Friday Q&A: Hip Pain

Q: I was hoping someone could give me some advice for poses that can help reduce the pain of minor hip dysplasia. My left hip regularly becomes inflamed and sore, and I would like to know what stretches can provide pain relief and also strengthening poses to develop the muscles in a way that will cushion my joint.

A: Dysplasia is an inherited condition. You are born with it. It is due to a shallow acetabulum and how then the hip sits inside the pelvis. It might be helpful for you to learn how much internal rotation and external rotation you have in that hip compared to your other, non-symptomatic hip. Once you know your available range of motion, you need to respect this and not try to put your hip into positions that it can't anatomically go into due to structural assymmetries. That said, you then need to look at how you position that hip in standing poses. If you tend to turn the front leg out too much or too little this will affect how the pelvis rolls over the hip. It would be helpful if you ask a teacher to help you analyze how you hold your legs and to try to get that hip into a more mid-range position. Once that hip is in neutral, you can strengthen the muscles around the hip by  holding your poses for up to 90 seconds. Building strength with isometric muscle contractions through the joint will nourish the joint and help keep it healthy.

The down side of this is that in standing poses you are typically in weight bearing positions, which may tend to aggravate the joint too much. If this is the case, you may want to try to recreate the neutral hip position in symmetrical seated positions such as Dandasana or Upavista Konasana. The same principle would apply to stretching muscles that cross both your knee and hip joints. Keep your hip/knee in neutral to avoid aggravating the joint. —Shari

A: In addition to the sound information Shari has shared with you, know that in adults with hip dyplasia, arthritis developing in the hips can also add to the unusual structure of the hip with dysplasia. So if you have not had a recent check up to assess your joint via xrays or MRI, it might be good to consider doing so, so you know the present condition of the joint.  And certainly, respecting the safe range of motion of that hip joint will give you a sense of how you may need to modify your poses, especially weight bearing ones. Another advantage to working one on one with a good teacher is  that you can also learn some poses that will be helpful when your hip is painful, which likely implies some underlying inflammation in the joint. Standing poses would not be a good idea at that time.

I like to teach students to re-create many of the standing poses while lying supine, or on your back, with the soles of your feet pressed against a baseboard, as if it was the floor.  In addition, doing some supported inversions with your legs in the air, such as Vipariti Karani or Chair Shoulderstand, will take most of the weight off your hip joints and potentially allow the inflamed area some rest.  A final suggestion is for the standing version of Mountain Pose. Imagine your pelvis bones lifting off your leg or femur bones as you root down with your leg bones towards your feet.  My students with hip arthritis often report back that this instruction feels very good in the hips.  —Baxter