Of all the things running through a woman’s head as she’s delivering a baby, it’s safe to assume preventing a hip injury isn’t among them.
But emerging data pinpoints a specific type of hip injury, known as a labral tear, that is especially common among women during and around childbirth. Often misdiagnosed as a hip strain, a pulled groin, a hernia or even sciatica, a labral tear is an injury to the rubbery tissue that cushions the hip’s ball-and-socket joint.
Dr. Benjamin Domb, an orthopedic surgeon and hip expert at Adventist Hinsdale Hospital, says the diagnosis is relatively new and still making its way through the orthopedic community. He says he’s treated about 10 women in the past six months with childbirth-related labral tears.
“I had one patient who came in a few weeks after giving birth with hip pain,” says Domb, himself a new father of a 4-month-old boy. “She said of all the pain she felt during delivery, the one she most clearly remembers was the sharp pain in her hip. That should tell you something.”
The injury isn’t new, says another area hip specialist, but has often been misdiagnosed or lost in the shuffle of delivery and post-delivery chaos.
“Labral tears have probably been happening for thousands of years, but it’s something we’re just now getting better at recognizing,” says Dr. Justin LaReau, a hip specialist at Hinsdale Orthopedic Associates.
Obstetricians aren’t usually looking for hip injuries, and for women with a newborn, a nagging hip pain can quickly fall to the bottom of the priorities list.
“We’re better at picking them up now, but still not great,” LaReau says. “It may be something that the orthopedic community and the OBGYN community need to get better at talking about.”
What is a labral tear?
The hip is a ball-and-socket joint, which means there’s a lot of friction. The labrum is a rubbery shield that surrounds the “socket” end of the joint to protect it, especially during extreme ranges of motion. When the labrum tears, Domb says, it leaves the hip joint unlubricated and unstable, presenting as nagging pain and which can lead to arthritis.
How does a labral tear happen during childbirth?
The “extreme range of motion” Domb mentioned as danger zones for hip injuries? The classic position in Western childbirth, with a woman’s legs up in stirrups and turned out at a sharp angle, fits the bill. During delivery, women are usually pulling up on their own knees, while someone else — often a nurse or family member — is pulling on her feet. When the feet get pulled outward, it causes an extreme rotation in the hip that strains — and can tear — the labrum.
How can I prevent labral tears?
The simplest prevention is to practice what Domb calls “good delivery form.” While that sounds like something to file in the “easier-said-than-done” category, Domb says it’s as simple as not pulling outwardly on the feet. (Ladies, tell your husbands now.) And while there’s bound to be a certain amount of pain during childbirth, LeReau cautions that if you feel an unexpected pain in your hip, tell your doctor right away and see if you can adjust your position.
But you can plan ahead, too. As with almost any physical activity, the better your fitness level and flexibility, the less likely you are to get injured during childbirth, Domb says. Try prenatal yoga or Pilates to improve core strength and flexibility, or if you can’t make it to the gym, take 10 minutes each day to perform simple stretches at home.
How do I know if I have a labral tear?
Labral tears can present many different ways, which helps to explain why they’re so often diagnosed as something else. Pain along the front or side of the hip or down the leg that doesn’t go away within a few weeks of childbirth is reason enough to see a doctor. And keep in mind that your obstetrician might not diagnose a labral tear just because he or she isn’t looking for it. “The eye sees what the mind knows,” Domb says. “As knowledge about the diagnosis percolates through the medical community, we should be able to get more of these diagnosed right the first time.”
What are my treatment options?
Labral tears don’t usually heal on their own. Most will have to be repaired through arthroscopic surgeries, of which Domb performs about 400 a year at the Hinsdale hospital’s Center for Hip Excellence. A non-surgical option is what’s known as platelet-rich plasma injections, a promising treatment for many types of tissue injuries in which blood is drawn from the patient, the parts heavy in growth-inducing enzymes are separated and injected directly into the socket to stimulate tissue growth.