Clinical Features: Case 1: a 46-year-old female cleaner presented with chronic low back, groin and gluteal pain. A painless click was also present in the hip. She had no recall of hip rotation injury but had chronic ongoing problems and a family history of hip abnormalities and replacements. Slump, Bonnet’s, Patrick Fabere, Scour and hip flexion with internal rotation reproduced the pain on the right. MRI revealed an antero-superior labral tear. Case 2: a 15-year-old female individual medley swimmer noticed sharp anterior right hip pain that was aggravated by rotation movements, with pain referral to the medial knee. A painful click was also present in the hip. There were no lower back or posterior hip symptoms. Orthopaedic tests compressing the anterior hip capsule were positive as was psoas muscle testing. Previous history included a gymnastics career and several rotation falls with injury and hip pain following. A diagnosis of anterior-superior acetabular labral tear was made.
Intervention and Outcome: The first patient was managed with lumbopelvic and hip manipulation and mobilisation, soft tissue therapy to the hip and active therapy that incorporated a progressive stretching and strengthening program. Hip and lumbar pain subsided with short-term treatment, but a painless clicking hip remained. The second patient was managed with a similar protocol. In addition, breaststroke swimming was removed from her training schedule for 3 months. The hip pain resolved in the absence of the frog-leg kick associated with breaststroke swimming.
Conclusion: The acetabular labrum is increasingly being recognised as a source of hip pain, particularly in athletes. Research is required in the form of clinical trials to determine efficacy of hip manipulation or mobilisation for treatment of this injury.
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