Hip Labral Tear Management: An Expert’s Approach

Hip labral tears are frequently identified in young, active populations, particularly in sports involving repeated hip flexion and rotation.

But their presence on imaging doesn’t always explain symptoms, and it rarely provides a clear direction for management on its own. The challenge for clinicians is interpreting these findings alongside the clinical presentation, and deciding how to load and progress the patient without over- or under-reacting to the diagnosis.

This blog gives a snapshot of an expert Case Study with Ed Clarke, who takes us through how he manages an acute hip labral tear from initial assessment through to return to performance.

If you want to see exactly how expert physio Ed Clarke assesses and manages a hip labral tear, watch his full Case Study HERE. With Case Studies you can step inside the minds of experts and apply their strategies to get better results with your patients. Learn more here.

Case and initial assessment

An 18-year-old footballer presented with sudden-onset anterior hip pain during a warm-up drill. There was no contact or obvious trauma, just a sharp pain while moving into hip flexion, abduction, and external rotation. He attempted to continue but was forced to stop as symptoms worsened.

The initial assessment revealed a cluster of findings: the patient reported a clicking sensation alongside sharp pain rated at 7/10. Hip quadrant testing reproduced symptoms, and he described a classic “C-sign” distribution of pain. Deep squats were painful, while resisted strength testing was pain-free. The log roll test was positive, and there was increased joint play on AP/PA glide which raised Ed’s suspcion of underlying microinstability.

Imaging later confirmed an acute anterior labral tear alongside cam morphology. While labral tears are highly prevalent in asymptomatic individuals, in this case, the finding aligned well with the clinical picture and helped provide context.

Ed outlines a three-phase rehabilitation framework for managing this type of injury. In the acute phase, the focus is on symptom modification, early loading, and setting the foundation for progression. See him explain in this video from his Case Study:

Importantly, the multidisciplinary team was involved early. Further investigation and a corticosteroid injection helped settle acute symptoms, allowing the patient to engage more effectively with rehabilitation.

Early phase management

As Ed highlights, early loading plays a key role from the outset.

Rather than avoiding movement, the aim was to adapt it. Load, speed, and position were modified to keep the patient moving while respecting symptoms. This approach helps maintain muscle function and avoid unnecessary deconditioning.

The programme began with low-load rotational work, progressing gradually as symptoms allowed. The focus wasn’t just on pain reduction, but on restoring control of the hip in positions that had previously been provocative. See some exercises Ed used in this clip from his Case Study:

Ed used initial asterisk signs to monitor progress, however he notes the importance of using provocative tests such as the Flexion-Adduction-Internal-Rotation (FADIR) test intermittently, as using it too much can flare patients up.

Rebuilding & return to running

As symptoms settled, rehabilitation shifted towards rebuilding capacity.

Strength and power development became central, alongside conditioning that started to reflect the demands of football. This phase wasn’t just about getting stronger, but about preparing the patient for the specific movements and loads required for football.

Before returning to running, the patient had to meet a set of clearly defined criteria:

• Pain-free clinical assessment: The patient should have full, pain-free hip range of motion and no reproduction of their familiar symptoms during clinical testing, including FADIR and hip quadrant tests.
• Completion of gym-based run preparation and reduced weight-bearing running: The patient should have progressed through a structured gym-based program that includes running-specific strength and loading drills, and should be able to tolerate reduced weight-bearing running (e.g. AlterG or pool running) without symptoms.
• Greater than 80% limb symmetry index: The affected limb should reach at least 80% of the unaffected side for hip strength, countermovement jump performance (both take-off and landing), and single-leg countermovement jump, indicating adequate strength and power symmetry.
• Single-leg calf raise and reactive strength: The patient should be able to complete more than 30 single-leg calf raises and demonstrate sufficient reactive hip strength, with the capacity to tolerate forces greater than 5 times body weight, indicating readiness for higher impact running loads.

These criteria helped ensure that progression wasn’t based on time alone, but on demonstrated readiness.

Wrapping up

Managing hip labral tears comes down to making the right calls at the right time. Not pushing too early, but not holding back unnecessarily either. It’s all about balance!

What’s useful in this Case Study is seeing how progression is built step by step, from settling symptoms to preparing for return to sport demands. The detail sits in those decisions, what to load, when to progress, and what to use to guide it.

That’s the kind of insight that’s hard to pick up from guidelines alone, and where Case Studies become genuinely useful in shaping how you approach similar patients in clinic.

Want to know exactly how expert Ed Clarke managed this patient? Watch his full Case Study here.