Labral Tears - Surgery or Not?

Releasing painful muscles is the first step in hip pain relief.

In my last post I wrote about chronic hip pain, what is counterproductive for it, and what works from my perspective as a Hanna Somatic Educator,

  • Strengthening painful hip muscles can cause further pain or injury.
  • Learning to relax the muscles of the hip joint and the compensatory full body pattern of contraction in which the muscles are stuck can provide long lasting pain relief, relaxed hip joints, and balanced movement.
  • Understanding Sensory Motor Amnesia and the Trauma Reflex, the root cause of chronic hip pain, will help you understand how to intelligently regain pain-free movement of the hip.

Exercises such as the "clam shell" or "butterfly," and lateral leg lifts only serve to tighten the hip muscles even more, making it more difficult to move the hip. Often they create more pain, not less. Sitting with the soles of the feet together and pushing the knees out to stretch out the inner thighs can cause tight adductors to contract back against the force of the stretch. Even psoas stretches performed in isolation, can induce the stretch reflex, causing muscles to tighten back against the stretch. This further reduces the amount of control your brain has over your muscles.

Muscles that the brain cannot fully contract nor fully release are muscles that cause pain.

  • Address the pattern of contraction, not the individual muscles.
  • Pandiculation is the most effective way of regaining muscle function, improving movement and resetting muscle length. When you contract a muscle first, then lengthen and relax it you address muscle function at the level of the nervous system.

I hope some of you tried a few of the Hanna Somatic Exercises I included in my last post. Here is a wonderful variation of one of my favorite Somatic exercises: the Steeple Twist. This variation, made by Charlie Murdach (a Hanna Somatic Educator and Feldenkrais practitioner) shows how differentiating movements with the hips creates improved overall movement. Remember to go slowly and only as far as is comfortable. "Micro-movements" are perfectly fine!

[youtube=http://www.youtube.com/watch?v=lGuBU-1M0xM&feature=relmfu]

All these movements are a good beginning to learning to relax the muscles involved in the "trauma reflex."

Improved body awareness and muscle control is crucial when you have structural damage.

If you know that you are injured, but your doctor tells you it's nothing to worry about, then it's critically important to focus your attention on how your brain and muscles are compensating to deal with the injury (Sensory Motor Amnesia), and how that is changing the way in which you move. Unconscious and habituated functional problems left unchecked can, over the years, result in structural damage.

Do you have to be A-Rod to get a good doctor?

About a year ago I finally convinced my doctor to give me an X-ray on my hip. I had intermittent hip pain that I knew intuitively wasn't merely a functional issue.  The X-ray showed a tumor on my hip and an MRI confirmed a tumor, the result of two labral tears. My surgeon, a well known sports medicine doctor here in New Jersey, took time to show me my results: labral tears, osteoarthritis, and a tumor. He told me that, "there's just not enough science out there about labral tears to go ahead and do the surgery."

Unrepaired labral tears could create the need for a hip replacement in years to come.

Before my appointment was over, I asked my doctor if he thought that not repairing the tear in my hip soon would set me up for a full hip replacement in the future, due to compensation over time. His reply: "Yes, that just might be the case."

As I said in my first post about hip pain, it didn't take Alex Rodriguez's doctors long to figure out that if the Yankees were going to get their star player back on the field, earning his millions and hitting home runs, labral tear surgery was a must. ASAP. Why was there no absence of scientific data there?

So where does this leave the rest of us?

Recovery from labral tear surgery is no walk in the park, especially if you have no addressed the Trauma Reflex that got you there in the first place; it can't be solved by surgery. Surgery helps to repair the structural damage (which is wonderful), but it doesn't address the Sensory Motor Amnesia that alters movement in the first place.

The winning combination: Surgery + skilled physical therapy + Hanna Somatic Education = focus on regaining full functioning of the body as an integrated whole

While the jury's not out about what route I will have the option to take, improving my own sensory motor system and paying attention to my daily movement habits is critical to create long-lasting pain relief.