A hip labral tear is a common condition where the cartilage ring surrounding the hip joint becomes damaged, often from repetitive forceful movements like sprinting and plyometric exercises, causing bones to rub together and leading to pain and stiffness; this condition typically heals slowly over 6-12 weeks with physical therapy focusing on pain management, joint mobilization, and gradual range of motion improvement, while femoroacetabular impingement (FAI) involves bony overgrowth on the femur that can pinch joint structures and often occurs alongside labral tears.
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Deep Dive
msk video hi rochelleAdded:
Hi, Ryan. My name is Charlie. I'm going to be your student physical therapist today. So, our goal for right now is to get a better understanding of that hip injury uh that you put on on our form, and we're going to find some other factors that affect your day-to-day living and things like that. And hopefully, we make a plan for you by the end of this. So, you ready to start?
>> Yeah.
>> Okay, cool. And I'll just be typing some info you give me as you talk. So, don't let that bother you at all.
>> Okay.
>> Is there anything about your background or personal beliefs, for example, like your religion that you want me to before we get started.
>> No.
>> Okay. And can I get your age?
>> 38.
>> Okay.
Now, moving on to your actual condition.
Uh, like I said, I saw in your form you're having some hip pain, but before we jump into that, I want to get a few background screening questions in. Uh, if that's okay.
>> Yeah.
>> So, I see you checked yes on our form for anxiety and depression. Is this something you're currently getting treated for?
>> Yeah. And I am working with professionals.
>> Okay. And are you on any medications right now for your depression or anxiety or just anything in general?
>> I take Alraam and Malta for my anxiety and depression and other than that I take a multivitamin.
>> Okay, nice. Do you know the doses for any of those you're taking?
>> I don't.
>> That's okay. And I saw you also wrote you've had an MRI and X-ray done before.
Did you happen to bring those results in review by chance?
>> No. Do you know what they told you when you got the back?
>> No.
>> Okay, that's fine. Uh, I'm just going to run through some final screens really quick. Uh, have you experienced any chest pain recently?
>> No.
>> What about nausea, vomiting, or diarrhea?
>> No.
>> Any fainting, numbness, or tingling?
>> No.
>> And then light head, or any vision changes?
>> No.
>> All right. All right. Finally, moving on. So, I know your form has been bothering you for 16 years since you were a college football player. Can you tell me a little more about this and how you initially hurt it?
>> Yeah. So, it's been hurting for a long time because I injured it when I was still in school and it I never got treatment. Um, I don't remember like ever hurting it that bad. Um, it kind of just happened the more I played.
>> Okay. And do you have any previous hip injuries before the one you had in college?
>> No. Okay. And what activities do you feel the most limited with your hip? I want to focus on things about like work and then maybe some things you like to do for fun.
>> Um, I'm a realtor, so it kind of hurts when I'm like sitting. Um, which affects my work because I need to be on my computer. I also like to do CrossFit.
Um, and it also hurts when I squat.
>> Squat. Okay. So, those are definitely some things we can set goals towards for your recovery to get you back to doing those things as quickly as possible. Do you have any concerns getting back to these things at all? Is anything preventing you from wanting to return?
>> Um, I kind of get a little anxious, but my help, so I'm good.
>> Okay, cool. And I want you want to touch a little more on your pain. Is there anything that specifically increases your pain like that squat you mentioned or anything that makes it better? Yeah. So, it's definitely that squat and sitting for too long makes it hurt and also like crouching and then after I exercise it hurts >> just like >> in general.
>> In general. Okay. And then for this pain you're feeling, can you describe it out of 10 like all the time? And then what about when it hurts the most?
>> Um, it's normally at like a two. It can get to like a seven or more than that.
And I but I feel it all the time and it also gets stiff.
>> Okay. Can you show me just point with your hand where your pain is?
>> Kind of like right here.
>> Okay. Like the front of your hip kind of. Okay.
>> And have you tried anything on your own to help with this pain?
>> No, just those meds I told you about.
>> Okay. Well, I think that's all the questions have you for now.
>> Uh we can get started. That sounds good.
>> Yeah.
>> Okay. We're going to start with a movement screen. So, I'm going to have you stand up. We're just going to start with our spine first. So, I'm going to have you just twist both ways and let me know if there's any pain either way.
>> What if we bend to her side and other side? Any pain?
>> No.
>> What if we go backwards?
Nothing.
>> No.
>> What about forwards? Try to touch your toes.
>> It hurts a little there.
>> Okay. So, same spot where it usually is, not in front of your hip. Okay. Um I know you having trouble doing a squat. I just kind of want to watch you do one.
So, could you try to get do a deep squat for me or as low as you can go without pain >> like right there?
>> Okay, cool. You can come up and then I just want to try some other hip things.
Can you We'll start with your left leg, which isn't hurt. So can you bring your left leg up and what about to the side across and then you can be twisted both ways and what about backwards? Does that all look pretty good? Well, now we're going to try the right leg. So just go till you feel pain. So we'll go bring your leg up tight there. Go about to the side.
Okay.
They're all pretty tight. What about twist your leg?
>> Same thing.
>> Okay.
All right.
So, yeah, just some specific movements I'm noticing uh that tenderness and pain you were talking about and that stiffness. I'm just going to poke around, see if I can find anything. So, I'm going to have you lay down on your back for me.
>> Okay.
>> And is it okay if I touch around your hip area?
>> Y.
So, I'm just gonna feel the side here.
Is there any pain on on this?
>> No.
>> What about up here on the top? Any pain here?
>> No.
>> All right. I'm going to take some measurements to see how well your hip is moving. Your left leg was completely fine, so I'm just going to skip that.
And we'll really just measure your right leg.
So, I'm going to have you just bend this knee for me.
Can you put this arm on your chest?
>> All right. I'm just going to bring this knee as high up as you can whenever you're ready towards your chest.
Is that it?
>> I'm going push a little further. Let me stop.
>> Right there. Okay. Definitely a little less than normal. I'm going to straighten out.
Now we're going to go out to the side like we did earlier.
Whenever you're ready, keep that leg out for us.
I'm going push a little further.
All right.
Definitely noticing a little less. If I try to push this way, does that hurt as well? Still across.
Yes.
>> Okay.
And then let me just I'm going to have you flip over to your stomach for me.
I'm going to come over here.
Cool. So, this time I'm going to have you lift this leg up while keeping your knee straight. Let me just line this up really quick.
And then you can lift that leg whenever you're ready.
Okay. Can I push a little further?
>> Sure.
>> All right.
I'm going to have you stay right there.
I'm going to do some uh strength testing.
>> So, I'm going to start with your unaffected leg. So, we're going to do that same movement and I'm going to push down behind your knee.
>> Uh just still let me push you. Okay.
>> So, we'll go up and hold hold.
All right. And now we're going to do this knee. So up, hold, hold, hold. Okay. And then I'll have you you can Can you roll onto your side facing me?
That's fine. Okay. I'm going to have you kick this leg up into the air, keep your knee straight, and I'm going to push.
Ready? Hold. Hold. Hold. Okay. And then can you flip over to your other side?
Thank you.
And you lift this leg up and hold hold.
Okay.
There for a second.
All right. I'm going to have you sit up on the edge of the bed for me like you were earlier.
Start with your left leg again. I'll just have you bring this hip up like this. And same thing on the push. Hold.
And we'll do this side. So bring this leg up.
Okay.
So pretty much all directions where we're seeing some weakness.
I'm just going to run some special tests. Uh see if I can kind of pinpoint what exactly might be the problem. So I'm going to have you go back down onto your You can lay on your back for me.
So, I'm just going to lift this leg up.
Let me know when you start feeling some pain >> right there. I'm going to bend your knee. See if I go a little further.
>> It's still a little painful, but you can definitely go further.
So, I'm not I don't think there should be a lesion or anything.
I'm going to test the length of one of your muscles. I'm going to just cross this leg over the other one.
My hair up. I just want you to push in this hand for me for three seconds. So, push push push. Any pain there?
>> What about push this way? So, push push push. Any pain?
>> Okay.
Let's do a few more things here.
I'm just going to push down here. Any pain with this? No.
>> What if I What if I pull them apart?
>> No.
>> Nothing.
>> Grab this leg.
>> Any pain here?
>> Can I have you flip over something really quick?
>> Any pain right here?
All right.
Uh, can I have you move onto your side for me? And you can face the wall.
Perfect. Just going to pull this leg back and see if you can touch the table. Any pain here at all?
>> No.
>> What about up here?
Up here? Any pain?
>> No.
>> Okay, perfect.
I'm going to have you lay back on your back for me. Just a couple more.
So, I'm going to bring your up. Might be a little painful.
Okay. H right there.
>> What if I move down here? Is it a little less painful?
>> Yeah.
>> But up here seems to hurt a little bit.
So, more in this front area, you would say.
>> Oh, yeah.
>> Okay, cool. I'm going to just push a little and see exactly what spot it seems to be hurting in. So, just let me know when it's too bad and I'll stop. I don't want to hurt it too much.
>> Right there.
>> So, when I put when I push in, >> it it hurts extra bad.
>> Yeah.
>> Okay. I'll stay away from that.
Just roll your leg a little bit. Oh, I hear clicking.
>> Yeah.
>> And popping.
>> Does that Does that usually happen?
>> Yes.
>> Okay. Good to know. Good to know. Uh, okay. I have one more test I'm going to do really quick.
Any pain here?
>> Yeah.
>> Yeah. Okay. All right. That should be all our test. So, I'm going to have you just sit in this chair for me, and we'll kind of discuss what I think is happening, what we can do to help you out.
Hey, Ryan. So, I think there's two things going on here, and I kind of want to explain to you what I think is happening. So, the first thing is I think you have a torn labum in your hip.
And I know that can sound kind of scary, but this is actually a pretty common thing that just happens to people and a lot of people have a torn labum and they're just walking around completely fine. Um, so basically your hip and groin can get a lot of pain from like forceful and repetitive movements. A lot of load applies there and this can just tear your labum. So especially what I'm thinking happened to you was in football you were doing a lot of sprinting and uh plyometric exercises and things like that and that probably really just wore down on your hip lab over time. So you know when you do these motions over and over and over again you get more pain and more wear and tear. Uh and this kind of just makes your bones rub together because there's no laboring in between them.
So if you do too much too quickly, uh your labum just kind of goes away after a while. And these do this does heal pretty slowly. Uh this is something we can definitely help address. So we can decrease your pain. It usually takes about 6 to 12 weeks. So uh there is a bright side. I think it's just something we can manage.
Uh you just need to make sure we're going to follow our program and do our treatment. And we'll just try to avoid doing those deep squats or those things that really irritate you for right now.
And then we'll also be doing some icing, heating, and joint mobilization where is where I basically uh move you through a range of motion what feels comfortable and we'll slowly work your range of motion up. Uh and then on top of that, I also think you have a FAI. So all that is, it's a contingent. So, what that means is the this big leg bone right here, your femur, uh when it goes into your hip, you can get a little bony overgrowth that sits on top >> uh and that can just pinch things. So, when we were having trouble on the table and you couldn't really move that much or even when we were standing and it felt like it was kind of tight and stiff, I think that's just from the like boness. So, uh and then that also a thing that can occur with the hip laboral tear I'm talking about because once that lab's gone they kind of just smash and grinding against each other >> and this is also something we can address with physical therapy so I'm not too worried about that either uh we're going to just start off does that all make sense first >> okay >> so we're going to start off with just some strengthening and stretching of your hips uh and we'll be doing those joint mobs I talked about earlier um yeah and then we'll go six total weeks like I said and then we'll reevaluate from and then we'll definitely start today.
Uh, is there anything you'd like to add to your treatment plan that could make it a better experience for you?
>> No, that sounds good.
>> All right, that's all right. Let's get started then.
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