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FAI/Hip Labral Tear

Original Post
Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135

Anyone experienced this? Did you have surgery?

I've been dealing with it for 6-8 months so far, no surgery....yet....every day is different, its pretty frustrating. Wondering if any other climbers out there have gone through this?

Take care!

Jim Clarke · · Summit Park, UT · Joined Jun 2009 · Points: 1,596

Had a labral scope on my hip…are you talking about a shoulder?

Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135
Shameless Shaemus wrote:Had a labral scope on my hip…are you talking about a shoulder?
No, hip...How'd it go for you? I appreciate any info...
Alyssa K · · South Lake Tahoe · Joined Mar 2014 · Points: 46

I had the surgical repair a couple years ago, and definitely worth it in the long run. The surgery isn't too bad (outpatient), I was on crutches for probably 2-3 weeks, and back to almost full speed at around 6 months.

Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135
bingo07 wrote:I had the surgical repair a couple years ago, and definitely worth it in the long run. The surgery isn't too bad (outpatient), I was on crutches for probably 2-3 weeks, and back to almost full speed at around 6 months.
2 years later are you back to %100?
Alyssa K · · South Lake Tahoe · Joined Mar 2014 · Points: 46

I'd say I was at 100% after about 8 months. It's actually been several years so I don't remember the timeline in too much detail, but the only impact the surgery has on me now is that my repaired hip is a little less flexible than the other one (pretty minor though, and probably could have been prevented if I stretched more after the surgery). I had a great physical therapy program for a few months after the surgery, which I think was very helpful in making sure I regained full function with minimal scar tissue. I remember the surgeon telling me that labrum tears just get worse and more difficult to repair over time because the labrum gets increasingly frayed, so if you're young and active it's worth it to get the surgery. It's hard to make the plunge knowing you're going to be out of commission for a few months, but it does pay off.

Have you met with any surgeons yet?

Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135
bingo07 wrote:I'd say I was at 100% after about 8 months. It's actually been several years so I don't remember the timeline in too much detail, but the only impact the surgery has on me now is that my repaired hip is a little less flexible than the other one (pretty minor though, and probably could have been prevented if I stretched more after the surgery). I had a great physical therapy program for a few months after the surgery, which I think was very helpful in making sure I regained full function with minimal scar tissue. I remember the surgeon telling me that labrum tears just get worse and more difficult to repair over time because the labrum gets increasingly frayed, so if you're young and active it's worth it to get the surgery. It's hard to make the plunge knowing you're going to be out of commission for a few months, but it does pay off. Have you met with any surgeons yet?
Thanks for the reply bingo. I have met with one. I've had two MRIs done, one with contrast...report says "mild fraying"...It really is day-to-day for me...Some days its worse than others, but it has improved significantly from when it first occurred(after a few months of rest) . I am nearly back to the activity levels I was at pre-injury. I am climbing as hard as I was when I stopped as well...Last surgeon recommended refraining from surgery unless the injury prevents me from doing what I want to do. So far it hasn't, but it has gotten pretty close and its frustrating. I have no problem taking 6 months off if that's what I have to do. But, I also don't want to have it done and risk the complications if I can continue with a little intermittent pain/annoyance, which she advises to accept...

Sounds like it really worked for you, was your pain debilitating or just annoying?
Alyssa K · · South Lake Tahoe · Joined Mar 2014 · Points: 46

If all I did was climb, I probably could have dealt with the pain since it wasn't too bad when just climbing. It pretty much put a stop to any running/hiking/long approaches though, which was what made the decision to get surgery pretty easy for me. The pain itself wasn't debilitating, but it was enough that running was pretty miserable and I was always stressing about making the tear worse by continuing to be active.

I just didn't want to have to take the labrum into consideration every time I did something active, and I was getting tired of not knowing when it was going to feel ok and when it was going to put a stop to an activity. It's probably also worth mentioning that the surgery is arthroscopic and complications seem to be pretty rare if you're using a good surgeon.

Jim Clarke · · Summit Park, UT · Joined Jun 2009 · Points: 1,596
alleyehave wrote: No, hip...How'd it go for you? I appreciate any info...
Sorry for delay…looks like you've gotten some good info. Similiar experience here...Had it done probably 10 years ago and it went fine. Occassionally get throbbing and aching after a long day in the hills.
marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20

This idea that the labrum will continue to get frayed unless operated on isn't based on any science that I'm aware of. If you have the classic symptoms of groin pain when the hip is flexed/internally rotated and this limits your activity then surgery sounds like a good option. But if your symptoms are less specific and you happen to have a labrum tear on mri then I sure wouldn't rush into surgery.

kenr · · Unknown Hometown · Joined Oct 2010 · Points: 16,608
bingo07 wrote:the only impact the surgery has on me now is that my repaired hip is a little less flexible than the other one (pretty minor though, and probably could have been prevented if I stretched more after the surgery)
What makes you think that your hip could not gain more flexibility by starting a serious rehab program for it now?

. . (Are there some credible studies that show that flexibility rehab only works if done early after the injury or surgery?) . .

Anyway I suspect that this result from a good rehab program by a good Physical Therapist is not untypical. The human body and unconscious neuro-muscular control modules get clever about compensating/adapting funcional capability to the residual limitation. Then it gets more and more difficult for the PT to justify reimbursement by the insurance company, when there is no obvious functional deficit.

And perhaps the observable/measurable gains in residual flexibility then come more slowly compared with the amount of time + effort devoted to rehab exercises. So a good PT from long experience knows that there's no point in pushing their patient further, and assumes that you don't have the motivation -- doesn't even mention that perhaps further gains could be made ... with more hours, perhaps with more rigorous equipment.

I'm wondering ... because currently I'm laboring to eliminate the remaining flexibility gap from a completely different injury which is notorious for (permanent?) range-of-motion limitation. The difference between the two sides of my body is obvious, yet it has no noticeable impact on my climbing - (but maybe someday it could prevent me from succeeding on some 5.12 stemming move?). So I'm pressing on it now while I still find I have the motivation.

Ken
rich magner · · Joshua Tree, CA · Joined Jan 2009 · Points: 95

Sounds familiar. I had a huge tear in my labram, as well as bone spurs and deformation of the femoral head. Partly genetic, mostly over use. I think i punched through and caused the tear on a climb but i cant be certain. It worsened over time until was using a cane. Eventually that didnt help either.

After 6 months of limping and yelping every few steps my insurance gave in. I had a total hip replacement because there was not enough joint left to save. Its been 8 weeks now, and i'm climbing again with no pain and greater range of mobility. If your insurance is as much of an ass pain as mine here are some tips:

1. Get second or third opinions and have the records ready to send off.
2. Document, document, document - your activity level, therapy you've tried, etc.
3. Stay on it.

Taylor-B. · · Valdez, AK · Joined Oct 2009 · Points: 3,186
kenr wrote: What makes you think that your hip could not gain more flexibility by starting a serious rehab program for it now? Ken
The surgical repair causes an increase in internal rotation due to the re-tightening of the labrum. I was told by my Doc not to over stretch externally 4-ever and to keep it "tight." I had some issues with my distal IT band due to the increase in internal rotation that was remedied with some new orthotics.

Try and find a Doc that incorporates PRP injection therapy. According to the Steadman Philippon Research Institute patients that had the PRP therapy fared way better.

Best surgery I've ever invested in!-Good luck

sprivail.org/
Stephen Burns · · Telluride, CO · Joined Jul 2010 · Points: 25

I have just been diagnosed with FAI/Labral Tear at the Steadman Hawkings clinic in Denver. When I went in for a consultation they explained the options on the table, surgery, cortisone shot, or just PT. As of now I opted out of surgery and am going for just the PT. While I can't really boulder anymore I can still climb crack, most sport. So long as I am not doing high inside steps all is wellish. I plan on getting the surgery come winter when I have time to recover and not be bummed about not playing...

fossana · · leeds, ut · Joined Apr 2006 · Points: 13,318

I spent 18 months of battling tendonitis in my hip flexors with various treatments and was finally diagnosed with a labral tear in my right hip. I never had the classic groin pain symptoms, but the theory was that the tear was causing instability. At the time I was an ultrarunner and running 40-85 miles a week.

I went to see Mark Philippon at Steadman Hawkins, who is one of the pioneers in the repair surgery. I had the surgery ~ 6 years ago, but it did nothing to remedy my symptoms. For me the only thing that helped was to cut way back on my weekly mileage, but the problems have never fully subsided. While I think the clinic is top notch from an active recovery standpoint I'm not convinced that I should have had the surgery with my symptom presentation.

Additionally, they also pulled some crap around the way they coded it with my insurance (after I had it pre-approved), so for some time period there was a question as to whether I would be responsible for the $30K+ in charges. I was not informed in advance that they were planning to employ this tactic to set a precedent to cover what at the time was a newer treatment regimen, so it definitely caused some stress.

Eric Chabot · · Salt Lake City, UT · Joined Jul 2011 · Points: 45

I had some symptoms of this (debilitating pain, snapping hip, etc.) and talked to an orthopedist. Didn't get any imaging done, just worked on stretching, core strengthening, and used cycling to loosen up my iliopsoas. I am pretty much fully recovered.

Not sure whether there was actually any labral tear/FAI, but my symptoms were similar and it resolved without surgery. Your situation may be different but I suspect that many people with these symptoms may be able to recover without surgery. Good luck!

I know how frustrating this can be, and how it affects all aspects of your life, not just climbing. I hope you recover soon!

Nate Manson · · San Diego, CA · Joined Jun 2010 · Points: 135

Just a little update, it seems my PT and time off has worked thus far. Since I started climbing again at the end of January. I had good days and bad days, and even a couple of bad weeks. I listened to my body and backed off when I needed too, did my PT as I should, and also got some ART work done. I just spent a few days in Joshua Tree(2nd time in two weeks) without ANY issues. I am back to climbing nearly what I was before I got hurt. Climbing 11s/12s in the gym and 10s outside(Jtree/San Diego area)...Sometimes I feel tightness but no real FAI pain like I had before. I'm cautious with anything that involves hard stemming/liebacks. I am now doing longer and longer days and we will see how it holds up after some of the all day ventures in Idyllwild/Sierras, but I'm optimistic.

Stephen, at this point I'm glad I didn't have the surgery. Consider giving it a few months of rest(hard, believe me I know) with PT...I've attributed a lot of my signs & symptoms with likely having weaker muscles in/around my hip, primarily not having an ass. After targeting these areas and working on stabilization(bosu ball does miracles), the improvement has been insane.

Seems more climbers have had this issue than I had thought. It makes sense though...

Taylor-B. · · Valdez, AK · Joined Oct 2009 · Points: 3,186
fossana wrote: I had the surgery ~ 6 years ago, but it did nothing to remedy my symptoms. For me the only thing that helped was to cut way back on my weekly mileage, but the problems have never fully subsided. While I think the clinic is top notch from an active recovery standpoint I'm not convinced that I should have had the surgery with my symptom presentation. Additionally, they also pulled some crap around the way they coded it with my insurance (after I had it pre-approved), so for some time period there was a question as to whether I would be responsible for the $30K+ in charges. I was not informed in advance that they were planning to employ this tactic to set a precedent to cover what at the time was a newer treatment regimen, so it definitely caused some stress.
That sucks, sorry to hear that! I work next door to the Steadman Clinic and have heard a lot of horror stories, I want to say that there is only about a %50 chance of a good recovery from the first surgery and that some people take more than one operation. They don't advertise those numbers. They pulled the same thing with my billing and insurance.

If you don't get your labrum fixed it can cause degenerative joint disease in the long run.
marty funkhouser · · Unknown Hometown · Joined Dec 2007 · Points: 20
Taylor-B. wrote: If you don't get your labrum fixed it can cause degenerative joint disease in the long run.
There is simply no evidence to support this claim.
J. Broussard · · CordryCorner · Joined Feb 2011 · Points: 50

Has the head of the femur been discussed yet?

When I had my labrum repaired (removed, to be exact) the surgeon also remolded the head of the femur to reduce, if not eliminate, the excessive wear that caused the problem in the first place.

If I wasn't climbing, playing hockey and running in the hills everyday I wouldn't have had a problem; as it's rare to have a perfectly round femur head.

Taylor-B. · · Valdez, AK · Joined Oct 2009 · Points: 3,186
jeff lebowski wrote: There is simply no evidence to support this claim.
It's physio-science. The labrum acts as a gasket to keep the ball and socket joint tight. When the labrum is compromised the joint becomes loose and mechanical deficits occur. This is more common in the shoulder, and that's why when you tear the labrum in your shoulder
(& hip) you are more prone to easily re-dislocate your ball and socket joint. The only exception is that when you age your ligaments "tighten up" and some Docs say that you are less likely to have this reoccurring issue, or being an alcoholic does the same thing to your joints and connective tissue. I see this almost every day at work and hear the Docs say the same thing to the patients.
Guideline #1: Don't be a jerk.

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