Supporting labral hip tear healing with integrative therapies

Photo Cred: Andrea Piacquadio/Pexels

By Avery St. Onge

A labral tear in the hip refers to an injury of the surrounding cartilage in the socket part of the hip joint, according to John Hopkins Medicine (JHM). A tear in the labrum is a result of overuse, and although the injury can affect many groups of people, most often the injury occurs in athletes participating in high-impact exercise. 

Labral tears in the hip are among the most common injuries Robert Silverman DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, sees in his chiropractic practice, Westchester Integrative Health Center in White Plains, New York. 

“I’m seeing labrum tears daily. Literally daily,” Silverman said.

Labral tears have a host of causes including overuse, degenerative conditions, traumatic hip injuries, aging, and deformities of the hip joint, according to JHM. The injury can lead to pain in the hip, groin, and buttocks, as well as stiffness and a clicking feeling in the hip joint during movement.

Labral hip tears can be diagnosed through physical exams, X-rays, or an MRI scan, according to JHM. Because they are often radiographic diagnoses, Lillie Rosenthal, DO, a board-certified physical medicine and rehabilitation physician in New York, said her patients who have received a diagnosis often assume that they’ll need surgery.

“Patients will come to me and say, ‘oh my God, I have a labral tear’ and I’m like, ‘alright, let’s back up,’” said Rosenthal. “’What’s your pain level? What’s your functionality like? What are you doing? What are you not able to do in your life?’ I’m usually talking people down from that diagnosis.”

According to Silverman, conventional treatments for labral tears in the hip often involve over-the-counter medications, injections, sometimes surgery, and at best, physical therapy.

“In a general practice, they probably wouldn’t be mentioning the things I’m mentioning,” said Silverman. “With an integrative approach everyone gets a chair at the table. You have to work with each patient and personalize their treatment protocol, allowing them to initiate their own health outcomes.”

Silverman said in his practice, there are four main parts to treating a labral tear in the hip including, chiropractic therapies, low-level laser, exercise rehab, and nutrition. 

Chiropractic

The chiropractic philosophy, Silverman said, is to keep the joints in line. In the case of a labral hip tear, Silverman would mobilize the hip joint instead of manipulating it, addressing the joints above and below the injury. Silverman explained that he would likely adjust the knee area, the sacrum, the ilium, and the lumbar spine.

“This should allow the body to biomechanically function in an optimum matter and take all the stresses off the injured joint,” said Silverman. “Many injuries in the musculoskeletal world occur because of lack of alignment of the body’s joints.”

Rosenthal said manual therapy can release tightness in the hip capsule trigger points like muscle knots around the hip.

“I employ manual therapy, specifically osteopathic manipulation to the soft tissue around the hip joints to increase range of motion, blood flow, and oxygenation to the hip,” said Rosenthal.

While Rosenthal doesn’t diagnose labral hip tears herself or directly address treating the tear, she does help patients with pain management.

“Manual therapy isn’t going to repair the labrum tear,” said Rosenthal. “What we are trying to do is a 360-approach, a comprehensive pain management rehab plan to address the problem.”

Low-level laser

Silverman defined low-level laser as a photobiomodulation, low-intensity light therapy that triggers bio-chemical changes within the cell. According to Silverman low-level laser therapy can:

• Increase metabolic activity
• Increase vascular activity
• Decrease inflammation

The therapy, said Silverman, can regulate the remodel of the extracellular matrix, which is everything outside of the joint, like cartridge, ligaments and muscles. Remodeling of the extracellular matrix by laser allows for protein synthesis, Silverman explained, dramatically decreasing protein degeneration. In addition, because the light therapy down regulates inflammatory cytokines, the inflammatory process is improved, the damage stage of the injury is slowed, and the repair phase is increased.

“It is the secret sauce to my treatment and the cornerstone of modalities I use for musculoskeletal injuries,” said Silverman.

Conventional medicine commonly uses injections to ease the pain of a labrum tear. Both Silverman and Rosenthal advised against this unless completely necessary. In the case of a cortisone shot, Rosenthal explained these injections have a “life limit” meaning after a certain number of shots, the tissue can actually weaken.

“That’s not a full 360 fix to the problem. It’s just suppressing the pain for some amount of time,” said Rosenthal. “The real answer to this is to try to strengthen around the hip the muscles to support the hip joint itself.”

If a patient had been prescribed steroid injections by another doctor, Silverman said it would be his job to provide alternative therapies that can work synergistically with their other doctor’s protocols, instead of clash with them, to achieve the best outcome for the patient.

Exercise rehab

According to Rosenthal, a tear in the labrum is usually a result of repetitive use strain on the body. She said caring for a labral hip tear should involve a training program which balances out muscles throughout the body, especially areas that require demand for whatever activity caused the injury.

Rosenthal recommends isometric exercises for most musculoskeletal injuries. These exercises strengthen the muscles and joints by tightening the targeted area without moving the joint.

In a YouTube video, Evan Osar, DC, owner, and chiropractic physician at Chicago Integrative Movement Specialists, said patients with labral tears often perpetuate or worsen their problems from stretching their hip incorrectly.

Osar explained that a patient should be elevated on a surface while doing exercises like the pigeon stretch, a forward bend which opens the hip. When elevated, he said, the pelvis is about to go over the top of their femoral head and they avoid overstretching their back.

In general, Osar said that when treating a labral tear in the hip with physical therapy, exercises that help mobilize the hip and actively start to move the pelvis over the top of the femoral head, are essential for recovery.

Silverman also suggested stretching the hip flexors to relieve tension in the hip region. He said he recommends hip abduction, single leg bridges, partial squats, and single leg balance exercises on unstable surfaces. In addition, Silverman said strengthening the core is important while healing the hip.

“The goal of your core is to hold your torso in an appropriate position and allow your extremities like a hip to function optimally,” said Silverman.

To safely strengthen the core, Silverman encourages exercises such as the dead bug and front plank.

Nutrition

Perhaps the most important intervention for musculoskeletal injuries like a labral hip tear, Silverman said, are changes in nutrition and supplementation additions. Silverman said patients with these injuries should be on a low inflammatory diet. He said patients should avoid foods they are sensitive to and if they’re comfortable, try intermitting fasting or restrictive eating.

For supplements, Silverman said glucosamine and chondroitin sulfate are well-researched nutrients to help form the shock absorbing components of cartilage and heal articular surfaces. In addition, he may prescribe hyaluronic acid which can help regulate the repair process during injury and post-surgery, curcumin to decrease inflammation, collagen, vitamin D, and omega-3 fatty acids. Silverman added that research indicates that BPC-157, a peptide derived from a protect protein found in the stomach’s gastric juices, can allow for regeneration following musculoskeletal injuries.

Although alternative therapies may not heal the labral tear, Rosenthal said the key to this injury is relieving pain for the patient, allowing them to live comfortably, and avoid injections or surgery.

“The goal here is to optimize the mechanics and reduce the strain and the torque on the joints and the injury,” said Rosenthal. “What’s most important is that you decrease pain and increase function.”