Hip tears and injuries are a little-discussed birth complication. Learn how these injuries happen, and how you can treat them.
Vaginal tears are regularly discussed as a birth complication—but hip tears? You don't hear much about those. But medical experts report more and more women that have a torn hip labrum as a result of giving birth, according to Benjamin Domb, MD, medical director at American Hip Institute and director of orthopedic surgery at Adventist Hinsdale Hospital. (For those not up on their anatomy, the labrum is the tissue that connects the hip's ball and socket joint.)
How does this happen?
During delivery, women are usually pulling up their knees and someone else is pulling out their feet. When the feet get pulled outward, it causes an extreme rotation in the hip that can strain the labrum and result in a tear. "Family members or medical personnel may attempt to help the mother by pulling her legs toward her chest," says Dr. Domb. "In so doing, they may inadvertently cause a hip injury such as a labral tear. Even worse, this can occur without the mother's control due to the presence of epidural." At the American Hip Institute at Hinsdale Orthopedics, Dr. Domb sees at least 30 such injuries annually.
Women are at higher risk of this injury during childbirth due to several factors. "First, the progesterone hormones that predominate in pregnancy result in ligament and cartilage laxity, or elasticity, which allows them to stretch more than usual and may predispose them to a higher likelihood of injury," says Jason James, a board-certified OB/GYN, medical director at FemCare Ob-Gyn in Miami, Florida, and chairman of OB/GYN at Baptist Hospital of Miami. "Additionally, the hyperextension of the hip joints that occur while a woman is pushing during the final stages of labor may result in stretching of the cartilage beyond the maximum physiological range, resulting in injury and tears."
Since obstetricians aren't necessarily familiar with this injury, it often goes misdiagnosed as a hip strain, a pulled groin, a sprain, hernia or sciatica. "Seventy percent of labral tears in the hip are initially misdiagnosed, and obtaining the correct diagnosis takes on average more than six months," says Dr. Domb.
How do you know if you have a hip tear?
"Hip injuries such as labral tears may cause persistent pain in the groin, or in the front or side of the hip," explains Dr. Domb. "Pain may be aggravated with prolonged sitting, twisting or bending the hip, rotational movements, or sexual intercourse."
Hip tears could make resuming regular activity difficult. "Some women may be unable to participate in sports or exercise-related activities and they may complain of difficulty with normal walking," says Dr. James.
What are the treatment options?
Getting a proper diagnosis is key to getting proper treatment. "Final diagnosis should be made by a hip preservation surgery specialist, usually with the aid of an MRI," says Dr. Domb. He notes that while the injury itself is not new, doctors are getting better at recognizing and diagnosing it.
"First line treatments include rest and minimizing weight bearing," says Dr. James. But staying off of your feet is not easy to do if you're a new mom. Getting someone to come in and help with the baby (and other household needs) is a good first step. If the pain persists, then you should look into secondary treatment, which is non-surgical. "Physical therapy, anti-inflammatories, and sometimes injections can help," says Dr. Domb. "If non-surgical treatment is unsuccessful, then the tear should be fixed arthroscopically."