2012 Annual Conference

Connors, Michael James PT, DPT, OCS

University of North Texas Health Science Center Department of Physical Therapy Fort Worth, TX

Hip labral tears are a common diagnosis found in dancers at various levels of competition.  Due to the small stature of dancers and the high rate of force needed to execute different dance maneuvers, these individuals are at an increased risk of sustaining hip labral tears.  EG is a 16 year old competitive dancer who experienced an insidious onset of left hip pain six months prior to imaging studies to confirm the labral tear.  She experienced a progressive decline in performance as a dancer with weakness and pain serving as the primary limiters of her dance activity.

This is a single case study design consisting of a comprehensive physical therapy program aimed at utilizing conservative treatment to avoid surgical intervention and facilitate pain free return to high level dance activity (ballet).  EG is a high level ballet dancer who presented to physical therapy with a hip labral tear as identified by MRI.

Initial pain complaints at initial assessment were reported at 4/10 with dance activity.  Upon examination, EG experienced weakness in hip flexion, extension and hip adduction assessed via MMT at 4-/5 on left.  Upon assessment of her core stabilizers, EG’s abdominal strength via MMT was noted to be 4-/5.  In assessing EG’s dynamic stability with single leg stance, she experienced tremendous difficulty in maintaining single leg support on left.  EG also demonstrated a higher degree of postural sway on LLE, which can also serve as an indicator of impaired core stabilization activation.  At the initial evaluation, EG presented with a Lower Extremity Functional Scale Score (LEFS) of 60/80, which translated into her being at 75% of maximal function. In addition to the normal standard of care for hip labral pathology, we utilized a progressively challenging core stabilization program to address proximal stability.  The program began in supine with a rapid progression to sitting, standing and then incorporating dance maneuvers into context of exercise for mirroring of everyday tasks.

EG was seen for a total of 6 visits over 8 weeks with continuous reinforcement of progressive HEP.  Upon discharge assessment, EG presented with bilateral hip strength at 5/5 for all motions and with core stabilizer strength at 5/5 as assessed via MMT. In assessing dynamic core activation in standing, EG experienced little to no postural sway or inability to assume/maintain single leg stance on left. Upon discharge, EG reported experiencing 0/10 pain with dance activity. EG was noted to have a discharge LEFS score of 78/80, which would correlate to a return to normal, premorbid maximal function.

Clinical Relevance/Conclusion

Hip labral tears are a common injury in high level dancers who utilize a combination of high levels of rotation and torque to execute many of the maneuvers as part of their routines.  Due to the diminished vascularity to the hip labrum, many of these adolescent athletes require surgical intervention in order to facilitate a return to prior sport activity.  The purpose of this case study was to illustrate the importance of examining and addressing limitations in proximal core and hip muscle strength as a means to facilitate non-operative recovery and return to sport activity in a dancer with a confirmed hip labral tear via MRI.