Labral Tears in Dancers

Remember when Lady Gaga had to cancel her world tour because of a labral tear? Labral tears are one of the more common diagnoses when it comes to hip pain especially in the dance world. Performers, dancers and athletes are all prone to suffering with hip pain at some point in their careers. But, it doesn’t have to put you on the sidelines if you seek out treatment early on. Keep reading if you want to learn more about labral tears and how to treat them.

What is the labrum?

The hip is a ball (femoral head) and socket (acetabulum) joint which allows motion in all directions. The labrum is a rim of cartilage that surrounds the socket and serves to provide stability to the joint by deepening the joint socket. It also protects the joint surfaces. Think of it like a silicone covering around the joint. Labral tears can occur through trauma, be present since birth (congenital), they can occur secondary to femoral acetabular impingement (when the ball and socket don’t fit together correctly), can occur due to capsular laxity and and they can occur on a degenerative basis usually from overuse. Athletes of all kinds are at risk for labral tears but especially dancers — they present with the highest risk overall due to the extreme ranges they use in their movements.

What causes a labral tear?

Extreme ranges of motion especially those that involve twisting and rotation can cause a labral tear immediately or can lead up to a labral tear over time. All those beautiful lines you are making in the studio could be leading to issues with your labrum. Early intervention is key to long term preservation and a return to doing the things you love. You don’t have to stop doing the things you love but you do need to learn how to better control your biomechanics to decrease symptoms and improve your ability to grow as a dancer/athlete. One study demonstrated that if a labral tear is present, forces through the hip joint increase by up to 92%. Because of this, untreated labral tears can lead to further degeneration and symptoms in the hip such as premature arthritis, tendonitis/tendinosis, bursitis and a loss of range of motion. The earlier you seek treatment, the better chance you have at preserving your mobility and preserving the hip joint.

So, what do the symptoms feel like?

Symptoms are highly variable but usually one of these will describe your symptoms:

• Pain in the ip or groin with crossing your legs

• Pain in the hip at end ranges

• Pinching, catching or a grating feeling in the hip

• Pain with combined flexion, adduction, and internal rotation (knee across chest)

• Pain with combined flexion, abduction, and external rotation (knee bent and resting out to side)

• Pain with resisted straight leg raise (raising leg against resistance)

The good news is that many dancers and athletes have labral tears that become non symptomatic with conservative treatment. The first thing to do would be to see a physical therapist or orthopedist specialist (brownie points if they are familiar with dancers) to evaluate you to determine if you could have a possible labral tear. There are several other diagnoses which could mimic a labral tear and you want a professional to evaluate your spine, hip, knee and ankle mechanics to determine where the symptoms are emanating from. If the symptoms are indeed emanating from a possible labral tear, conservative treatment could consist of physical therapy which can include soft tissue mobilization, joint mobilizations, modifying activities for a short time period and a targeted exercise, stretching and mobility regimen to be performed first with your therapist and then on your own as prescribed by your therapist.

Common compensatory mechanisms we see in the office specifically with dancers who present with labral tears are poor coordination of the core muscles with hip movement, little to no internal rotation of the hip, a lack of control at end ranges of the hip (hiking the hip up to get that develope higher?) and a poor length tension ratio between the hip flexors, hip extensors, and hip rotators.

Here are some exercises you can do to at home to help you find some relief and get you working those hip muscles in a better way to reduce compensations

Kneeling Hip Flexor Stretch — helpful for opening up the front of the hip and creating more length in the hip flexors and quads for hip extension movements and arabesque. Caution if you have knee pain. Make sure to use a cushion, towel or rolled up yoga mat underneath the knee during the stretch. The stretch should be primarily felt along the front of the thigh and hip. If you experience any knee pain, stop.

https://www.youtube.com/watch?v=RmfyTYfDhLA

Clamshells with Develope — This exercise is meant to help strengthen the abdominals and the external rotators of the hip — the muscles you should be using to turn out your legs and to help you balance on one leg in a turned out position. You want to keep your abdominals engaged when performing this exercise and make sure you can place a hand under your waist line when lying down on the mat. During the exercise, only the hip is rotating outwards and the work should be felt deep into the back of the hip. When performing the develope make sure you are not sinking into the mat and or hiking the hip up to get the leg higher — keep the torso lifted and long and maintain space in the hip when reaching the leg up.

https://www.youtube.com/watch?v=NIWEQNUN7I0

Shin Box — this exercise is meant to stretch the internal rotators of the hip and then get those same muscles to fire up. Start off by sitting into the shin box position (90 degrees from hip to knee in the front; 90 degrees from hip to knee in the back) and see if you can get equal weight into both sit bones. When you achieve that, begin to shift your weight forward slightly maintaining a neutral spine and lift your back foot off the mat.. Keep the back knee in contact with the mat. As you can see, my mobility and control is pretty limited and something I am working on. A progression of this exercise would be to use less assistance from your hands and to lift the lower leg higher.

https://www.youtube.com/watch?v=E5fU2BhR24U

Hip Controlled Articular Rotations –This exercise is meant to teach you how to control and increase your symptom free available range of motion in the hip without compensating. You want to make sure you are not creating any symptoms as you range the hip – no clicking, pinching or hiking up of the pelvis to get the leg higher. You can see I am holding onto a couch to help me focus solely on lifting the leg as high as I can. A progression of this exercise would be to go hands free, lift the leg higher and finally to add a kettlebell into the hand of the moving leg.

https://www.youtube.com/watch?v=xRUhU6D2w3o

Give these a go and see how they feel! When you’re ready, call (212) 353-8693 to seek out a physical therapist who understands a dancer's needs to help you get to the next level.

Natalia Rodriguez, DPT

References:

Huang R, Diaz C, Parvizi J. Acetabular Labral Tears: Focused Review of Anatomy, Diagnosis, and Current Management. The Physician and Sportsmedicine. 2012;40(2):87-93. doi:10.3810/psm.2012.05.1968.

Hunt D, Clohisy J, Prather H. Acetabular Labral Tears of the Hip in Women. Physical Medicine and Rehabilitation Clinics of North America. 2007;18(3):497-520. doi:10.1016/j.pmr.2007.05.007.

Mayes S, Ferris A-R, Smith P, Garnham A, Cook J. Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants. Clinical Journal of Sport Medicine. 2016;26(4):307-313. doi:10.1097/jsm.0000000000000257.

Neumann G, Mendicuti A, Zou K, et al. Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: evaluation using MR arthrography. Osteoarthritis and Cartilage. 2007;15(8):909-917. doi:10.1016/j.joca.2007.02.002.