Within 1 week, I examined 2 women with the diagnosis of lumbar pain who each happened to mention having a hip labral tear. Of course, neither woman volunteered information about the pelvic floor dysfunction she has lived with since having children. When I took the extra step and openly asked if they had any “issues” in the pelvic floor region, both women initially looked surprised and then relieved as they shared (perhaps for the first time) the problems they’ve had. I started to wonder about the contribution of pelvic floor dysfunction to acetabular labral tears, or vice versa, and I knew each problem had to be addressed for the referring diagnoses to be treated completely and effectively.
Considering the anatomy of the acetabular labrum in relation to the pelvic floor structures, there is undeniably a connection. A thorough review of pelvic anatomy is given in the Functional Applications in Pelvic Rehabilitation course by Kathe Wallace. Just briefly, the acetabulum is the depression in the pelvis (os coxae) where the femoral head articulates. The labrum sits in the acetabulum, which faces anteriorly along with the femoral head, requiring the anterior aspect of the labrum to stabilize this portion of the hip that lacks bony contact. The obturator internus muscle, which is a deep hip external rotator and abductor, attaches to the posterior aspect of the obturator foramen and inserts on the medial surface of the greater trochanter. When this muscle is in spasm or inhibited, the pelvic floor and the hip can suffer.
In 2009, Groh and Herrera published a review of hip labral tears, and the general consensus was that labral tears “occur more frequently in women than in men.” The fact that women have more hip dysplasia than men has been suggested as a cause for this finding; however, many of the women with labral tears do not have concomitant hip dysplasia. Alas, Hunt et al (2007) pointed out that women have a generally higher incidence of pelvic-floor pain, which could contribute to the higher incidence of labral tears.