Why you should NOT test for a hip labral tear.

We blame chronic hip pain on whatever diagnosis exists at the time.

Upon the invention of X-Ray technologies, chronic hip pain was due to osteoarthritis and hip impingement.

Upon the invention of MRI technologies, hip labral tears started getting the blame.

But for thousands of years, we had no way to test for hip labral tears or any other modern day diagnosis.

Chronic hip pain is nothing new. It's been around for a very long time.

Probably as long as humans or at the very least, upon human reliance on farming and society.

What did people do about their hip pain before they knew they had a hip labral tear? Or hip impingement? Or osteo-arthritis?

They figured it out. They endured.

And eventually other things distracted them - like even more intense pain, war, tragedy or whatever else our ancestors had to deal with.

In this article, I'll explain why I believe getting tested for a hip labral can actually make things worse.

Worse in the context of not only the pain itself but also in the duration and difficulty of recovery.

Section 1 - Gold standard test for hip labral tears - the MRI.

I take pride in my ability to be motivated by facts. By reason and objectivity.

But it's recently come to my attention that this might be naive.

The more I learn about the human brain and what motivates, drives and influences human behavior, the more I realize that I might not be as objective and "fact-driven" as I once thought.

We all buy into things because of emotion. Without emotion, facts don't have life. And if there is no life, it doesn't stick with us.

Regardless of how powerful a piece of information can be.

So I can and will tell you that a bunch of studies show that hip labral tears DO NOT cause hip pain.

Like this one that showed 85% of people without a history of hip pain had hip labral tears.

Or this study that showed 69% of people without hip pain had hip labral tears.

But I now understand that this is not enough. We want more. We NEED more to buy in.

That is why I want to share a story with you about one of my clients that I became close with.

I'll call him Dan to maintain his privacy. 

I met Dan a few years ago when I first started helping people with hip pain professionally.

During our first video session, Dan was about 10 minutes late. He then took another 10-15 minutes to get settled once he finally showed up.

He told me needed a moment and walked out of the door then came back in. This happened a few times before he finally sat down and started speaking to me.

He explained how it was such a hectic day because he had a bunch of appointments for his hip labral tear.

He then started telling me about his pain. He told me every single detail he can think of from the last 5 years.

How the pain started. What makes the pain worse. What helps the pain. Etc.

He ended by asking me which exercise would help get rid of his hip pain?

By the time he was done, we only had about 20 minutes left in the session and I've barely said a word.

So what did I do?

I told Dan that there was no exercise in the world that would get rid of his pain. This was not a hip problem.

It was not a hip labral tear problem either. It was a brain problem.

More specifically, it was how Dan's nervous system interacted with his environment that was the problem.

With 15 minutes left, I had Dan sit in a safe position I call the "supine reset."

I guided him through a gentle meditation in this position and he seemed to feel a bit better after.

I told him I'd send him an exercise routine to work on before our next session.

But later that day, he emailed me back saying he'd get surgery for the labral tear.

From my experience, I know there is nothing to do in this situation except wish him luck.

I didn't think surgery would solve his problem but it's not my place to change people's minds once they've made a decision.

About a year later, Dan reached out to me and told me that the surgery was a complete failure.

He was still in pain. The surgeon told him that the labral tear was fixed. He couldn't understand why the pain was still there.

He purchased another online session with me. He told me was desperate and would try anything at this point.

During the session, I explained that in order to start seeing any progress, we have to address the low-hanging-fruit first.

This was his overactive nervous system. His brain's conditioning that there was some imminent and intense threat in his environment.

Yes, the pain was in his hip and there was likely some stiffness in this area of his body. But everyone has stiffness.

Exercise can help with stiffness. But exercise is not the cure for intense pain signals from the brain.

It took some convincing and some emailing back and forth but eventually Dan bought in.

He started becoming more aware of how he responded to pain signals in the body. And he started making changes to those responses.

Eventually, he realized the pain wasn't there. At first, it was just for a short period of time. But eventually, he experienced longer stretches of being pain-free than being in pain.

He recently sent me an email telling me he went on vacation with his family and only had a couple of flare ups.

I told him this was amazing and that I still get flare ups once in a while too.

And this is true. My body hurts sometimes. Not only my hip but also my back, neck and shoulders.

It happens to every single person. If they say it doesn't, they are lying to you. It's part of being human.

What makes a couple days of discomfort turn into years of suffering is based on how we react to these sensations.

Section 2 - Do THIS instead of testing for hip labral tears

Do you think it was helpful for Dan to know he had a hip labral tear?

For someone like him, it made things MUCH worse. It pushed him further away from actually feeling better.

Dan's story is enlightening because he actually went through with the surgery. He also had a nervous system that was really jacked up because of his personal history.

The surgeon fixed Dan's labral tear. It was sewn back together. But Dan still complained of hip pain.

The surgeon didn't know why. He probably thought Dan was crazy.

But Dan wasn't crazy. He is human. Just like me. And just like you. We all suffer from the human experience.

Unlike our ancestors, there is no larger immediate threat that distracts our brains and nervous system.

Our bodies do get stiff though. For many of us, we feel this the most in our hips.

This stiffness, combined with weakness, poor movement habits and an overactive nervous system can cause chronic hip pain.

Instead of prying and probing into the hip, we're much better off learning how to "dance with the pain." 

To dance with pain, we need to get educated on how chronic pain works and how exercise can support our healing journey,

I recognize there are non-invasive tests that can also be done like the FABER and FADIR test.

I talk about those tests in detail here and here, respectively, so I won't dive into those topics here. 

My thoughts are not much different for those tests but obviously they are at least much easier, cheaper and safer to perform.

Closing Thoughts

The above Mark Twain quote helps illustrate the principle that we need to look at health situations differently depending on the situation.

Not all lids are hot. And not all medical tests are helpful.

In a similar way, just because testing for hip labral tears can cause more harm than good does not mean this is true for all health and/or pain issues.

I think this is a mistake too many people make when they have a poor experience with medical testing.

With so much amazing modern technology, we have to learn and recognize when that technology helps us and when it doesn't.

When it comes to hip labral tears, be more like our ancestors with hip pain. Let hip pain just be hip pain.