An injury that is all-too-common amongst hockey players is the dreaded labral tear of the hip. Currently David Pasrnak, Tyler Seguin, and presumably Nikita Kucherov (he has had season-ending hip surgery, although in available reports, the labrum was not specifically mentioned), are all recovering from arthroscopic surgery to repair a torn labrum in the hip. I think it is important to understand how the hip joint works first, before we dive into what exactly the labrum is and what it does.
The hip is a ball and socket joint. The end of your long thigh bone, the femur, is shaped like a sphere, and this fits into the nice round socket, located on each side of the pelvis. The socket covers a good portion of the ball, making it a very stable joint. The labrum is a rim of cartilage that lines the edges of the socket, and helps the joint fit together better. It makes the socket a bit deeper, and also creates sort of a vacuum sealed effect, preserving the overall integrity of the joint.
Problems can arise with the hip joint when something is a bit off with the shape of the joint. Sometimes the socket has a little extra bone on one edge which creates a pinching effect in the front of the hip. Alternatively, sometimes the ball is somewhat more oval in shape, and it also catches with certain hip movements or rotations. In isolation, this isn’t a huge deal, it would be something we might call a ‘microtrauma’. But these little microtraumas can add up, especially in professional athletes, and hockey players in particular. These guys literally have to get custom jeans made because their gluteus maximus (see: butt muscles) muscles are often too large for regular pants. So you can just imagine the level of force being transmitted through the hip joints over time! This can start to cause tearing or fraying of the cartilage rim, or labrum, which can then cause pain, and sometimes a sense of ‘giving out’ of the hip joint. The pain can be in the groin, or in the front of the hip joint, and generally just make it difficult to generate the same level of force while trying to push off with that leg during skating.
It is possible to simply rehab a labral tear, or a similar injury that causes pinching or impingement in the front of the hip. Generally you want to improve mobility in the hip joint, as well as work on strength in the core and the muscles surrounding and controlling the hip itself. It is entirely possible, and some would argue better in the long-term (think the entire life-span of the individual) to go the rehab route. The problem is it takes time. And with athletes in the midst of their fleeting professional careers, fast-forwarding to the part where you get to play again almost always sounds like the better option. The risk of course, with hip surgery, is that you have a greater chance of developing osteoarthritis in the joint later on, often requiring a hip replacement. For a 25 year-old professional athlete, the trade-off often seems well worth it. On the flip side, going the rehab route (i.e. not doing surgery) also carries the risk that the same problem will return at some point down the line.
The surgery to repair the hip is done arthroscopically. This means there are multiple small incisions into which tiny instruments, including little lights and a camera, are inserted. The surgeon repairs the tear in the labrum, and will often resurface the hip joint, which means they shave off extra bone, to make the ball and socket fit together better. For this reason, you often can’t put weight on the leg for around six weeks, and crutches are required at first. This is because you have changed the shape of the joint, and you can’t place too much stress on the bone as it is healing. The good thing is, it is a day surgery, so you don’t actually have to spend much time in the hospital.
And of course, after surgery, you rehab! This process can take around 5 to 6 months, and in the early going, things are pretty light. As mentioned, you can’t put any weight on the joint, and you often aren’t allowed to move the joint too far in any one direction in order to protect the repair. So the early focus is on managing pain, and slowly introducing some mobility, as well as some very light strengthening. Gradually you are allowed to do a little more as the weeks go by, eventually transitioning to weight-bearing exercises, through all parts of the range of motion of the joint. Then, you start to tailor the exercises to suit the sport for the given athlete, trying to mimic the stresses the hip joint is expected to withstand as return to play gets closer and closer.
There is no question, this is a long haul. Surgery of this kind will almost always end the season for an athlete, so it is never taken lightly. Tyler Seguin for example, had to play through his hip injury through much of the 2020 Stanley Cup Playoffs, as there was no quick fix for his problem. Who knows if the Dallas Stars would have come as close as they did to winning the Cup if Seguin had decided to shut it down!