New Moms Have Higher Risk for Hip Labral Tears
This article is discusses the importance of leg and hip positioning during birth to avoid hip cartilage, called the acetabular labrum, tears. Caregivers should never push mom’s legs back during surgery. This article also informs you about what tears are and how women, especially moms, are at higher risk.
In my previous post, I discussed The Importance of Early Intervention in Labral Tears.
Pregnancy brings with it a bevy of physiological and hormonal changes. They greatly influence orthopaedic health, not to mention psychoemotional well-being. However, what has historically been overlooked is the risk at which the acetabular hip labrum and related structures are placed during pregnancy, labor, delivery, and the postpartum. Hip labral tears are debilitating and painful, preventing normal ambulation, ADL completion, or participation in any recreational activity, including sex. Tears can also lead or contribute to pelvic pain, with the average time of injury to diagnosis being an average of 2.5 years. This delay in diagnosis can put mothers at high risk for developing chronic pelvic pain, and yes, put them at higher risk for a labral tear.
Several theories have been posited as to why pregnancy and being a new mom brings a higher risk of hip labral tears. Increased joint laxity (hyper mobile joints) has been widely debated but is generally accepted as a plausible mechanism in back pain, sacroiliac joint dysfunction, pubic symphysis dysfunction, or related pain. Increased (axial) loading through the joint combined with joint laxity are thought to be compounding factors. These changes alone could explain the presence of a prenatal tear, says researchers Brooks et al (2012).
Unavoidable changes in joint structure and function during labor and delivery also place mothers at higher risk, which means screening for hip joint intra-articular pathology is vital in the clinical setting. Further, forces applied externally during labor can be responsible for hip labral tears. Brooks et al (2012) found 4 of 10 women (all with labral tears) reported a specific incidence during labor, such as a pop, twist, or sudden sharp pain in the hip, that led to their diagnosis of hip labral tear. The range of motion that is most often forced in the hip during labor is flexion and internal or external rotation, combined with abduction. This is a common mechanism of injury that applies torque at the hip joint and can commonly be delivered by a birth assistant (husband, relative, or health care professional). Birth biomechanics education is an important aspect of hip labrum preservation that should be included in interdisciplinary care.
Screens to identify mothers at highest risk for hip joint pathology and special tests to target the hip labrum and related structures should be considered a regular part of prenatal and postpartum care in women’s health physical therapy. Hunt et al (2007) raises the importance of interdisciplinary interaction in maternal health care since “differential diagnosis of anterior hip, groin, and pelvic pain spans many health care specialties from gynecology to general surgery to musculoskeletal medicine and orthopedic surgery.”
Finally, pre-existing conditions of the hip and pelvis, such as femoral torsion, femoracetabular impingement (FAI), hip dysplasia, shallow acetabulum, and lumbopelvic instability or failed load transfer can all contribute to the incidence of, and increased risk for, hip labral tears. Since over 80% of women give birth in the United States during their lifetime, the vast majority of women are at risk for hip labral tears. Universal screening and education for hip joint preservation should be made available, through women’s health PT, as part of national agenda to improve birth and maternal health outcomes.
For Health Care Professionals: A discussion of postpartum risk, screening, and education are offered in the new Hip Labrum Differential Diagnosis course.
Ginger Garner PT, MPT, ATC, PYT
Ginger Garner’s new Hip Labrum Injury course emphasizes evidence-based assessment and management of the hip in an interdisciplinary educational environment. Her courses are known for their interprofessional focus on partnership in medicine and welcome physical therapists, physicians, physician assistants, midwives, physical therapy assistants, nurses, and anyone who works with populations where hip labral injury could be a concern. The course will address differential diagnosis and assessment of extra-articular factors that implicate hip labral injury. Ginger will discuss both conventional rehabilitation and integrative medicine techniques for management and preservation of the hip. Learn more