Labral tear (hip)

Hi Lynne

Oh, that is terrible to be feeling pain. I very much doubt that this injury comes from your yoga. Your labrum tear tends to be from repetitive weight bearing and or shearing activity. Typically it happens with contact sports, from accidents, from golfing or softball or football. It can be aggravated by many activities like riding a bike or even from weight bearing the hip, stressing the labrum during your training for example.

Has your doctor recommended any treatment (eg to remove the tags or clean up the area)?

If you need help with modifications of poses, let me know

Namaste
Gabrielle 🙂

Hi Tiffani

Wondering what your question is!

Namaste
Gabrielle 🙂

Hi Tiffani

I was confused because the posts copied were for other people’s issues. Do I understand you have a labral tear in the hip? What other information could you give me? Cause? What do you do in and out of the studio that causes you pain? I would like to know more please. Be as specific and as precise as you can. It can only help us both. 😉

Namaste
Gabrielle 🙂

😆
I see now. Your post is not a quote at all. It IS the question. It seemed you were quoting someone else…because my response was wrapping it up within the quote box.

OK let’s start again

Wow, that is terribly frustrating and upsetting to have damage sustained possibly as a result of a pose assist. Just as an aside: Were you asked permission for this assist?

Given you have received this advice only today it seems you have probably not had any time to test out this theory. If you were to avoid forward bends, twists and anything weight bearing pretty much cuts out moving at all. That was not supposed to be a joke. But it seems that many professionals will give generalizations which are very broad to cover themselves!

My questions still stand though Tiffani. What do you CURRENTLY do in and out of the studio that causes you pain? Please be as specific as you can. For example: Walking bears weight on the hips. Does it hurt when you walk or run or any other daily activity? Does your hip or hips (are both affected?) hurt only in practice?

Namaste
Gabrielle 🙂

hello,
I just came across this website today and thought I would offer my 2 cents. I am a yoga instructor (and worker bee in corporate america) and tore my labrum last March in my teacher training program from an unnecessary assist in frog pose. I would never teach or practice frog pose, and have only done it a couple times; its a pose that never feels good. I had arthroscopic surgery to repair my torn labrum, fix bone spurs, and ligamentum teres last Thanksgiving and have just begun to slowly enter back into my practice through the long recovery and physical therapy process. Pre-surgery, my surgeon told me avoid twists and obvious hip openings as it was only making matters worse. In fact, I stopped practicing completely because the pain post practice was unbearable. This type of injury most likely doesn’t heal on its own since there is no blood supply to this tissue. Post surgery, he told me that because I am hyper mobile I need to be careful with the hip and other joints as my body doesn’t know when to stop extending and stretching esp in yoga. I don’t know if this is the case with any of you, but my advise would be to take things VERY slow and easy. I was the same way in the onset of the injury; I would feel OK in class doing pigeon, then a few hours later in terrible pain. Since you know something is damaged and if something hurts, get out of the pose immediately. And hot yoga may not be the best. An article I read also discussing preventing injuries in your practice http://www.iayt.org/publications_Vx2/ytip/aug06/Goodall0806.pdf
Good luck! daba http://www.yogawithdaba.com

Hi Tiffani and Daba

Thank you very much for bringing your voice of experience Daba. Tiffani, I am also of the opinion that great care should be taken to avoid pain, and that surgical intervention and restorative care should be undertaken.

Please report back with your progress. I am looking forward to reading of Daba’s recovery (if she’s willing to oblige).

Namaste
Gabrielle 🙂

Hi Gabrielle,

I’d just like to add to your post about the mechanism of labral tearing – impingement is most often what causes them. Not always; in their absence, heavy load-bearing things like deep squatting with weights can certainly result in tears. They can also be idiopathic. So what causes the impingement? It can be congenital – bony deformations/joint abnormalities (such as acetabular retroversion, like in Legg-calve Perthes disease or simply abnormal acetabular coverage of the femoral head)..most likely, there is some element of this structural-predisposition which becomes symptomatic with repeated movements that reach the extremes of range of motion…ie; yoga. In the physical sense of the practice, yoga is about creating impingement.

I’m a physician, I’m also a dedicated…and now seriously injured yoga practitioner. I’ll probably need surgery, though trying desperately to avoid it. Having a lot of pain – but the physical is really nothing compared to the sadness of losing this part of my life. There is absolutely no question, however, that these injuries are the direct result of yoga. Ask any orthopedic surgeon in the US who practices in a city with lots of yoga, like NYC. They’ll tell you that the popularization of yoga in the past 5-7 years has done wonders for business. I love it no less, but it’s foolish to ignore the problems that, despite the dogma of the yoga therapeutics community, are inherent in the practice.

Thanks, Gabrielle…I’d love to share some of my thoughts on this.

I think you’re absolutely right about preparing a joint before pushing to quickly – I’m sure we’ve all done it, and it’s not totally without value – I think it’s can help us gain some insight into our behaviors outside the yoga studio. It’s also true that improving flexibility requires a level of what will generally be perceived as discomfort, if not pain.

Alignment is something I’ve been thinking about a lot – in yoga, we talk a lot about “proper alignment” and finding flexibility and strength through proper alignment. But anatomically, we’re all different, meaning what we think of as the ideal alignment, can’t be the same for everyone. Certainly balancing soft tissue bulk/flexibility over time, will help many people conform to this ideal…but not everyone. When the variation is in something other than soft tissue (bone) there is a problem that stretching, weight training, etc. isn’t going to address in a healthy way.

Some common examples are variations in acetabular and/or femoral structure. Take femoral retroversion (rare, but a good example). For these individuals, the external hip rotation or deep flexion of poses like king pigeon or frog, will likely never be possible. But they don’t know they have it and neither does their teacher – they go to class and try with all their might to “open” their hips…for them, this means bone-on-bone, not just soft tissue stretching. No matter what they do, short of dislocation or breaking the rim of the acetabulum, the hips aren’t going to open; they’re just going to impinge, tear labrums, beat away at the articular surface.

I can’t ever remember hearing a teacher say anything but things to the effect that over time, with proper alignment, patience and hard work, hips will open. But that’s just not true for everyone. Unfortunately, it’s only after they’re injured that they get some imaging studies and find out that the pain wasn’t getting them closer to full expression of the pose, just closer to a damaged joint.

I’m not suggesting an abandonment of the entire alignment paradigm….but maybe more teaching around understanding our own structure, possibilities, and sadly, our limitations, and then making our practice our own.

Thoughts, anyone?

JB

Hi Maria

Thanks for all your detailed information. I hope you get some answers from people who have had the same or similar issues.

The way the forum works is that most people who contribute to a thread like this one will usually choose to be notified of responses. So it’s very likely that Daba, Tiffany and Jackie will all receive your message. You may like to wait a little while to see what responses you get. Additionally you can send them a Private Message (see the PM button?) asking them to respond – hopefully posting their answers right here on the forum – so everyone can benefit from your experiences and continue to broaden the publicly available knowledge!!!

Your experience is not uncommon. Unfortunately many people believe yoga is the cure-all. It is the most wonderful tool. Not everyone has the hardware to get into those generally amazing hip openers. Anyway, at this moment I think anyone would certainly be jumping the gun to offer asana advice without you having had your post-op appointment. It’s always good to know where you ‘stand’. I am pretty sure that you will not have to completely throw away your asana practice. There will be a middle ground for you!!!

Namaste
Gabrielle 🙂

Thank you for your responses! I responded earlier and it hasn’t shown up, so I apologize if it does later and this is a repeat.

I’m not exactly sure how I tore it because it wasn’t something that happened all of a sudden and I knew I had injured myself. There were a couple of things it could have been. One was the switch to Anusara and the heavy emphasis on hip openers and that I was in an immersion which consisted of six weekends over the course of one year. It seemed to worsen after each weekend. I also fell once and may have banged it enough to do something or worsen whatever was going on. A bruised femur showed up on the MRI. I had been having some problems over the past few years so all of this may have just exacerbated an existing issue. I will never know.

Dr. George Whitelaw in Milton did my surgery. I don’t know if there was any bone shaved. I will ask tomorrow. I couldn’t wait until late fall to see Dr. McCarthy. This became pretty debilitating and painful and severely limited my activities. I had seen Dr. Whitelaw before and I was told he does these procedures frequently. It was done at Milton Hospital, which has a start of the art facility now, and I thought everything went very smoothly. Right now I am fine as long as I rest and stay on the pain meds. If I try moving around too much on the crutches, it aggravates it. So this may not be as speedy a recovery as I had hoped, given what he found once he got in there.

I also did two rounds of cortisone. The first one helped for a little while, the second one didn’t help at all.

I have heard of Marc St. Pierre but haven’t been to a class of his yet. I was already injured by the time he began teaching around here, but maybe at some point I will take one of his classes. I know of a couple of great teachers who offer therapeutic, gentle yoga classes which I will likely attend when I am able, to get myself back into the swing of things again. For now, I’m doing nothing but resting it. I will likely go to PT, but I am ok with that. It’s been a long time and I’m sure there are a lot of imbalances that will need correcting.

I have practiced all over. Most recently I was taking classes with Nikki Jacobs at Healing Tree Yoga in Quincy. She is now at a new studio, Dancing Crow at the Derby Shops in Hingham that I am anxious to try out. Prior to that I was traveling to Cambridge for Patricia Walden’s Iyengar classes, Newton to Peentz Dubble’s Iyengar classes and Northampton for a teacher training at Karuna with Eileen Muir as well. I started out though with Baron Baptiste in Boston, which I absolutely loved. It was so cleansing!

Where do you practice Tiffani?

Bopper876 and Tiffani … I had my surgery on July 9, 2010. It’s been 11 weeks. I am still experiencing quite a bit of discomfort. But it is getting better. I only have to take a painkiller at night about once a week now, but am still taking Aleve during the day.

I think it’s going to take a long time, as in several more months, to get back to normal, or to not feel discomfort most of the time. I also have wondered at times if it will ever be healed again, or anything close to normal. It will be nice to get to a point where pain is not the uppermost thing on my mind. I can walk now, but if I overdo it, I pay for it. Any activity usually results in some discomfort for a day or so, but I think it’s part of the healing process.

My labral tear was ‘significant’ I was told. It was excised and bone was shaved that was irritating the tissue. I am finally at the point where it’s not waking me up in the middle of the night, though I still am having to ice it frequently, especially after walking, exercise or yoga. Ice helps tremendously. I have slept with a pack off and on it all night at times.

I did do PT for about eight weeks. My PT did trigger point therapy for the first 15 minutes and that was a tremendous help. Then we did some exercises and stretching after, which was usually pretty painful for a couple days after. I find allowing myself to recover after exercise to be very, very important, otherwise it prolongs the pain.

I am back to yoga now, but starting with gentle beginner’s classes. I went to a couple of viniyoga classes, which I absolutely love. I definitely recommend doing much, much less and easing back gently and very, very slowly.

I just got back from Florida and had access to a pool for a couple of weeks and spent an hour a day working with the hip in the pool. If you can do that, it’s worth the time. I made more progress in that time than I did in PT. I was able to move the hip in it’s full range of motion without having to deal with gravity. I used a foam noodle for flotation and doggie paddled and anything else I could think of to get the joint moving in all directions. I found walking in the shallow end, water chest high, was the best thing for it. I really focused on my gait and walking normal.

I can now walk with only a slight limp now because I was able to stretch the quadriceps muscle enough so that my gait is more normal. For some reason, I have been having a lot of pain in my quad.

I also find a foam roller to be essential(Walmart – $15). I use it on the glutes, quadriceps and IT band areas specifically and anywhere else that is tight. I carry a tennis ball around with me and massage out the glutes against a wall and that helps a lot also to loosen those muscles. It’s like constant self-administered PT!

I’d be interested in hearing about how you are both progressing, and from anyone else, and any things you discover that are working well for you.

Mary Jane

Hi Michelle,

I decided to go through with the surgery because the pain became so severe I couldn’t walk without crutches. I was doing well postoperatively after a few months. Was walking without crutches and seemed like I was getting better. As my activity level increased though, the pain came back and I am now back on crutches again. It’s been five months from the surgery. I have gone back to physical therapy and started seeing a viniyoga therapist last week. If the PT doesn’t work the surgeon suggested I may need a new hip.

None of this means that this will happen to you or that surgery wouldn’t be successful. I have arthritis in the hip now and some narrowing, whatever that means. He didn’t explain further. I am going for a second opinion this week. I’m not going for a total hip replacement without at least one more opinion.

I’ve read where people manage their pain and labral tears without getting surgery. Maybe it depends on how bad the tear(s)are.

My best to you. I also have had one injury after another the past several years. I know how you feel.

Mary Jane