Labral Tears – Surgery or Not?

Releasing painful muscles, not strengthening them, is the first step in hip pain relief.

In my last post I wrote about my perspective as a Hanna Somatic Educator regarding chronic hip pain and what is counterproductive, and what works.

  • Strengthening painful hip muscles can cause further pain or injury.
  • Learning to relax the muscles and the pattern of contraction the muscles are stuck in can provide long lasting pain relief, relaxed hip joints, and balanced movement.

Exercises such as the “clam shell,” and lateral leg lifts tighten the hip muscles, making it more difficult to move the hip.  They can, in fact, create more pain. Sitting with the soles of the feet together and pushing the knees out to “stretch out” the inner thighs can cause tight adductors to contract back against the force of the stretch. Even psoas “stretches” performed in isolation, can induce the stretch reflex, causing muscles to tighten back against the stretch.

  • Address the pattern of contraction, not the individual muscles.
  • PANDICULATION is the most effective way of regaining muscle function, improving movement and re-setting muscle length. When you contract a muscle first, then lengthen and relax it you address muscle function at the level of the nervous system. You provide needed sensory feedback to the brain and  “wake up” the cortex to take back control of the muscular system.

I hope some of you tried the small sample of simple Somatic Movements I included in my last post. Here’s a wonderful variation of one of my favorite somatic exercises, called the “steeple twist.” This variation, made by Charlie Murdoch (a Hanna Somatic Educator and Feldenkrais practitioner) shows how differentiating movements with the hips creates improved overall movement. Remember to go slowly and only as far as is comfortable. “Micro-movements” are perfectly fine!

All these movements are a good beginning to learning to relax the muscles involved in the “trauma reflex.”

Improved body awareness and muscle control is crucial when you have structural damage, like a labral tear.

If you know you’re injured, and your doctor tells you to “wait and see,” or “it’s not a big deal,” then it’s critically important focus your attention on how your brain and muscles are compensating to deal with the injury (Sensory Motor Amnesia), and how that is changing the way in which you move.  Improving somatic awareness applies to all of us – elite athletes, teenagers, and  Baby Boomers hitting their 60′s. Unconscious and habituated functional problems left unchecked can, over the years, result in structural damage.

Do you have to be A-Rod to get a good doctor?

About a year ago I finally convinced my doctor to give me an X-ray on my hip. I had intermittent hip pain that I knew intuitively wasn’t merely a functional issue.  The X-ray showed a tumor on my hip and an MRI confirmed a tumor, the result of two labral tears. My surgeon, a well known sports medicine doctor here in New Jersey, took time to show me my results: labral tears, osteoarthritis, a tumor. He told me that, “there’s just not enough science out there about labral tears to go ahead and do the surgery.”

Unrepaired labral tears could create the need for a hip replacement in years to come.

Before he walked out the door I asked, “do you think that if you don’t fix the tear in my hip now, and I walk around compensating for slightly the next 5 years due to intermittent pain, that I might be causing worse structural damage, thus setting me me up for a full hip replacement?” He replied, “yes, that just might be the case.”

As I said in my first post about hip pain, it didn’t take Alex Rodriguez’s doctors long to figure out that if the Yankees were going to get their star player back on the field, earning his millions and hitting home runs, labral tear surgery was a must. ASAP. No absence of scientific data there.

So where does that leave the rest of us?

In googling, “labral tear surgery” recently, I came upon a forum on both Men’s Health and Runner’s World. The desperate pleas for help regarding recovery from labral tear surgery were horrifying. Terrifying. Depressing.  From the feedback I read, never in my life would I consider this kind of surgery.  The one saving grace was this: I’d be willing to bet that few to none of these people realized that their original functional problem – the trauma reflex that got them into the problem in the first place – wouldn’t be solved by the surgery. The surgery helped to repair the structural damage, which is wonderful. It didn’t address the sensory motor amnesia that altered their movement in the first place.

Surgery combined with Somatic Education focused on regaining full functioning of the body as an integrated whole and skilled physical therapy would be a winning combination.

I’d be willing to bet that what A-Rod got was a winning combination: excellent surgeons, excellent functional trainers, and PTs who knew what to look for (gait symmetry, ribcage symmetry, evenly swinging hips, even leg length that comes from relaxed obliques, lats and abdominals). I would add to anyone’s rehabilitation program Hanna Somatic Education.

So while the jury’s not out about what route I will decide to take – or have the option to take. Improving my own sensory motor system and paying attention to my daily movement habits (which are fodder for yet another blog post) is critically important and profoundly helpful in creating long lasting pain relief….which is what we’re all looking for, right?

I teach a variety of workshops on how to release tight hip joints, hamstrings, backs, necks and shoulders. There are lots of movement patterns, and each one gives more and different sensory feedback to your brain, in order for your brain to intelligently and safely increase flexibility, proprioception and muscle control. If you’d like to bring me to your area for workshops, weekend seminars or private, clinical sessions, please contact me. There are lots of options for learning more: online video consultation, phone consultation or private sessions.


Click here to buy my instructional pain relief DVDs.

39 thoughts on “Labral Tears – Surgery or Not?

  1. My husband has been doing that steeple since you taught it in your Baltimore spring-2010 workshops. I have a video of him doing it after we did 16 hours of a floor repair – even at 2am! He finds those movements help all of his low back pain, too – and he doesn’t have any labral issue.

    • The steeple is one of my favorite movements. There are many variations of it, you can get wonderful movement in the back and hips, all without straining. I’m so glad your husband’s continuing to do Somatic Movements daily! All you need is 10 minutes a day to remind your muscles that they can contract, lengthen and relax and you’re good to go!

  2. PS: I was at a west-coast event with fitness personnel in 2010. I also had been suffering with hip issues at that time. I had a session with a great PT who suspected that I had a labral tear. This session was hands-on and very painful and didn’t seem to fix anything. There was also a Somatic Educator at that event; he did 15 minutes of a hip exercise with me: he didn’t touch me but directly me to do all the movements myself. The pain was GONE in 15 minutes… and never returned.

  3. Stunning stuff…I can’t believe the difference. I really appreciate this. If I can throw the discus again without pain…well, that would be a joy.

    If I ever may be of service, let me know.

    • Dan, you are very welcome! I’m so glad you’re feeling such relief from the movements you’ve learned. This work is profound and I thank Thomas Hanna and his insight every day as I help people regain their physical independence. If you ever get to the east coast (I’m only 20 miles outside NYC), I would be very happy to work one one one with you. Even one hands-on clinical session (very different from just doing the movements) may be just what you need to get you back throwing the discus. Please keep in touch and let me know how you’re doing.

  4. Pingback: How to Do “Warm Up” with Somatics « Pain Relief Through Movement

  5. Hi, I just ordered your DVD. I am getting surgery for a labral tear in August. Haven’t been able to run since last September, but have had hip problems for years. I am wondering what happened to Charlie’s video? Is there another place to see this movement. BTW I did visit with Charlie a couple of summers ago when I first heard about Feldenkrais, unfortunately I cracked a rib the day before I went in so I had a hard time moving! From there I did Feldenkrais largely through ATMs and cds. I found a half-steeple video of you on another page (piriformis). I did those videos last night and it took the pain and tightness (pinched nerve) out of my hip, back, and leg. Thanks, it comes and goes now day to day and I was looking for something before I go overseas tomorrow for a couple of weeks and I don’t want my hip to get “stuck” . Hopefully I have a bit more control over it now. I look forward to checking out the DVD when I return.

    • Hi,
      I’m not sure what happened to Charlie’s video, but I’ll take a look and see if I can’t get it back up on my blog. I liked his steeple variation…
      While Feldenkrais is excellent work, there are definite differences between Feldenkrais and Hanna Somatics. The most important ones are the understanding of sensory motor amnesia, and the technique used to reverse it and re-set muscle length and control: pandiculation. I emphasize that a bit more than most of my colleagues, because it’s truly the gold coin of Somatics. Contracting, lengthening and relaxing muscles within the pattern that you’re stuck in (for you, I’d say you probably have a trauma reflex more than anything else?) will more rapidly change your movement habits. ATM work is wonderful for further exploration once you’ve got a handle on your reflexive patterns of compensation, and habituation.
      Thanks for ordering the DVD! You won’t have it before you leave tomorrow, but you now have a few movements from my website, which should help you along. Do the movements on my hip pain blog series (I think it’s post #3), and notice your walking while you’re gone. You’re going for symmetry and balance and equal relaxation on both sides of the waist/trunk rotators.
      Bon voyage! Enjoy your trip!
      Martha

  6. Thanks Martha,
    I don’t know why I never found your site before. I have been all over the internet looking for fixes for years. My blog is even called “Recover your stride’ because I have been trying to learn about every therapy I could to fix my weird running pattern and disfunctions. I have eased up a lot of the discomfort I had years ago with a lot of the stuff like Feldenkrais, but I could never find anything that targeted my disfunction with the hip and all of the ramifications running with “two different sides” of my body. I have learned about the muscles and varieties of treatments for them, but not how to relearn new patterns. Unfortunately after years of heavy running and its many compensations, my hip won’t allow me to run anymore. I was impressed with the moves I did last night, because it took me right out of pain. I have never heard the term pandiculation before, but I look forward to studying more when I get back from Kenya. A lot of what you wrote makes sense already and is what I was looking for for years: someone to explain how it all fits together and how to target and relearn how to move as well as why it works. “Sensory motor amnesia” is like what I have been saying for years- my body has forget how to move and work together properly. I look forward to the DVD and coming back from Kenya and digging into your website.
    Jim

    • Have a wonderful time in Kenya! You’ll get lots of walking in and it will be interesting to see how your hips feel (after you get over the long plane flight!). Just keep doing what you’ve learned from my blog – especially arch and flatten, arch and curl, the side bend and the washrag. Those should pretty much keep you feeling balanced and in control.

      Best to you, Martha

  7. I am looking for some more info. I just came across this page while reading about torn labrums, which after 2 years of pain and misdiagnoses, it has finally been diagnosed as a torn labrum. I have constant hip pain, glute pain, chronic tight hamstrings and back. Any info or direction would be greatly appreciated!

    • Hi Andrew,
      I commiserate with you in your frustration to figure out the source of your problem.

      I can help you! There are options as far as learning how to release and relax the muscles involved in this kind of muscle tightness and pain. My suggestion would be to do a combination of things: begin by learning all the basic Hanna Somatics movements that are on my “basics” DVD (called “Pain Relief Through Movement” – available from my website). Then, if you live in an area where you can see a Certified Hanna Somatic (Clinical Somatic) Educator, make a series of about 4 sessions of hands-on clinical sessions. These sessions will teach you to begin to release and relax the muscles that are involved in your hip, glute, hamstring and back pain. All these areas are related and are part of a PATTERN of muscular tightness.

      Learning how to release and relax the muscles involved in a pattern that would result in a torn labrum (Sports accident? Injury? Repetitive compensation?) is critical to regaining muscle function and eliminating pain. After teaching your muscles to release and your brain to regain equilibrium and restore balanced muscle function you’ll have a better idea of whether or not you might do well to get your torn labum surgically fixed. If you choose that road (and it’s certainly not a bad choice!), restoring proper muscle function and regaining brain control and awareness of those muscles is of paramount importance. You can have the surgery, but not address the muscular dysfunction and find yourself having muscle pain because you didn’t address the underlying problem: tight muscles.

      Jim (you can see several of his comments below) at recoveryourstride.com, had labral tear surgery with great success and is now beginning to understand (and experience) just what kind of pattern of muscular compensation was responsible for his tears. He is combining surgery with Hanna Somatics and getting some good results. On his blog you can read a post about a recent Skype session he and I did and what he learned from it.
      Accidents, injuries and trauma cause us to compensate (by creating a “trauma reflex”) by tightening muscles on one side of the body and down into the hip. This alters our gait and can create torn labrums and potential structural damage over time. So can a sudden accident. Are you an athlete? What kind of accidents have you had?
      Hanna Somatics is a very effective method to help you with a torn labrum. However, I need more information in order to be able to help you more fully.

      I’m available to consult with you via Skype (where do you live?), in person or on the phone.
      All the best to you!
      Martha

  8. Not quite sure you know enough about this subject to talk about it. Your very first image doesn’t even label the proper location of the labrum. Secondly, many labral tears will not heal, no matter how many somatic twists you do. It has no blood vessels to supply it, and hence cannot heal itself (and thus the reason for surgery). Best leave this subject to those with more time. Bad advice is often worse than none.

    • Hi,
      Thanks for your comment. I think you may be misunderstanding what I wrote about. Let me clarify:

      In this post I question the contention that doctors have about NOT doing labral tear surgery – thus my question, “Do you have to be A-Rod to get a good doctor?” The point of my post is not to advise people on whether or not to get labral tear surgery – but to point out how functional problems can lead to structural damage and how to begin – if you’re not sure about surgery – to learn to release tight muscles that only worsen your hip pain. Doctors, I’m afraid, have little experience in addressing issues from that perspective. I know this from both a clinical and personal perspective. This is where Somatic Education comes in, not only AFTER the problem occurs (a labral tear and reconstructive surgery), but BEFORE the problem even develops (uneven weight distribution and a trauma reflex that could, over time, cause structural joint damage).

      I agree wholeheartedly – no amount of Somatic Exercise will “fix” a labral tear. We’re on the same page. What WILL help hip joint pain, labral tear or not, however, is Somatic Education. Once you learn to release tight muscles that put pressure on hip joints (or shoulder, ankle, knee joints), then you’ll have a better idea of how severe the problem really is.

      Myself? I think labral tear surgery is a good idea. That’s why I question doctors’ hesitancy to do it. I also understand where they’re coming from: just doing a surgery isn’t necessarily going to “fix” everything. I’d add to that that you have to address the pattern of muscular dysfunction (or overuse or trauma,in the case of athletes) that created the problem in the first place.

      Do you have hip pain?

      All the best,
      Martha

  9. I’m a ballet dancer with a 1cm left hip labral tear and from my MRI we can see evidence of early chondral degeneration and a minimal bony proliferation in the superolateral rim. There is probably similiar pathology in the right hip but the MRI focuses on the left. My femoral head is relatively normal. There is no discrete full thickness defect.
    I have been doing PT with a dance specialist therapist for about a month and a half now…also pilates to strengthen my core and some acupuncture.
    I have also become a very healthy vegan :)

    I found your blog and was concerned to see that you do not recommend clam shell exercises as I have been doing these. We have been working lots on strengthening the muscles around the hips, the glutes and the abs.
    I see that you do not recommend this. Now I am worried and confused.
    My PT doesn’t feel that surgery is a good answer to a labral tear issue. I am with her but having read a lot on the internet am now not convinced as it seems that PT doesn’t necessarily work either :(

    I am thinking of buying your DVD.
    Would you please address my issues a little please?
    Have you had the surgery yourself at this point?
    Or have you cured yourself?
    Thanks,
    Rosanna

    • Hi Rosanna,
      Thanks so much for your questions. The most important question is this: is what you’re currently teaching you how to minimize your pain? If the answer is “no,” then what you’re doing isn’t working. You’re missing some information that could help you. Hanna Somatic Education fills that information gap.

      My best advice is to go back and re-read my blog posts about hip pain. I wrote them from my own clinical experience as a Hanna Somatic Educator, AND from my own experience as someone with labral tears. Purchase my “basics” DVD and begin to learn the exercises, slowly and mindfully. Consider purchasing my “Pain-Free Legs and Hip Joints” DVD as well. You will learn how to release the muscles of your core that have habituated due to stress reflexes – the stress of ballet training, accidents and injuries over the years, injuries you may have danced with – all these things cause your brain to teach the muscles to stay so you can continue moving. This is the origin of sensory motor amnesia. Experience how to release the full body pattern of contraction that your muscles are stuck in and you will begin to experience less muscle pain. No PT or MD can help you with this. They don’t know about sensory motor amnesia, how it occurs as a full body pattern, how it’s at the root of most chronic muscle pain, nor how to teach you to safely and gently reverse it.

      Also – tight muscles create joint compression. More clam shells only makes it worse! Try thinking about exercises this way: when would you ever actually perform a clam shell movement in real life? In ballet you develop strong hips/legs/core by doing…ballet movements that are part of the ballet vocabulary. Train movements that are functional and useful. This is now, thank goodness, the widely accepted understanding behind functional fitness. Train REAL LIFE movements, not random body parts.

      Labral tears, which occur for many reasons (one being repetitive compensation due to accidents/injuries/repetitive stress), are a structural deficit. Hanna Somatics can’t “fix” them. What HS can do is teach you how to become aware of the full body pattern of muscular dysfunction that you’re stuck in, and that you’re unaware of. It’s like having sloppy ballet technique; you can only improve your movement and muscle control through slow, aware movement, and not by force, like repetitive exercises and strengthening.

      I still have my labral tears; I have yet to find a surgeon who is willing to do the surgery for me, although I would be willing to do it. If I didn’t do Somatics and apply the concepts to everything I do in my life with my movement I’d be in constant pain – and I am not.

      I’ve gotten some very helpful feedback from many of my readers as well:

      1. the labral tear surgery was a “life saver,”and they’re now back to sports, movement, life.
      2. the labral tear surgery was difficult and they suggest “doing everything” before going for it.

      #1 is the most common experience. So much depends on you and the expertise of the surgeon you use.

      For those who did the surgery, they realized how important Somatics is to their rehabilitation. Why? Because the original muscle dysfunction that caused the problem wasn’t solved through surgery. Surgery is the only way to structurally repair the labral. Faulty muscle function can, over time, cause structural damage. Once the damage is done, surgery helps. After the surgery, if you don’t want other problems to crop up, it’s imperative that you regain balanced muscle function and voluntary sensory motor control. This can only be done by you, and a Certified Hanna Somatic (Clinical Somatic) Educator can help teach/guide you to re-educate your muscles and movement. Once you’ve eliminated your sensory motor amnesia and are moving with more ease and efficiency, find something you love to do that is functional, vigorous and strengthening. Vigorous movement is essential to a strong body. Combine that with voluntary sensory motor control and efficient muscles and you’re good to go for a very long time.

      You are extremely fortunate to live in an area that has several skilled Somatic Educators! I would be happy to recommend someone to you. Let me know. I’m here to help.

      All the best to you ~
      Martha

  10. Hi Martha,
    Thanks for yout thoughtful reply. I have read back over the posts and am understanding what you are saying regarding somatic education, I believe. It seems to make sense. I tried some of the exercises and what is strange to me is how easy they are compared to most of what I do at PT, though I have to say that my therapist DOES work with me to correctly execute tendus, piles etc.. as I have been using the incorrect muscles for much of my technique. (She also pulls my hips out with a band..is that bad??) Should I just stop going to her or limit what I do with her??
    I see you were a professional dancer so this is very interesting to me. Labral tears are supposedly very common in ballet dancers! I am not a pro but I dance A LOT!
    I see you also say that you should move and do what you love as far as movement is concerned. I have gone back to beginner technique classes to really concentrate on my form and movement and feel that at least it does no harm. I am relearning how to use my body correctly. I am also doing a slow barre pointe class. I just feel that if I stop I will be so unhappy :(
    I am supposed to limit deep plies, pirouettes, twisting motion…should I?

    The weird thing about my pain is that is is low grade, deep, dull and throbbing, regardless of what I do…nothing seems to make it better or worse. I am thinking that it could be a matter of tendinitis? It doesn’t FEEL muscular as I can massage and feel nothing…it feels VERY deep…in the bone joints and tendons, I guess?
    I also love to hike with my dogs and don’t want to stop doing that!

    I am thinking of seeing a supposedly excellent laproscopic hip surgeon in my area called Dr. Marc Safran….my doctor recommended him…though reviews say he has a less than great bedside manner ….so I am not sure about him…I guess I should go and see him anyhow. I am so scared to be cut :( Especially if it makes it worse! And I can’t bear the idea of not exercising for a long period!

    If I can reduce the achiness with these methods, I would not get surgery…why do you think no one will preform surgery on you?? I thought surgeons loved to cut!? ;)
    And if you are managing the pain and relearning correct alignment, etc.. why would one need to get surgery?

    What is your opinion on pilates? I enjoy it and it feels good.
    How about the gym? I know that it is about tensing muscles but if one enjoys the benefits of good musculature, is it worth it or more harmful than good?

    I am so frustrated…I am unsure what I should and shouldn’t do! :(
    It’s like everything I ever knew was wrong!
    I WANT to dance and dance and hike and be active!!!!!! But am I making the tears worse?

    I am going to get the DVDs.
    And yes, please recommend a somatics educator in my area (by the way, how do you know where I live!?? )
    Do they generally accept health insurance? I am not well off :(

    Sorry for the long post…I am quite depressed about all of this ….and I really appreciate the guidance!

    • Hi Rosanna,

      You’ve asked a lot of questions in your last comment. You’ve described a series of different things that you’re doing – from Pilates to basic barre class, to PT, and hiking. You also say that “regardless of what I do…nothing seems to make it better or worse.” It sounds as if it’s hard to pinpoint what could possibly help or not help if you’re undertaking so many different methods at the same time.

      Here’s a suggestion: Stop doing PT (is stretching your hip with a band bad? Yes. It can invoke the stretch reflex), Pilates, ballet class, and the gym. Focus for 3 weeks on learning the basic Somatic Exercises, plus a few extra legs and hips exercises. Walk with your dog. Walk a good amount. Let the new learning integrate into your sensory motor system. Then let me know how things are going. My suspicion is that you will begin to learn things you didn’t know about where your sensory motor amnesia lies.

      You won’t get weak or flabby in 3 weeks time. It’s an exploration, same as any other movement method.

      The reason I would consider surgery is because I want more than just “managing pain.” I would like to not have pain when I sit in a car. I have gotten excellent results with Hanna Somatics, yet when a surgeon agrees with me that there is potential to set myself up for a hip replacement due to the wear and tear that can occur due to faulty structure (labral tears), that is cause for concern.

      My opinion on Pilates is that it depends on the teacher. Pilates tightens and strengthens the core. Somatics teaches you to eliminate sensory motor amnesia – involuntarily tight muscles that create inefficient movement/muscle function. Learn the release the core first – then go strengthen it. If you want to get to the bottom of your hip pain, Pilates isn’t going to help you do that.

      Thanks for your comment ~
      Martha

  11. Hi Martha, I’m intrigued by your theory. In 2007, I had a discectomy of L4-L5, L5-S1. I had complete relief of back pain, but then I started to get sciatic pain, often switching legs. In 2009, I had another discectomy of the L5-S1 level. Now, 3 years later I still am dealing with come and go sciatica again switching legs every 6 months or so. I have done everything naturally possible. Eat a whole foods diet & lost 25lbs, did Egoscue method, Energy therapy, and multiple Chiropractors. I am currently in the care of an Orthogonal Chiropractor. But after continued pain, I reluctantly went to a new Spine Surgeon. He said the MRI of my back looks good, just some minimal degeneration and arthritis. He bend my hip in flexion and internal rotation and that recreated my pain. He said I have a hip labral tear. I was so glad with that news because at least it wasn’t my back! He said all I would need is a small surgery, but as I research online, I’m getting a little worried. Tomorrow I have an MRI with dye injected into the left hip. I am nervous about that of course, but I’m more nervous that I have possibly a tear on both hips because now my symptomatic side just this weekend has switched to my right hip. GEEZ! I have a history of a shorter right leg and I thought the only way to get that right was to do chiropractic. I would love to do some exercises to help but I’m not sure which DVD would be good for me. For years, I’ve been calling it sciatica, but now it feels really in my hip. My pain is across my illiosacral crest and down my butt and side of hip and on the greater trocanter across to my sacrum. Mostly just my butt with a little front groin pain and catching. I’ve done a lot of piriformis stretches too because a lot of the chiropractors have encouraged that too. Now from reading your blog and website I feel I’ve been misdirected. I need to know if there is someone in my area (Gilbert, AZ) that could help or if I could get relief from the DVDs?? HELP!

    • HI DaNelle,
      It doesn’t sound as if you’ve been misdirected. All the practitioners you’ve worked with are doing what they know how to do. The trouble is that they don’t understand how muscle pain and dysfunction develops in the brain due to stress reflexes. Understand that and you’ll be able to help people more easily when it comes to conditions like that which you describe.
      Leg length discrepancy is not a medical issue and chiropractors can’t fix it because they don’t understand how it develops due to a trauma reflex and habitual contraction on one side of the waist muscles. That causes the hip/pelvis on one side to “hike up,” which presents as a PERCEIVED leg length discrepancy.

      Krishna Raven-Johnson is a Hanna Somatic Educator in Tucson, AZ. I’m not sure how far that is from where you are. Tell her I sent you!

      I think you could get a lot of relief working with my DVDs. Start with the “basics” DVD, then go on to Pain-free Legs and Hips. I would suggest reading my book to get a background in Hanna Somatics. I also have several more exercises (including photos) in my book than I could put on the DVDs. Anyone can benefit from learning the Somatic Exercises. They won’t hurt you if you do them as I instruct: slowly, and gently. If the blog posts about labral tears “speaks” to you and makes sense, you’re on the right track. Even if you have the labral tear surgery you will need to release and relax the muscles within the full body pattern you’re stuck in (trauma reflex) in order to regain symmetry and full voluntary muscular control. I’ve heard good things about the surgery, and I’ve heard “so-so” things. After almost 2 years of having labral tears I would do the surgery if I could find a doctor willing to do it. I feel generally quite good, but only because I do Somatics daily and pay close attention to the way in which I move.

      It never hurts to improve your brain’s control of your muscles. In fact, improving your brain’s sensation and control of your muscles and movement is the single most important thing you could possibly do for your overall health.

      I hope this addresses your question adequately.
      All the best,
      Martha

      • Hi Martha, I had an MRI with dye of my left hip and it came back fine with no labral tear. I’ve been pretty depressed about not finding a solution to my leg and butt pain, but then on the MRI it also showed sacroilitis and I immediately got a SI belt to wear. After a day my horrible pain almost is completely gone. My chiropractor said a damaged SI joint can take 6 months to heal and wearing the belt can help that and also keeping in alignm ignment can help. I want to know if you think Hanna somatics can really help it. When I did a side bend today it hurt my sciatica really bad on the side I was contracting. Hopefully the dvds I get today will help. Do you think the Basics DVD can help me?

      • I’ll bet that the reason you had sciatic pain when you did the side bend is because you weren’t using your waist muscles, but were instead arching the lower back just a bit. I see it ALL the time!! Simple bending to the side in the side bend is merely addressing tight waist muscles and, when done properly, should cause no pain – unless you’re arching your low back OR not actually moving the hip (even though you think you are!). This is what sensory motor amnesia is all about: what you think you’re doing isn’t actually what you’re doing.

        So yes, Hanna Somatics can help you with your SI joint issues. A belt, while it will help, won’t teach you what you’ve been doing to cause the problem. It doesn’t get to the ROOT CAUSE of the problem: the brain/muscle connection.

        I hope this helps. Hands-on sessions or a Skype session would be really good for you. FYI – SI joint issues don’t have to take 6 months. Remember that MDs are going on what they know: passively allowing a joint to rest. They don’t understand (nothing against them; it’s simply not a part of their training) how to re-educate muscles. It’s the muscles that attach into and PULL ON the SI joint that are the issue. You’re also probably stuck in a trauma reflex. Somatics can help.

        All the best,
        Martha

      • Thanks Martha. I’ll keep trying and I know the belt won’t fix anything, but hoping it will help calm things down so I’m not in so much pain. I hope I get the DVD today so I can start. I’ll try to do my best with doing the exercises correctly and maybe contact Krishna too. I know the main thing is to get out of this trauma reflex so I can fix the real issue.

  12. Hello, I came across your material Friday, have begun to do the exercises published on your web site, ordered the book and DVD. I have hip pain; it’s been diagnosed as osteoarthritis by a doctor who looked at my xray for about 15 seconds.
    For almost a year and half I have had extreme tightness in the psoas area and it seems the exercises are giving me some relief, so thank you for that, I wished I’d come across this sooner, as it seems my body had responded to this tightness with exactly what you’re trying to avoid.
    I’m getting a second opinion from another doctor next week who does do labral tear surgery.
    I would love to work with a Hanna somatic practitioner. Do you know any in Atlanta, GA? Thank you!

    • Hi Kristi,

      Yes, I know what you mean by, “I wish I’d come across this sooner.” Me, too! This is why I want to make Hanna Somatics a household word – so that when you get injured you go for movement re-education (not just PT), which is what Hanna Somatics is. We need to be encouraged to pay attention to our bodies and movement, and it would be great if doctors were in on the educational process as well.

      We don’t have anyone that I know of in Atlanta, GA. I travel, however. It’s not that difficult to organize Essential Somatics workshops and clinical sessions. If you’re interested let me know. It’s a great way to bring me to your area so that not only you, but others you know (including MDs, PTs and massage therapists) can learn about Hanna Somatics.

      Let me know what your second doctor says. Osteoarthritis is real, yet it doesn’t always have to cause pain. Arthritis can be a “garbage pail diagnosis” for some doctors – especially when they don’t know what else to tell you. There are doctors, however, who are beginning to understand that movement is key when it comes to muscular pain and injury.

      All the best,
      Martha

  13. Hi Martha,
    Thanks for sharing this article. I was keen to watch the video but it appears to have been “removed by the user”. Look forward to it being reinstated.
    Tony

    • Tony,
      I’ll check out which video you’re talking about. I’ll get it back up there so you can use it! In the meantime, check out the videos on my website homepage; several of them are, I’m quite sure, part of my “prescription” for happier, more relaxed waist and hip muscles.

      Thanks for the heads-up about the video.

      All the best,
      Martha

  14. Just desire to say your article is as amazing.
    The clarity in your post is just nice and i could assume you’re an expert on this subject. Fine with your permission let me to grab your RSS feed to keep updated with forthcoming post. Thanks a million and please continue the gratifying work.

  15. Thanks for your blog. I am a Thai boxer who recently underwent X-rays, ultrasounds and mri’s re: hip pain when I performed roundhouse kick over waist height. I can still axe kick above head height but when I turn my hip in I experience pain. Originally diagnosis was inconclusive but my most recent diagnosis of the same results by another surgeon who specialises in hip surgery et al advised it was a superior Labral tear that requires surgery. Not to do so would ensure future hip surgery on a grander scale. Not really convinced and I thought you offered an alternative but your blog seems to say one thing then state another. Are you for labral surgery given the negative feedback historical data suggests or are you against it. I’m a an extremely fit 47 yo male experienced in multiple MMA’s hoping to avoid hip surgery where possible. My hips and glutes etc especially the right side are usually quite tight but I do a lot if stretching too.

    • Hi Nick,

      Apologies on the delayed response! This blog post doesn’t advocate for a staunch position on labral tear surgery. I ask questions and advise people what to look for and what to do about the full body pattern that occurs as a result of an accident (which can tear the labrum) or that is at the root of why the labrum would tear (the Trauma Reflex, a muscle function problem that can cause structural damage.

      I wrote, “Surgery combined with Somatic Education focused on regaining full functioning of the body as an integrated whole and skilled physical therapy would be a winning combination.”

      Hanna Somatics cannot fix a labral tear! If you have a labral tear and can’t get it surgically fixed (as is my situation), then the advise that I give will help you immensely. The only option to living with a structural deficit is, as far as I see it, Somatic Education and functional strengthening.

      The surgery will fix the structural damage, yet no surgery can address the dysfunctional muscular holding pattern that occurs due to the Trauma Reflex. Surgery will also not address the muscle contractions that occur in compensation to the surgery. Thus the above statement about surgery and Somatics being a winning combination. Only Somatic Education can teach you to improve muscle function and reverse Sensory Motor Amnesia, which is what I suspect you have in your right hip. You need to change that from the inside out and Hanna Somatics (from my perspective) is the best way to do that.

      Thanks for your comment. I hope my response has helped.

      Best to you,
      Martha

      I definitely need to write a follow up to this post!

  16. Hi,
    I just came across this post in my search for the best way to manage my recently diagnosed labral tear. I had two injuries to my left hip as a teenager that, looking back, I should have had checked out by a doctor due to the nature of those injuries. I think they are a big reason why I’m having problems now (I’m 35).
    I used to be very fit, running, hiking, and swimming. Three years ago, I became very sick, and one of my comorbidities is Fibromyalgia. My question is, will these exercises help relieve the pain that this causes? I would assume so, since muscle tension is a big part of this disorder. Also, is this something that can be safely done by someone who has Postural Tachycardia Syndrome?

    • Hi Shay,
      Yes, Hanna Somatics can very extremely helpful for both the compensation patterns that your brain/sensory motor system has created in response to your labral tears and for fibromyalgia. In both cases it’s important to learn to release and relax the muscles that are chronically contracted (and aren’t needed for a specific movement).
      Whenever you have muscles that are contracted all the time your nervous system is working too hard. It’s ALWAYS best to have muscles that are relaxed and under the control of the brain, ready for any action. Pandiculation is what you need to do (which is what you do when you do the Somatic Exericses) to keep your brain in control of your muscular system.

      As to PTS, I’ve never worked with someone with that condition, however I will posit that if you are stuck in the red light reflex you are more likely to have trouble with your heart, blood flow and breathing. Since they don’t know what causes it and there’s no treatment for it (that works) I would say that Hanna Somatics will only HELP you!

      All the best,
      Martha

  17. Hi Martha
    I have your DVD and really enjoying it for working on my hips (diagnosed labrum tear). Happy to avoid clamshells, thanks for that advice! I now have awful ischial and upper hamstring pain, and am wondering which movement (or if you have a new one) would best address this. Thanks!

    • Hi,

      My suggestion is to work your way through the basic Somatic Exercises (on my Pain Relief Through Movement DVD) and, once you learn to release the muscles of the back and belly, move on to focus on the trauma reflex. The side bend, washrag, steeple twist are all wonderful exercises to begin to re-balance and recalibrate the waist muscles in order to release the muscles of the hip joint. I would also recommend the exercises from my pain-free legs and hips DVD.

      Working one on one with a skilled practitioner is always the best way to make progress when it comes to addressing the trauma reflex inherent in an injury like labral tears. Depending upon where you live I could recommend someone for you to work with.

      All the best,
      Martha

  18. Thanks! I am in Los Angeles, and happy to go to a practitioner if you know of one. Meantime, i am onto all the movements from your DVD and trying not to sit at my computer…..

    • We have lots of Somatic Educators in CA. We just don’t have any in Los Angeles, unfortunately. James Knight is in San Diego I believe, so you might want to contact him. You can also work with me over Skype. There is information about Skype sessions on my website under “sessions and workshops.”

      Best to you,
      Martha

  19. That video just revolutionized my hip! I have a suspected labral tear and I feel so much better after those exercises! You are now bookmarked!

    • I’m so glad you’re feeling better after doing the exercises. The best thing for hip pain is to release the muscles first and get that brain back in the driver’s seat. Regain awareness of what it feels like to be “you” and this first, important step will give you more information than you realize.

      All the best,
      Martha

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