Students with Labral Tears?


May 12, 2015     hip | labrum | Anatomy | Lower Limb | Your Questions

Transcript of: How should I deal with my students who have a labral tear?

Hey there, back again, going to answer another question. If you haven’t submitted your own: yoganatomy.com/myquestion. Go ahead and give me a question and I’ll do my best to get it answered for you.

This month’s question is from Lex Fry. “Hi David, looking forward to your online courses.” I didn’t say anything about my courses yet. I do have some online courses coming out. You’ll find those courses at yoganatomy.com if you’re interested.
Anyway, she’s looking forward to them when they’re ready. There are a couple of them ready already. She is already applying stuff from my book. Oh yes, don’t forget the book. Anyway, so much to think about in the book and there’s a lot to think about in that book.

Learn a system for working with injuries

The Question:

Alright, “I’m teaching ten classes a week at a local liberal arts college including two classes a week specifically oriented towards college athletes. This semester I seem to have a number of student athletes with diagnosed or suggested hip labrum tears causing a fair amount of pain and limitations in their athletic training and performance. In each case, I’m finding very tight psoas on affected sides but lots of impingement to stretching. I would love to learn more about this area of the hip and how it also impacts the surrounding muscles and tissues with inflammation, finding this in lacrosse players, soccer players, and rowers mostly. Any advice for working around with this issue and developing a practice?”

The Answer:

Alright, wow, labrum tears getting very popular out there in the yoga community. You’re dealing with a different community, of course. Wow, good question and timely I’ve had a couple of emails in the last month about labral tears.

I wouldn’t say I’m done with my own research on the topic of labral tears as relative to yoga, but a theme seems to be emerging regarding labral tears happening in yoga practice specifically, and then I’ll get more to your questions. What I can see so far is that there’s almost always an underlying hip shape that exists.

Sometimes it’s related to the positioning of the socket in the pelvis or angle of the femur in the way that it connects in. Usually, that’s there first. Maybe the person has done a lot of impactful type of activities like you’re talking about, soccer players, lacrosse players, or rowers who are doing really repetitive movements at their hip joint. I’m going to guess that for most of them probably there was something specific going on in their hip joints before this.

There are a lot of people who do all these activities and don’t end up with labral tears. Keep that in mind just like the majority of people who do yoga, but don’t get labral tears. Probably your own bone shape is partly to play into this. It’s hard to know what that is or what’s lying underneath the skin because we don’t have x-ray eyes. It’s hard to know ahead of time.
What seems to cause it in yoga is compressing the hip joints, so they’re fully flexed and then adding on abduction. However, I know people that it’s happened to them, going in the complete opposite direction, which is external rotation like doing leg behind head which is really deep external rotation of the hip joints. Either way, it seems to be at the extreme ends of that range of motion either internal or external. Keep that in mind.

What I would say is, if these students are already dealing with it, maybe avoid full hip flexion on those sides and see how that goes. With this kind of group, you’re probably not doing any kind of leg behind head work anyway. I wouldn’t worry about that.
Once the inflammation is in there, basically you just need to back off of everything until the inflammation comes down because otherwise you keep inflaming it. Something else that happens is calcium is usually sent to places of inflammation in the body. It’s one of the mechanisms that we use to reduce inflammation. This is sometimes how bone spurs and nodules start forming on the bones.

Keeping something inflamed is not really a great idea from an anatomical point of view.
Anyway, the fact that there’s inability to stretch in this particular population Lex, is probably more indicative of the muscles kind of shutting down. Not shutting down I guess, not literally shutting down but tightening up, splinting the area, trying to prevent a certain amount of movement because the body is kind of sensing that that kind of movement is going to add to the inflammation and or injury, so it stops doing that.

Not so dissimilar than if you had a car accident and you went through a whip lash and your neck muscles got tight. The muscles splint down and keep your head from moving so you don’t add on to the existing injury. That’s probably the real reason why you’re having a hard time stretching these areas for them.

Alright, I hope I gave you a little bit of food for thought. And those of you who are on the labral tear thing with yoga, go get it checked out. Know what you’re dealing with so that you can make really good decisions about how you want to proceed forward with your yoga practice. Alright, if you’ve got another question, throw it at me yoganatomy.com/myquestion.

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