How to manage a torn labrum with physical therapy (PT)?

From the Guidelines

Managing a torn labrum with physical therapy is a viable initial treatment approach, as most soft-tissue injuries, including labral tears, can undergo a period of conservative management before considering surgery. According to the American College of Radiology 1, traumatic shoulder pain, which may result from labral tears, can often be managed conservatively before surgical intervention is considered.

When managing a torn labrum with physical therapy, the goal is to restore shoulder stability and function. This can be achieved through a structured rehabilitation program that includes:

• Gentle range of motion exercises during the acute phase (first 1-2 weeks after diagnosis) to avoid movements that cause pain
• Strengthening exercises targeting the rotator cuff muscles and scapular stabilizers using resistance bands or light weights, starting with 2-3 sets of 10-15 repetitions, 3-4 times weekly
• Exercises like external and internal rotation, scapular retraction, and proprioceptive training to improve joint position awareness
• Applying ice for 15-20 minutes after exercise sessions to manage inflammation
• Considering NSAIDs like ibuprofen (400-600mg three times daily with food) to control pain during the rehabilitation process

Physical therapy typically lasts 8-12 weeks, with sessions 2-3 times weekly initially, gradually decreasing as the patient learns to perform exercises independently. If pain persists despite 6-8 weeks of consistent therapy or if function doesn't improve, consultation with a physician is necessary as surgical intervention may be required 1.

From the Research

Management of Torn Labrum with Physical Therapy (PT)

• A torn labrum can be managed with physical therapy (PT) as part of a conservative treatment approach 2, 3, 4.
• The goal of PT is to improve pain, function, and quality of life, and to address any underlying biomechanical issues that may be contributing to the labral tear 5, 3.
• A typical PT program for a torn labrum may include:
  • Pain control and education on proper movement and posture
  • Hip and lumbopelvic stabilization exercises
  • Correction of hip muscle imbalance and biomechanical control
  • Sport-specific functional progression
  • Strengthening exercises for the hip flexors, abductors, and extensors 3
• Studies have shown that PT can be effective in improving outcomes for patients with labral tears, with significant improvements in pain, function, and quality of life reported 6, 5, 3.
• However, the success of PT may depend on various factors, such as the severity of the tear, the presence of any underlying conditions, and the patient's overall health and activity level 6, 5.
• In some cases, PT may not be sufficient to manage the symptoms of a labral tear, and surgical treatment may be necessary 2, 4.

Factors Associated with Success of PT

• Patient age, with older patients being less likely to respond to PT 6
• Type and severity of the labral tear
• Presence of any underlying conditions, such as femoroacetabular impingement or degeneration
• Patient's overall health and activity level
• Adherence to the PT program and any home exercises or modifications 6, 5

Return to Play and Activity

• The return to play and activity after a labral tear can be challenging, and may require a gradual progression of exercises and activities 6, 5.
• Studies have shown that patients who undergo PT for a labral tear can return to their previous level of activity, but may need to modify their activities to avoid exacerbating the condition 6, 5.