Labral Tears
Dancing Smart Newsletter
January 28, 2005
Hello everyone!
Right to the question of the week:
I'm just catching up on reading some of the newsletters I missed, and I wanted to make another suggestion about the snapping and popping in the hip joints, (which is something I've had for many years). I'm now 25, still dancing, still have this problem, which is not incredibly painful, sometimes uncomfortable, but most often, I just feel like the movement in the joint gets "stuck."
I have several dancer friends who have had the same "symptoms" or sensations and been diagnosed with labral tears--one had so much pain that she opted for the surgery, which was not very invasive and a relatively quick recovery (she and I both had surgery to extract neuromas, and, while that recovery period wasn't bad, she said this was even easier). I work part time in a PT office, so I talk to the therapists all the time about anything that comes up and from the little I've learned about labral tears, and from the kinds of hip joint pain of which my friends and students often complain, it seems like they must be quite common among dancers. Have you, in your work found this? And, in teaching, do you think there is a way to prevent this as students dance regularly grow and constantly absorb changes in their bodies?
-Annie
Labral tears are being diagnosed more often because our ability to see inside the hip capsule with arthrograms and MRI"s is getting better. While I have not worked with many dancers with diagnosed labral tears, I do believe that the repetitive stresses that dancers put their hip joint through makes them ideal candidates for this type of injury.
What is a labral tear? Let's start by remembering that the hip joint is a ball and socket joint. The head of the thigh bone is the ball, and the acetabulum is the socket. In latin 'labrum' means lip. So the acetabular labrum is the ring of cartilage that is attached to the edge of the acetabulum and acts to deepen the bowl shape where the head (or ball) of the femur rests.
Injuries to the labrum can occur from chronic trauma, such as a dancer working to turnout their leg through sheer muscular determination and force, and also acute trauma, such as a fall or violent motion at the joint.
Signs and symptoms that accompany a labral tear might be pain with certain movements, (usually in the groin area), loss of strength, decreased range of motion, and a 'catching sensation' in the hip.
I checked in with my sports Doctor, Vernon Patterson, and asked him about acetabular labral tears. He reported that the majority of patients he has seen with labral tears had a history of acute injury while weight bearing that resulted in a sudden onset of groin pain and a period of pain and disability. The injury may have been much earlier in their career, but he would expect them to recollect such an experience. If the dancer did not have any injury history to the area he would be concerned about congenital hip pathology that would most likely be bilateral (affecting both sides of the body) and make them highly susceptible to early degenerative joint disease including labral tears.
You can treat labral tears conservatively with anti inflammatory medications and movement modifications. If the pain does not get better, arthroscopic surgery is an option to repair the tear. Having the surgery does not take away the potential for another tear to occur, especially, if the movement mechanics of dancing have not been addressed as part of the rehabilitation.
I'm delighted that your dancer friend that opted for the surgery had such a successful outcome from surgery. Dancers are typically very motivated patients! I'm sure she also tried conservative treatments prior to making such a choice.
What can we do as teachers to prevent this possibility from happening in our students? We come full circle to our roles in helping them understand how to create turnout in THEIR body with THEIR specific hip structure. We need to stop holding the myth of 180 degrees of turnout as the gold standard to reach.
As teachers, it would be useful for those in a studio setting who have the same students for an extended time period, to test the range of turnout each student has, so you can compare the first position they are working in to what you found in the joint. We need to develop the mindset that says most students start with average turnout, and through months (years?) spent stretching and strengthening and balancing out the hip joint muscles, their turnout will improve. Slowly and safely. We need to do the occasional barre without the barre, and see how well they support themselves through their own muscular efforts and alignment.
Thanks, Annie, for a great question!
On with the dance!
Deborah