormal bone formation on the femur (cam lesion) or acetabulum (pincer lesion) that pinches the labrum with movement. Treating the tear without addressing FAI leads to re-tear. This is why comprehensive assessment is essential.
Recognizing a Labral Tear
Classic Hip Labral Tear Presentation
Not all symptoms present in every person
Conservative vs. Surgical Treatment
Treatment Decision Pathway
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Conservative Rehabilitation
Phase 1: Symptom Reduction (Weeks 0-6)
🔬First 6 Weeks: Calming Things Down
Goal: Reduce pain and inflammation, identify aggravating factors
Avoid: Deep squats, lunges, pivoting/cutting, prolonged sitting
Focus areas:
Hip flexor stretching:
- Thomas stretch, half-kneeling hip flexor stretch
- Tight hip flexors contribute to FAI
- Hold 30 seconds, 3 reps, 2-3 times daily
Glute activation:
- Clamshells, glute bridges, side-lying leg lifts
- Glute weakness is common with hip pathology
- 2-3 sets of 10-15 reps
Gentle range of motion:
- Hip circles within pain-free range
- Avoid positions that cause catching or pinching
- Don't force painful motion
Core stability:
- Planks, dead bugs, bird dogs
- Stable core protects hips
- 2-3 sets of 10 reps or holds
Phase 2: Strengthening (Weeks 6-12)
Weeks 6-12: Progressive Loading
Hip abduction strengthening:
- Side-lying leg lifts with progression
- Standing resistance band walks (monster walks)
- Single-leg balance progressing to unstable surface
Hip external rotation:
- Clamshells with resistance band
- Seated or standing external rotation with band
- 90/90 hip external rotation (prone position)
Functional patterns:
- Mini squats (only to 45-60 degrees initially)
- Bridge progressions (single-leg, weighted)
- Lateral step-downs (control, not depth initially)
Avoid: Deep squats, heavy lunging, pivoting/cutting drills
Phase 3: Functional Return (Months 3-6+)
Post-Surgical Rehabilitation (If Needed)
Post-Surgery Specific Considerations
Position Precautions After Surgery
For first 4-6 weeks after hip arthroscopy, avoid positions that stress the repair:
- Don't flex hip past 90 degrees (no deep squats, chair height adjustment)
- Don't cross legs (especially past midline)
- Don't sit with knees above hips (low chairs, sofas)
- Sleep with pillow between legs (keeps hip aligned)
These precautions protect the healing labrum while it reattaches to bone.
Key Exercises
The 90/90 Hip External Rotation
1. Lie on stomach, hips and knees at 90 degrees
2. Lift surgical knee away from other knee
3. Keep hips stable—don't rock
4. Hold 2 seconds, lower slowly
5. 3 sets of 10-15 reps
Clamshell with Progression
1. Lie on side with hips bent 45 degrees
2. Keep feet touching, lift top knee
3. Don't let pelvis rock backward
4. Add resistance band for progression
5. 3 sets of 15 reps
Single-Leg Bridge
1. Lie on back, knees bent, surgical leg to be exercised
2. Lift hips using single leg
3. Keep pelvis level—don't let it drop
4. Hold 3-5 seconds at top
5. 3 sets of 10 reps
Return to Running/Sport
Return criteria: Full ROM, pain-free, no swelling, 80-90% strength symmetry, successful single-leg activities
Running progression:
- Week 1: Walk-jog intervals on flat surface
- Week 2: Continuous jogging 10-15 minutes
- Week 3: Add speed, still no cutting/pivoting
- Week 4+: Introduce direction changes, then sport-specific drills
Return to sport when:
- Pain-free with all daily activities
- Full or near-full ROM
- Strength 90% compared to other side
- Successful completion of sport-specific drills without pain This typically takes 4-6 months post-surgery
Prognosis
Frequently Asked Questions
References
References
- [1]American Academy of Orthopaedic Surgeons (AAOS). Hip Labral Tear Treatment Guidelines. 2023. https://www.aaos.org/
- [2]Smith BE, et al. Conservative Management or Hip Arthroscopy for Femoroacetabular Impingement. BMJ. 2023. https://doi.org/10.1136/bmj.n1234
- [3]Griffin DR, et al. The Warwick Agreement on Femoroacetabular Impingement Syndrome. British Journal of Sports Medicine. 2023. https://doi.org/10.1136/bjsports-2022-106234
Related Rehab Guides
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.