Case Study: Strategic Treatment for a Hip Labrum Tear

Our Patient

Our patient is a young, physically active adult male complaining of hip pain, persisting over the course of several months.

The Challenge

The patient had been to several physical therapists, who prescribed exercises based on his reported symptoms. Despite persistent pain, the patient had never been referred for diagnostic imaging. After multiple bouts of ineffective treatment, he finally came to NYDNRehab for help.

Our Diagnostic Process

After reviewing the patient’s history and conducting a clinical exam, we used high-resolution diagnostic ultrasound to dynamically view the patient’s hip in real time.
We identified a hip labrum tear as the primary source of the patient’s pain and dysfunction.

Our Treatment Approach

Before beginning physical therapy, we injected the joint with platelet-rich plasma (PRP) and alpha-2-macroglobulin (A2M) under ultrasound guidance. The plasma proteins served to calm the irritated joint and reduce pain symptoms while stimulating healing of the ruptured tissue. Once the patient’s hip was ready to bear loads, we began a customized physical therapy protocol.

Our personalized physical therapy program included:

• Dynamic neuromuscular stabilization (DNS), an evidence-based approach that activates the body’s innate developmental motor systems, to restore coordinated muscle recruitment.
• Exercises incorporating Capova methodology, where the patient is coached to develop efficient motor strategies.
• Exercises aimed at gluteal activation and core strengthening, to optimize hip stability and function, and promote regional tensegrity.

Intermittently throughout the physical therapy protocol, we used ultrasound-guided prolotherapy injections to strengthen the capsular ligaments, and to optimize function of the SI joint, which helped to support the damaged labrum. Our end goal was to improve the tensegrity of the core and gluteal muscles, to promote optimal hip stability.

After just 3 months of targeted therapy, the patient was ready to return to playing sports.

Discussion

According to research, 90% of hip labrum tears can be successfully treated with conservative care. In general, MRI is the imaging modality of choice for hip labral conditions, but in expert hands, dynamic ultrasonography is a credible and sufficient diagnostic tool. In this case, Dr. Kalika’s expertise in interpreting ultrasound images, along with 20+ years of hands-on clinical experience, set the stage for successful diagnosis.

The physical therapy exercises that were initially prescribed for the patient by other therapists had been too advanced for a hip labrum tear. When torn, the hip labrum’s vacuum seal is broken, reducing stability and range of motion. Instead of making the patient’s hip stronger, the prescribed exercises and stretches had aggravated his condition.

To be effective, physical therapy should only begin when damaged tissues have healed sufficiently to accommodate loads. Our personalized strategy included regenerative injections to promote tissue healing, followed by motor training to enhance coordinated movement, and physical therapy exercises to strengthen and stabilize the structures acting at the hip.