The gold standard for labral tears (both in the shoulder and the hip) for treatment has been surgery for a long time. Labrums have been thought to not be able to heal on their own. However, labral surgeries have not been shown to have the best outcomes, especially when someone is having multiple surgeries on the same joint.

Research over the past decade has increasingly shown that conservative management — primarily physical therapy — is not only viable but often the preferred first-line treatment for many labral tears, both in the shoulder (glenoid labrum) and the hip (acetabular labrum).

1. Labral Tears are common in people with no symptoms: Studies show that 40-70% of people have labral tears on their MRIs without any symptoms at all. (https://pubmed.ncbi.nlm.nih.gov/23104610/) The fact that asymptomatic people have labral tears demonstrates that the labral tear itself may not cause the symptoms. The symptoms could be caused by instability, muscle strain, poor load tolerance due to weakness. Also, pain does not always indicate damage.
2. Sham surgery is no different than surgery: Here is a strong randomized control study (https://bjsm.bmj.com/content/bjsports/51/24/1759.full.pdf ). This study looks at 3 groups of patients all that had SLAP tears in the shoulder. One group got a SLAP Repair, one group got bicep tenodesis surgery, and 1 group had a sham surgery. All groups got PT afterwards. The article shows that all groups improved significantly in terms of pain and function but there was no difference between outcomes between the surgeries or the sham surgery. Meaning — is it the labral repair that is improving patients pain/function or is it PT afterwards? Or placebo effect from surgery “Fixing” it?
3. Stronger people with structural deformities have no pain; Here is a study looking at asymptomatic people with FAI hip impingement (structural deformity that can lead to labral tears at the hip) (https://pubmed.ncbi.nlm.nih.gov/30038915/) It finds that the people with the deformity but without pain had stronger hip muscles, and ROM than the people with the deformity and pain. Meaning potentially that if you strengthen and increase ROM with PT, you can take away the pain even though there is a structural deformity there without surgical intervention. Classically, this structural deformity is often treated with surgery in the hip.

Here is a case series about conservative management of hip labral tears via PT. These patients had confirmed MRI labral tears and clinical tests that confirmed labral tears. Pain, function and strength improved significantly without surgery:

2024 Research Update: What the Evidence Now Shows

Hip Labral Tears: A growing body of evidence supports PT as a first-line treatment for femoroacetabular impingement (FAI) syndrome with associated labral tears. The landmark FIRST trial (2019) — a multicenter RCT — found that arthroscopic hip surgery combined with PT produced similar outcomes to PT alone at 2 years for FAI and labral tears. A 2023 systematic review in Arthroscopy: The Journal of Arthroscopic and Related Surgery concluded that while hip arthroscopy can provide good short-term outcomes, high-quality evidence does not consistently show superiority over structured PT programs. The International Hip-related Pain Research Network and current orthopedic guidelines recommend a minimum 3–6 month supervised PT trial before considering surgery for most patients with hip labral tears without mechanical symptoms such as locking.

Shoulder Labral Tears: For SLAP (superior labrum anterior to posterior) tears — a common labral injury in overhead athletes and throwing sports — the evidence has shifted substantially away from surgery. A 2023 meta-analysis in the American Journal of Sports Medicine found that non-operative management with PT produced outcomes comparable to surgical SLAP repair in most patient populations, with lower complication rates. The exception remains Bankart lesions with frank instability from recurrent dislocations, where surgical stabilization has stronger evidence. For anterior instability after a first-time shoulder dislocation in younger athletes, current guidelines recommend a shared decision-making approach, as both PT-led rehabilitation and surgical stabilization have demonstrated efficacy depending on patient goals and risk tolerance.

What PT for Labral Tears Actually Involves: Effective physical therapy for labral tears focuses on optimizing neuromuscular control around the affected joint, addressing movement impairments that increase joint stress, and building strength in stabilizing musculature. For the hip, this means focusing on hip abductors (especially gluteus medius), deep hip external rotators, and core stability. For the shoulder, this means rotator cuff strengthening, scapular stabilizer work, and sport/activity-specific movement rehabilitation. A well-designed PT program should also address contributing factors such as thoracic spine mobility, hip flexor tightness, and any biomechanical deficits in the kinetic chain.

Updated Conclusion (2025): The evidence is clear: physical therapy should be trialed before surgery for most patients with hip or shoulder labral tears without significant mechanical instability or locking. Six months of quality PT with a therapist experienced in labral tear management frequently achieves outcomes that match or approach surgical results — without the risks of anesthesia, surgical complications, prolonged recovery, or the risk of poor long-term surgical outcomes. If you have been diagnosed with a labral tear, speak to your orthopedic surgeon about trying PT first. At Joint Ventures, our clinicians have extensive experience treating labral tears in both the hip and shoulder, and we can help you develop a plan tailored to your specific injury and goals.

https://www.jospt.org/doi/pdf/10.2519/jospt.2011.3225

In conclusion, there is still a lot more research to be done about conservative management of labral tears in the shoulder and hip. In light of this research, if you have a labral tear, talk to your MD to trial PT first to see if you can meet your functional goals without surgical intervention. If you trial PT for 8-12 weeks and still have persisting limitations and decide to get surgery, you will have maximized your ROM And strength pre-surgery and will certainly have a better outcome.If you have suffered from a labral tear in your hip or shoulder, you could benefit from Physical Therapy. Call us to set up an appointment: (617) 536-1161.

-Marissa Morin, PT, DPT, OCS