Hip Labral Tear

author : AMSSM

comments : 0

Triathlete can recover from hip labral tear

Member Question:

Can anyone come back from hip labral tear repair surgery to race again? I'm 14 days post-op from a large tear that required four anchors, CAM resection, and capsule repair. I'm riding my bike with zero resistance on the trainer, but I fear I'll never really run again.

Answer from George Pujalte, M.D.
Member, AMSSM

Coming back to race after arthroscopic hip labral repair is certainly possible. Sports-specific rehabilitation is critical and tends to be a rather long and involved process that is different for every athlete. The key is not to be in too much of a hurry to get back too soon and let your body guide the rehabilitation based on pain and symptoms. Case reports and series indicate 3-4 months of intensive rehabilitation is the absolute minimum time for return to competition. Most of these studies focus on professional football and hockey players, many of whom are financially motivated to return as soon as possible with less concern for the long term health of their hip after their playing days. For this reason, many doctors and therapists recommend an even more conservative timeline with not starting a return to running program before 3 months (and often closer to 5-6 month postoperatively for many patients). A return to running program will also take a few months to get back into running any significant mileage and thus it’s not unreasonable to expect up to 7-12 months from surgery for an endurance athlete to feel ready to compete. Fortunately for a triathlete, running in the pool, swimming, and cycling are important parts of rehab which can begin much sooner.

It is good that you are biking at zero resistance, but if you have any pain with this, it is a good idea to back off, as many post-operative labral repair patients are just getting off “non-weight bearing” status and beginning to wean from crutches two weeks following the surgery. It is important to remember that the surgeon put things where they belong at the time of surgery, but it takes at least 6-8 weeks for your body to heal the labral and capsular repairs and it’s your job to protect your hip during this time. This can be hard for athletes who often believe they can speed the healing process up by working harder than other patients. However, during these first few months this is often counterproductive. Although it is often difficult for endurance athletes to accept, there are really no activities in the first 6-8 weeks after surgery that are safe for your hip that will allow you to maintain an aerobic base. You really have to be patient after this surgery and the more patient you can be now and function within the physical therapists recommendations the easier the later parts of the rehab will be.

Triathletes and cyclists must also remember that cycling is an ‘impingement’ position that loads the labral repair area. To avoid this during early rehab the seat should be higher than normal and patients should sit up straight and avoid reaching for handlebars or trying an aero position. The goal of early postoperative cycling is to regain pain free motion and can be accomplished in a few minutes a couple times a day.

As mentioned previously, there is little evidence regarding outcomes of hip arthroscopy in triathletes but, overall outcomes have been very encouraging in athletes with most studies showing that 75-95% of high level athletes are able to return to their previous competition level. Although not exactly endurance running, there is good research on NHL hockey players who place large demands on their hips and two-thirds were still playing in the NHL more than 5 years after surgery. This is impressive when one considers how hard it is to stay in a professional league for 5 years even if you’ve never had surgery.

The numbers are on your side but patience and rest are critical to a successful recovery from this surgery as is finding a skilled therapist who can frequently remind you of the anticipated timeline and progress you individually as your body tolerates back toward your long term goals. Always remember, the goal is to have a good hip for many years to come even if it means taking things slowly initially and really listening to your body.

George G.A. Pujalte, MD, FACSM and Matthew M. Crowe, MD
Sports Medicine
904-953-2000| Fax: 904-953-0626
Mayo Clinic | 4500 San Pablo South| Jacksonville, FL 32224
http://www.mayoclinic.org/departments-centers/sports-medicine/florida/doctors

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date: January 31, 2017