Webinar Recap: Non-Surgical Hip Labrum Repair
We recently hosted a webinar on non-operative hip labrum repair presented by Murphy Grant from University of Kansas. Murphy, who uses water heavily for his athletes, offers a presentation packed full of exercise ideas and videos.
Murphy states that hip pain is not uncommon, nor is it a new injury, but the identification of different hip pathologies has improved. What used to be just considered groin pain, can now be identified more specifically.
Hip pain occurs in about 20% of the population. The hip is a strong joint that aids in holding us up and the intrinsic stability needed to do this is pretty unique. More specifically, the labrum provides stability and flexibility to the hip joint and is also a shock absorber.
Unfortunately, 75% of labral tears have no known cause. Tears usually occur in the anterior and anterior superior area and involve the ring of cartilage around the acetabulum. Some tears cause no pain or just some stiffness.
In the webinar, Murphy discussed the reasons why he uses the water for repair of labral tears:
- An alternative to traditional training – it changes things up and puts the patient/athlete in an entirely different environment.
- Warm water relaxes patients/athletes.
- Water is 100 times denser than air – which aids in improving posture and balance and stability.
- Promotes body awareness and balance – provides instant feedback
Some suggestions for planning a water rehab program. (Murphy strongly suggests trying exercises in the water yourself to get a feel for how the water affects the exercises):
- Warm up goals:
- Enhance strength
- Improve posture
- Work on balance
- Increase ROM and flexibility without pain
- Program Goals:
- Pain-free ROM
- Sports specificity or activities of daily living (ADLs)
In the meat of this webinar, Murphy provided very specific protocols for each phase of the rehabilitation process. His awesome videos help demonstrate the proper body mechanics for each exercise while also providing progression options and techniques.
- Phase 1 – partial weight-bearing activities. Don’t go beyond 90 degrees and avoid external rotation
- Phase 2 – partial weight-bearing activities. Go for pain-free range up to 105 degree
- Phase 3 – restore muscular strength and endurance
- Phase 4 – more active moving around, cardiovascular work and sport-specific activities.
After the webinar, Murphy answered questions from the audience:
- Do you have a preference for using footwear or going barefoot in the water?
- I leave it up to the athlete and what is comfortable. I have athletes and patients go barefoot. I wear footwear because I’m spending hours in the pool.
- What is the estimated timeframe to progress through phases?
- I utilize about 2-3 weeks in my progressions. Make sure you are consistently following up with the healthcare provider. Phase 1 usually lasts 1-3 weeks and phase 2 can often last 3-4 weeks. Make sure that the patient/athlete is safe. Don’t start fast-pacing the rehabilitation. Reevaluate and add exercises into plan as needed.
- How do you add progressive resistance for patients performing exercises?
- In the aquatic medium itself, I can just turn on the resistance jets. If you don’t have that opportunity, use the HydroTones, which give the most resistance. I will use resistance bands and will even do kettlebell activities in the water. Be creative with what you want. I include a lot of different toys into the pool.
- Talk about the frequency of workouts: how many times per week? how long is a session?
- Anywhere between 30 minutes to an hour per session. I try not to keep them in the water any longer than an hour. With our athletes, they’re still doing ground-based things at the same time. They may be in the pool 3 times per week, and on the ground another 2 days during one week, but also doing ground-based things on water days. Then the following week, they may be in the water 2x per week. Do it in collaboration with ground-based exercises also.
- Are there any phases that you are only doing pool work?
- All of those exercises, in each phase, I’m doing in the pool and on the ground. But there is o need to double up an exercise. For example, introduce single leg hops in the pool, sooner than ground-based.
- Is manually created turbulence as effective as resistance jets?
- Manually created turbulence can be, but it’s not as consistent as the person creating the turbulence gets fatigued. There’s nothing wrong with that. I agitate water often in my sessions, it’s just harder to keep consistent for an entire length of an exercise.