Friday Q&A: Hip Pain and Skiing

Q: I commented a while back on being old and having bad hips, but that was just basically a whine about pain. Now I actually have a real question. Last week I went downhill skiing in two feet of thick powder snow (very hard skiing). At the end of the day my hips felt great. Thighs and calves were pretty sore, but hips felt better than they had for ages. I think that this was the result of exercising each side equally—it was the only way to get through the powder without falling. How can I make sure in yoga practice that I am actually exercising each side equally? My teacher points out that each side may feel different in an asana, but that is usually the end of that. I understand that opposing body parts often "feel different" but is this a situation that we are not supposed to attempt to fix? I feel a great imbalance between right and left sides. Especially in the hips. What to do?

A: Your observation about symmetrical exercises making your hips feel better is very astute. Yoga is asymmetrical and that can be problematic for certain orthopedic issues. I am not a skier but what I can imagine is that the movement comes from weight shifting with the hips in a non-moving, weight-bearing position with the knees flexed and the ankles fixed within the skis. This position causes significant isometric muscle contraction to keep the joints stable. Muscle contractions increase blood flow to the area significantly, and if you had good alignment in your ski position, then the weight bearing forces were also nourishing the joint cartilage because of the increased blood flow. Proper alignment, with significant muscle contraction through all sides of a joint for a significant time period is what nourishes arthritic joints. You also did this activity for a SIGNIFICANT time, not just a 1.5 or 2 hour yoga class, which is not non-stop movement. Proper alignment, with significant muscle contraction through all sides of a joint for a significant time period is what nourishes arthritic joints!

So how to apply this to asana practice? One way might be to concentrate on “co-contraction” of opposing muscle groups when you are in standing poses, as well as in seated positions, inversions and backbends, that are specifically targeting your hips. Focus on activating your hip abductors, hip extensors, hip flexors, and hip adductors. Finding neutral in your hip joint before moving into an asana is also critical. Move your leg to a position without too much internal rotation or too much external rotation but balanced between the two extremes. Once you are in the pose, focus on isometrically contracting all the muscles that help you stabilize. Timing the sides also can be important, with a full 30-45 seconds on each side (use a kitchen timer as this time may be actually longer than you think). I would also recommend being careful to avoid pain in your hips going into or out of asana because this just increases the inflammatory response and causes more wear and tear on the joint cartilage.

—Shari


A: Dear Happy Hips,

My take on this is a bit different than Shari’s, so you’ll have to try both of our approaches to find out which is best for you (and your hips).

First off, it would be helpful to know more about your hip pain prior to this glorious curative day of hard skiing. Which hip hurts, which movements have been aggravating in the past, and how has your yoga practice impacted the typical course of your hip pain?

I have skied and also skied in powder, and although you have to work harder to get through powder conditions, there is actually much less joint impact than in usual conditions, as the powder softens each thrust of the ski into the hillside. So in one sense, you might want to see how your hips respond to normal ski conditions But, of course, be careful.

Also, there is a balance between external rotation of one hip as the other hip internally rotates, in order to keep your skis parallel as you cut side to side on your downhill trip. Rarely are your hips in neutral for very long. In addition, you are in constant movement at the joint, not only with the rotational movement of the joint, but with the flexing at the hips and knees that increases and decreases moment by moment. This dynamic movement is different than some yoga practices, which have a held static quality, as in the Iyengar system, as we have discussed in the past. And this dynamic movement may be a better type of way for you to work with your hip.

Although the joint is in constant flux while you are skiing, the overall muscle tone around the joint is consistently engaged, so you are not relaxing into the joints and letting the muscles be more passive. This may also be providing more support around the joint than say in Pigeon pose forward bending version, for instance.

How does this translate to your yoga practice? Well, first off, you may want to work on dynamic mini vinyasa flows that partially replicate your experience on the mountain. You may want to work with a local teacher who also skis in order to create some personal movements for your unique situation. And notice if long-held, static poses aggravate your hip, as this may not work well for you long term.

—Baxter

Read More

Arthritis, Exercise and Yoga

by Nina

Hey, I heard this really nice little piece on arthritis and exercise on NPR that I wanted to share with you. Fortunately, NPR has both the audio and a transcript of the piece on their web site (see here). What I liked so much about this particular piece was how simple and clear it was about why it is important to continue to exercise when you have arthritis (even though most people don't) because exercising, while it cannot reverse arthritis, is the only way to prevent the arthritis from getting worse. Here's why:

1. Arthritis breaks down your cartilage, the natural shock absorbers in your joints. As a result, blood doesn't circulate as freely and doesn't deliver adequate nutrition to your cartilage. Exercise massages the joints, improving the blood supply to the joints, providing your cartilage with more nutrition.

2. The stronger the muscles are around the joint, the more protection your body can provide for the joint. Your muscles take up the weight and pressure, instead of the joint itself.

The end of the piece even mentions yoga as a good way to improve the strength of the muscles around your joints! (That's refreshing because most people are under the misconception that yoga is only about stretching.) But yoga is also a good way to massage your joints to get the blood flowing because in a well-rounded practice you move your joints in every direction. Just think of all the directions in which your hip joints move in the various standing poses. And your knee joints are bent or straight, turning out to the side or even turning in slightly (such as in Eagle pose). Your shoulder joints really get a workout, too, as you hold your arms overhead, out to the side, behind your back, or across your body (again, as in Eagle pose).

For strength building, it's easy to think of standing poses (especially those with bent knees) and balancing poses that strengthen the muscles around the knees and hips. But what about your shoulder joints? Downward-Facing Dog and Plank pose spring immediately to mind because you are bearing weight on your arms as they extend forward. But there are also other poses that you can use to strengthen your shoulder joints in which you bear weight on your arms reaching sideways (such as Vashistasana, sometimes called Sideways Plan pose) or behind you (such as the backbend Purvottanasana, sometimes called Upward Plank pose). Here's Esther doing Purvottanasana:

That looks like it does a good job strengthening the hip joints, too! Yeah, it can definitely be a challenge to practice with pain in your joints or to practice modified versions of poses you used to be able to do without props (I know because I have mild arthritis in one of my hip joints), but enjoying more mobility in your daily life and possibly avoiding joint replacement surgery, well, that's a pretty big payoff.

Read More