Introduction
Acetabular labral tears are a leading cause of chronic hip and groin pain in young adults and athletes, often associated with femoroacetabular impingement (FAI). While arthroscopic repair remains a common treatment, a growing body of RCTs supports physiotherapy as a first-line or adjunctive option—particularly for pain reduction, functional improvement, and long-term joint preservation.
Clinical Background
The acetabular labrum plays a critical role in:
- Enhancing hip joint stability
- Maintaining negative intra-articular pressure
- Protecting articular cartilage
Labral tears are frequently linked with FAI (cam/pincer morphologies), though they can occur in isolation due to trauma or repetitive motion in rotational sports.
Key RCT Evidence Supporting Conservative Physiotherapy
1. Bennell et al. (2018) – The FIRST Trial
Compared arthroscopic surgery to a 12-week physiotherapy program in patients with FAI and labral pathology.
Physiotherapy included individualized strengthening, motor control, and education.
Results: No significant difference in patient-reported hip function and pain at 8 and 12 months.
Conclusion: Physiotherapy is a viable first-line treatment in FAI-associated labral pathology.
2. Emara et al. (2011)
Conservative treatment involving physiotherapy and activity modification resulted in statistically significant pain reduction and improved Harris Hip Scores.
Particularly effective in patients without mechanical locking and with manageable FAI morphology.
Physiotherapy Protocol Overview
Our labral tear protocol includes:
- Strengthening of gluteus medius/maximus, hip rotators, and core
- Neuromuscular re-education to optimize joint loading
- Manual therapy for mobility restrictions in adjacent structures (e.g., lumbar spine, SIJ)
- Functional movement retraining (squats, step-downs, gait analysis)
- Return-to-sport/activity programming with load progression
Pre- and Post-Operative Physiotherapy
- Prehab improves post-op outcomes, minimizes muscle atrophy, and enhances neuromuscular control
- Post-surgical rehab focuses on progressive loading, joint protection, and early mobility per surgeon protocol
When to Refer to Physiotherapy
- Imaging-confirmed labral tears with mild to moderate symptoms
- Patients who prefer to avoid or delay surgery
- Failed conservative management with general exercise (without specialty input)
- Post-operative patients requiring structured rehab
- FAI patients at risk for cartilage damage or OA
Conclusion
RCTs confirm that structured physiotherapy is a safe and effective alternative to surgery for many patients with labral tears. Moreover, physiotherapy plays a critical role in optimizing outcomes pre- and post-arthroscopy. Collaborative care between physicians and physiotherapists can improve recovery, reduce surgical burden, and extend joint longevity.
References:
Bennell, K. L., Spiers, L., Takla, A., Vicenzino, B., Ferreira, P., Harris, A., … & Hinman, R. S. (2018). Physiotherapy versus arthroscopic hip surgery for femoroacetabular impingement: A randomized controlled trial. British Journal of Sports Medicine, 52(10), 669–676. https://doi.org/10.1136/bjsports-2017-098945
Emara, K., Samir, W., Motasem, E., & Ghafar, K. A. (2011). Conservative treatment for acetabular labral tears. Journal of Orthopaedic Surgery and Research, 6(1), 20. https://doi.org/10.1186/1749-799X-6-20
