Labral Tears of the Hip

            "To keep the body in good health is a duty... " - Buddha

               The joints in our bodies are protected by two types of cartilage.  Hyaline cartilage covers the surface of the bones and protects them from the friction damage that would occur if the bony surfaces rubbed against each other.  White fibrous cartilage can be found in joints that are subjected to frequent stress.  This type of cartilage helps keep joints intact and acts as a shock absorber.

            Movements that are repeated over and over again will gradually start to wear away cartilage just as a stream will erode the surface of a rock over time.  When joints are placed in unnatural positions, such as a turned out position, the body’s weight cannot be distributed normally over the joint, and undue stress is placed upon it.  Unnatural joint positions also occur when the dancer's body is misaligned or the dancer has a muscular imbalance.  When this stress is combined with repetitive movements, tiny tears begin to occur in the cartilage.  After a while these tears increase and result in bigger tears.  Additionally, jumps, leaps, pivots, and turns create enough force to cause cartilage damage on their own.  It is not surprising then that those who participate in ice hockey, soccer, football, golf, and ballet are at a greater risk for developing tears in the cartilage of the hip joint.

The labrum is a ring of white fibrous cartilage that can be found along the edge of the acetabulum, or the socket in the pelvis where the femur sits.  Its job is to hold the femoral head in place by increasing the depth of the hip socket. 

            The labrum often tears away from the acetabulum due to overuse and small injuries that may occur during twisting or pivoting movements and accumulate over time.  Dancers who experience a labral tear may complain of pain in the front of the hip, feel a “catch” in the joint when moving, experience stiffness in the hip, and/or have a limited range of motion at the joint.  These feelings may get worse after a long walk, or after staying in one position for a long time.  As the tear grows, the pain may radiate down the leg, to the side of the hip, or toward the lower back, and may become constant enough and severe enough to cause the dancer to avoid certain exercises and/or lessen the amount of time spent in class or rehearsals.

            If left untreated, a torn labrum can cause a shift in the way the femoral head sits in the acetabulum and increase the stress on the joint, predisposing the dancer to arthritis.

            Labral tears are diagnosed through an MRI scan of the hip.  More and more frequently, medical professionals are trying to avoid surgery and work instead with physical therapists to help dancers with this injury.  Anti-inflammatories will help with pain management, and physical therapists can work with dancers to eliminate any muscular imbalances they may have and to strengthen the muscles of the hip.  If the pain continues, cortisone shots can also help.  Because the inner side of the labral cartilage has no blood vessels, it has no way to repair and/or heal itself as do other soft tissues like muscles and tendons.

            If physical therapy does not work, or if the tear is too severe, surgery may be required.  During the surgery, any pieces of cartilage that have completely torn off can be removed, and the surgeon will trim the torn edge of the labrum and re-attach it to the edge of the acetabulum.  The recovery time for this type of surgery is a long one – 4-6 months with physical therapy for rehabilitation.

            The good news is that, although labral tears have been very common among ballet dancers, dance medicine specialists believe that education can play a key role in decreasing the risk.  Providing both dance educators and dancers with information about proper anatomical training, the dangers of muscular imbalances, the dangers of fatigue and overuse of the body, and the benefits of cross-training can help produce healthier dancers who can dance longer, stronger and happier without this type of injury.

Injuries of the Hip

            “There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform, and learn how to cope with injuries.” - D. Gere

 The most common hip injuries among dancers are muscle strains, tendonitis, and bursitis.

            Dancers tend to have muscular imbalances because they repeat the same exercises and use the same muscles in the same ways over and over again.  These imbalances lead to tightness in certain muscle groups.  Tight muscles are susceptible to injury since they have a limited range of motion.  As a result, dancers often strain their hamstrings. 

            The hamstrings run along the back of the thigh and are responsible for extending the hip joint and flexing the knee.  As with all injuries, the dancer should rest the leg and use ice and anti-inflammatories to reduce pain and swelling.  Once healing begins, gentle stretching and rolling the injured area with a tennis ball or foam roller will help with scar tissue tightness and rehabilitation.
            Tendonitis refers to the irritation and inflammation of any of the tendons that connect the muscles at the hip joint.  Tendonitis manifests itself as pain around the joint and develops gradually.  At the onset, the pain will lessen, or even disappear,  when the dancer is moving but will increase afterward.  Eventually, the pain will become constant and radiate to the knee and/or lower back.  The dancer will feel stiff and tight in the morning or after dancing and moving, and stretching will be uncomfortable.  Rest, ice, and anti-inflammatories will lessen the swelling and irritation and help to alleviate the discomfort.  Being sure to warm up the area completely before dancing will help as well. 

            Tendonitis is usually caused by muscular imbalances and/or alignment issues that place stress on certain areas of the hip.  When exercises are repeated over and over again while the body is misaligned and not working correctly, the tendons become irritated and inflamed.  A physical therapist who knows about dance can help determine the cause and help to correct alignment issues and/or suggest cross-training exercises to help with imbalances so the tendonitis does not keep recurring.

            Another condition that can be caused by muscular imbalances and/or misalignment in the body is bursitis.  Bursae are tiny fluid-filled sacs that help prevent and reduce friction at joints where body parts are constantly moving against each other.  The most common type of bursitis is trochanteric bursitis, which occurs on the outside of the hip. 

stretch for IT band
gluteal stretch
            Dancers with this condition complain of pain on the outside of the hip when lying down or when pressure is applied to the area.  This pain increases during activity and is felt especially when walking up stairs.  Stretching the iliotibialband or a stretch of the gluteal muscles, which tend to be tight in dancers, may help relieve pressure on the bursa. 

            Bursitis can also be caused by trauma to the hip.  A fall in which the hip collides with the floor can irritate the bursa sac and cause a painful inflammation.  Ice and anti-inflammatories will help with the pain and irritation.  If the attack of bursitis cannot be traced to a specific trauma, then a physical therapist should be consulted to determine the cause of the condition and help correct it.