One cause of chronic pelvic pain symptoms, that frequently gets overlooked, is a tear in the hip labrum.
The hip acetabular labrum is the fibrocartilagenous ring lining of the “socket” part of the hip joint. The hip is a ball and socket joint. The labrum functions to absorb shock, lubricate the joint, distribute pressure, and aide in stability.
Causes of labral tears include trauma, impingement (also known as femoroacetabular impingement or FAI), hypermobility, dysplasia, and degeneration. Hormonal influences such as during pregnancy or underlying collagen disorders can predispose patients to labral tears. Hip labral tears can also occur during delivery due to the extreme external rotation that the hip joint is placed in during vaginal birth. Repetitive rotational sports such as golf or extreme yoga poses can place stress on the hip capsule and iliofemoral ligament and result in a labral tear.
Symptoms of labral tears include hip or groin pain, buttock pain, clicking, locking, loss of range of motion, and giving way. Others may have pain in the vulvovaginal area or testicles/scrotum and have pain with intercourse. Hip labral tear symptoms can mimic or be related to vulvodynia, pelvic floor muscle dysfunction, or pudendal neuralgia.
Although tears can occur in all regions of the hip labrum it is more common to have an anterior acetabular labral tear because the anterior hip joint area has less blood supply, increased vulnerability to wear and degeneration, mechanical weakness, and is subjected to greater stresses. Hip labral tears have low potential to heal on their own due to the lower vascularization. Studies show that some patients can successfully undergo physical therapy and return to their sport without reoccurrence of pain. Many, however, require surgical repair of the labral tear and are prescribed physical therapy to prepare for surgery and also undergo rehab post-operatively.