Understanding Hip Pain in Young patients: Labral Tears, FAI, and Osteoarthritis

Not all hip pain is arthritis, many younger people in their 40's and 50's experience hip pain. How to solve it depend supon getting an accurate diagnosis

If you’re between 40 and 50 years old and experiencing persistent hip, groin, or thigh pain, you might be wondering what’s causing it—and more importantly, how to fix it. Hip pain in this age group is common - I should come clean and own up to having a vested interest in hip ssiues ...I have some of these issues myself - but the underlying causes can vary significantly. Three of the most frequent culprits are:

1. Hip labral tears (damage to the cartilage lining the hip socket)

2. Femoroacetabular impingement (FAI) (a structural, bony issue causing abnormal hip joint contact)

3. Osteoarthritis (OA) ('wear-and-tear' joint degeneration rather than an inflammatory arthritis )

While these conditions can overlap, they have distinct symptoms and treatment approaches. Here we’ll break down the differences, explain how to recognise each one, and discuss how physiotherapy and sports therapy can help.

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Hip Labral Tears: A Hidden Cause of Young Hip Pain

What Is the Labrum?

The hip is a ball-and-socket joint where the femoral head (the "ball") fits into the acetabulum (the "socket"). The labrum is a ring of cartilage that lines the outer rim of the hip socket, providing stability, shock absorption, and smooth joint movement. When this cartilage is damaged—whether from injury, repetitive stress, or structural issues ( see FAI below ! ) —it can lead to pain and dysfunction. It is also more common in hyperflexible people.

Common Causes of Labral Tears in 40-50 Year Olds

• Repetitive movements (e.g., running, golf, or sports involving twisting e.g dancing, gymnastics, MMA)

• Femoroacetabular impingement (FAI) (more on this below !)

• Trauma (e.g., falls, car accidents, sudden twists, or heavy lifting)

• Age-related changes (cartilage becomes less resilient over time )

Symptoms of a Labral Tear

• Deep groin or front-of-hip pain, sometimes radiating to the thigh or buttock in a C-type shape round the top of the thigh.

• Clicking, catching, or locking sensations in the hip. May feel it needs to ' click or clunk '

• Pain with specific movements (e.g., squatting, pivoting, prolonged sitting, or getting in/out of a car)

• Stiffness, especially after inactivity. Stiffness often clears quickly, within a few steps.

Key Difference from Osteoarthritis (OA):

• Labral tear pain is often sharp, pinching and mechanical (worse with certain movements). Movement and walking may not be affected at all - the hip isn't necessarily stiff.

• OA pain tends to be more constant, usually more achy with stiffness after rest and gradual loss of motion and restriction in prolonged weight bearing activities e,g walking, standing..

" FAI is a major risk factor for labral tears and early osteoarthritis in younger patients.

Femoroacetabular Impingement (FAI): A Structural Cause of Hip Pain

What Is FAI?

FAI occurs when there is abnormal contact between the femoral head and the acetabulum, often due to excess bone growth. The head of the femur ( thigh bone ) butts up against the edge of the acetabulum ( socket ) and can cause pinching of the soft tissues - including the labrum - and bony pain if left unchecked. There are three types:

1. Cam impingement – Extra bone on the femoral head.

2. Pincer impingement – Extra bone on the acetabulum.

3. Mixed impingement – A combination of both.

These differences are more academic, really only becomes relevant when deciding on a treatment, symptoms are fairly consistent. FAI is a major risk factor for labral tears and early osteoarthritis, making early diagnosis and management crucial. It's often found in actve, sporty people especially those that were sporty as teens as a response to the stresses placed on a still developing skeleton. The body senses the increased stresses those areas under high load and lays down extra bone to reinforce the bone.

Symptoms of FAI

• Groin pain especially with hip flexion (e.g., sitting for long periods, squatting)

• Stiffness and reduced range of motion (difficulty bringing the knee to the chest)

• Pain with rotational movements (e.g., turning the leg inward or outward)

• Gradual onset (unlike a sudden injury, FAI often develops over years)

Key Difference from Osteoarthritis (OA):

• FAI symptoms are movement-specific (worse with certain positions). Stiffness may occur in certain directions ONLY

• OA pain is more constant, worsens with activity and improves with rest, and is associated with joint "grinding."

Hip Osteoarthritis (OA): Wear-and-Tear Joint Cause of Hip Pain

What Is Hip OA?

Osteoarthritis is the progressive breakdown of joint cartilage, leading to bone-on-bone friction, inflammation, and pain. While it’s more common in older adults, early signs can appear in your 40s and 50s—especially if you have a history of injury, FAI, or labral damage.

Symptoms of Hip OA

• Deep, aching pain in the groin, thigh, or buttock

• Morning stiffness (>30 minutes) that eases with movement

• Reduced range of motion (difficulty putting on shoes/socks, stepping up deep steps)

• Pain that worsens with activity and improves with rest (early stages)

• Later stages: Constant pain, night time discomfort, and joint "grating"

Key Difference from Labral Tears & FAI:

• OA pain is less mechanical (not just with certain movements).

• Stiffness is more pronounced after rest. Usually taking longer to clear - hour or so rather than just a few steps

• X-rays typically show joint space narrowing and sometimes bone spurs along the margins of the joint.

How Physiotherapy & Sports Therapy Can Help

For Labral Tears & FAI:

1. Activity Modification – Avoiding aggravating movements (e.g., deep squats - addressing positioning and form, prolonged sitting).

2. Strengthening – Targeting glutes, core, and hip stabilisers to improve joint alignment and power.

3. Mobility Work – Gentle stretching and manual therapy to restore movement.

4. Movement Retraining – Correcting gait, squatting, and rotational patterns.

   
   

For Early Osteoarthritis:

1. Low-Impact Exercise – Swimming ( some strokes better than others ) , cycling, and strength training to maintain joint health.

2. Pain Management – Heat, joint mobilisations, and pacing strategies.

3. Weight Management – Reducing excess load on the hip

In some cases, imaging (MRI/X-ray) or referral to an orthopedic specialist may be needed. Severe OA may require injections or joint replacement surgery, but early physiotherapy can delay progression and improve function staving off any need for early surgical intervention..

When to Seek Help

If you’re experiencing:

✅ Persistent groin or hip pain

✅ Clicking/catching sensations

✅ Stiffness that doesn’t improve with movement

✅ Difficulty with daily activities (stairs, walking, sitting)

…it’s time to get assessed. A physiotherapist can help determine whether your pain is from a labral tear, FAI, OA, or a combination, and create a tailored rehab plan for you.

Conclusion

Hip pain in your 40s and 50s shouldn’t be ignored. Understanding whether your discomfort stems from a labral tear, FAI, or early OA is the first step toward effective treatment to help prolong activity and minimise stresses on a probable vulnerable part of the body. With the right approach—whether it’s targeted exercises, activity adjustments, or manual therapy—you can regain mobility and stay active for years to come.

Need Help? Book an assessment with our physiotherapy or sports injury team to get a clear diagnosis and a personalised recovery plan.