Is Yoga Tearing Labrums?


September 1, 2015     hip | injury | Yoga Injuries

Is yoga tearing labrums? There is no simple answer.

I’m hearing more conversations about labral tears in the yoga world recently. Are the instances of labral tears increasing? Are we just getting more informed about accurately identifying pain and injury within the yoga community? Is it the yoga that is tearing the labrum? These are valid questions, however, the answers to questions like these are difficult to fully uncover. The possible cause of any injury is hard to discern, much less prove without a doubt. As I referenced in a prior article from June of 2014, there are many aspects to the conversation around injuries. These conversations are a good thing because they make us take stock in and question how we are practicing asana.
Let’s start exploring this conversation by learning a little more about what the labrum is and what we mean by a labral tear.

What Is The Labrum?

labrum tears in yogaLet’s start with the basics. The labrum is an additional piece of fibrocartilage and connective tissue around the edge of the socket (acetabulum) that receives the ball (head) of the femur. The two together make up what we call our hip or acetabulofemoral joint.
To keep it as simple as possible, the labrum essentially extends the acetabulum to add stability to the joint (this is the typically accepted theory). It is also associated with managing stress coming into the joint as well as helping to seal the joint. More research is being done to figure out exactly how the labrum functions.

A Labral Tear

The labrum in the hip is similar to the meniscus in the knee joint. It can tear. This can happen over a long period of time or all at once with direct trauma to the joint. The tear can be in the form of a flap. It can also occur as degradation, lesions, or a fraying of the cartilaginous material. The labrum can also peel off the bone making space between itself and the bone.
Like the meniscus, the labrum has a difficult time healing on its own. Blood supply is limited to the majority of the structure with the outer edges typically receiving the most blood supply. This means small tears to the outer edges may heal on their own, but the circumstances of each individual tear dictate whether they will heal or not.

Typical Symptoms

The most common symptom of a labral tear is a “pinching” sensation in the hip joint. Of course, this is not the only reason you may feel pinching in certain postures. Check out my article on Hip Pinching in A Twist. Having said that, the type of pinching I’m referring to with the labrum is not one that is relieved by rubbing your iliacus muscle as I describe in that post. It’s more like a pinching sensation that never seems to go away in the position causing it.
Most commonly the pain and sensation is felt on the inside of the thigh and groin area. Other symptoms include pain that feels like it is “deep” in the joint including sensations in the back of the hip joint. Clicking sounds when you walk or do certain movements in the hip joint are also common symptoms. This is not to say that any one of these symptoms is definitely a tear. Good evaluation by a professional is necessary for any diagnosis.
If you think you may have a tear, go see a doctor. At some point you will need an MRI with contrast to confirm a tear.

Pre-existing Conditions

There are certain pre-existing conditions that make you more likely to end up with a labral tear.

Hip Dysplasia

Hip dysplasia is a condition where the acetabulum (socket) is misshapen. Usually it is larger than it should be which allows the femur to move within the socket more than it should. There are varying degrees of this and if diagnosed as a child, various types of harnesses can be used to stabilize the joint so that the bone formation can continue normally, reducing future problems.
“In a study of patients with mild to moderate hip dysplasia and hip pain, McCarthy and Lee (2002) found that 72% of the 170 hips studied had labral tears, and 93% of these tears were in the anterior region of the labrum.”

Structural Differences

Any structural differences that create less distance between the femur and acetabulum can make the probability of labral tears higher. This includes a short femoral neck (the area between the head and the shaft) or a condition known as Femoral Acetabular Impingement (FAI). Wikipedia link
There are different types of FAI. The neck of the femur can have a bony growth along it. When there is a bony growth there, it is known as a Cam deformity.
It is also possible to have what is called a Pincer deformity. In this case there is bony deformation on the pelvic side of the joint. It is due to a deeper than normal socket or an abnormal tilt to the socket.
It is also possible to have a mix of the two (the most common). In all cases the femoral neck ends up bumping into the socket quicker. This can by itself reduce the range of motion possible at the joint. It also increases the chance that the labrum gets pinched and torn.

Reduced Acetabular and/or Femoral Anteversion

If the acetabulum is facing backward more than normal you either have what is called reduced anteversion or if pointing backward then it’s called retroversion. You can also have decreased anteversion or retroversion of the femur. This is referring to the line created by the femoral neck relative to the distal (bottom) end of the femur.
Without over-complicating it, with these shapes in your hip joint, you are more likely to have the neck of the femur bumping into the socket more quickly. For instance, in acetabular retroversion, flexion of the hip, along with adduction, bring the femur and the socket into contact pinching the labrum. (Lavigne et al., 2004; Ganz et al., 2003)
labrum cross section

What If You Don’t Have Any of These?

In those that do not have any of these pre-existing conditions, the cause of labral tears varies, but generally includes direct trauma. Activities such as running, cycling, tennis, soccer, hockey, golf, and ballet can be associated with labral tears. It seems reasonable that yoga would be included in the list. Something like dropping into a hanumanasana too quickly could do it.
A wide range of movements may be associated with labral tears but most commonly they include hyperextension of the hip joint, especially when also including external rotation of the joint at the same time. Having said all of that, up to 74.1% of labral tears (Santori and Villar, 2000) are not associated with any known specific event or cause. It is believed that repeated microtraumas over a long period of time might be the culprit.

Personal Interviews

I reached out to a friend of mine who had a labral tear and general hip degradation. She is both a yoga practitioner and a teacher. She ended up with a complete hip replacement. I know what you’re thinking; it was the yoga that did it. After all, she’s a practitioner and a teacher.
When she went to the doctor she was diagnosed with a mild case of hip dysplasia as well as decreased anteversion. One factor alone would have put her at a higher risk; two increases the probability that if she just did moderate activity/exercise of any type, she might have ended up in the same place. There’s no way to know for sure. Did the practice of asana make it happen? Or was it just what she chose to do as her activity?
Because she has been through this herself, she has since worked with a few other practitioners who ended up with labral tears.
Three students that she has worked with were diagnosed with at least one of the pre-existing conditions. Unfortunately I don’t have all of the details of years of practice of asana or other activities prior to or during their yoga practice. On top of that, it’s not a very large sample of students, so there’s only so much we can learn from these particular experiences. It could just be a coincidence that each of them had at least one pre-existing condition.

What should I do with my practice if I have a labral tear?

First and foremost, check with your doctor or PT. My friend suggested that from her experience there are definitely some do’s and don’ts. Keep in mind that they would change depending on where the tear was located, how severe it was, if you have a pre-existing condition described, and which pre-existing condition you have.
Basically, take extreme ranges of motion off the table. In almost all of these situations, even if the students didn’t feel pinch or pain during their practice (by avoiding the pinching feeling completely through modification) and they did backbending, or complete forward bending, they were more likely to feel pain later in the day. That pain was possibly due to inflammation.
So, the simplest answer is to avoid the pinching sensation if you have it. Second, avoid depth of movement in any direction at the hip joint in any posture. In theory you could test certain movements. If you choose to do something like this, do just one movement (and not to an extreme) for a few days and test the outcome. Then test a different one by itself for a few days. This way you can isolate which movements are more likely to be exacerbating the problem for you. Then feed this information back to your physical therapist or orthopedic doctor.

Should I Have Surgery?

This is a discussion that you should have with your doctor. Typically, they will send you to physical therapy first. There are exercises that they can give you that can help strengthen or stabilize the hip joint that may reduce problems.

Conclusion

I would suggest that it is possible that yoga does cause labral tears. For me the question that follows is whether or not it is the sole cause. I’m sure sometimes it is. Is it the “straw that breaks the camel’s back”? Is there a pre-existing condition that has set you up for it? If you didn’t do yoga but instead were a runner, cyclist, football (soccer) player or dancer, would you have ended up with a labral tear anyway?
The question is not whether or not people practicing yoga are tearing their labrum. They are, just as they are in other activities. Is the rate higher in yoga than other activities? I couldn’t find a study specifically about this, although there is plenty of conjecture out there. It may be that asana practice is causing more labral tears by more regularly taking already destabilized or not ideal joint shapes and pushing them to the edge of where they should be going.
More research is needed.
The only way to know if you are more at risk than the person on the mat next to you is to have been diagnosed with one of the pre-existing conditions discussed. Then you would “statistically speaking” be at greater risk.
References:
Ganz R., Parvizi J., Beck M., et al. 2003. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop. 417:112–120.
Lavigne M., Parvizi J., Beck M., et al. 2004. Anterior femoroacetabular impingement, part I: techniques of joint preserving surgery. Clin Orthop. 418:61– 66.
McCarthy J.C. and Lee J.A. 2002. Acetabular dysplasia: a paradigm of arthroscopic examination of chondral injuries. Clin Orthop. 405:122–128.
Santori N. and Villar R.N. 2000. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 16:11–15.
Additional articles: Remember, what works for one person may not work for you. Proceed with caution with anyone’s recommendations, including mine!
http://www.findwholeness.com/blog/body/finding-relief-from-a-labral-tear-when-surgery-is-not-recommended/#comments
https://drbenkim.com/natural-treatment-hip-labral-tear
This article is loaded with great information. It was originally published in 2006. If you’re aware of new studies, especially related to yoga directly, let me know so I can update the information in this post.
http://ptjournal.apta.org/content/86/1/110.full