Keeping Your Hips Happy and Healthy

by Shari

After reading Women's Flexibility is a Liability in Yoga by William Broad and responding with Is Women's Flexibility a Liability in Yoga? Shari's Response to William Broad and Differences Between Male and Female Pelvic Structures I thought some general advice about how to keep your hips healthy and happy would be helpful for both women and men alike.

I suggest you start by finding your hips and assessing your mobility. I often ask my students to begin by locating their hip joints. They are not on the outside of your pelvis but the spot where when you lift your legs up when you are climbing stairs, you feel the muscle moving under your fingers. This is the head of your femur (thigh bone).

Hip Joint Located Behind Inguinal Ligament

Next, test your own amount of leg external and internal rotation. Lie on the floor in Savasana (Corpse pose), with your feet slightly apart. Then, moving from your hips while keeping your legs straight, turn your legs out so your feet turn away from each other. This is external rotation.  As you do this motion, make sure you are doing the movement from your hips not from your lower leg/knee. Observe how far you can turn your legs out, and whether both sides are the same. Next, moving from your hips while keeping your legs straight, turn your legs in so your feet are turning toward each other. This is internal rotation. Again, as you do this exercise, make sure the movement originates from your hips not from your lower leg/knee. Observe how far you can turn your legs in, and whether both sides are the same.

Once you can sense how much actual hip rotation you actually have (and whether you are the same on both sides), you can begin to assess your own foot placements for standing poses. Start by exploring your particular hip alignment in wide-legged, side-facing standing poses, such as Warrior 2 or Triangle pose. See whether it is easier to feel your hip position if you step into your standing pose from Mountain pose (Tadasana) by stepping back with your left leg and keeping your right leg stable, rather than stepping the right leg forward and the left leg back (the traditional Iyengar yoga cue). Then, as you take your stance in the pose, first try keeping your front heel in line with your back middle arch and notice how your back leg internal rotation feels. If you find that in order to do this alignment you have to reposition your lower leg moving from your knee to correct this alignment, try a wider front heel to back heel stance and see if this feels like less tension in your knees and back hip.

I remind my students to not square the pelvis (see Squarer's Beware) but to allow the front pelvis to be in the same plane as the front knee and the back knee to be in the same plane as the back pelvis. In these types of poses, your front leg will be in external rotation relative to your back leg, which is in internal rotation. While working with your hips, don’t forget your knee positioning—to protect your knees, please align your knee with the middle of your ankle joint and generally in line with your second toe. All these joints should be lined up. Proper alignment that is optimum for you may take some experimentation, so if in you’re doubt, use a mirror to help you check exactly which direction your knees and hips are facing.

Continue this exploration in all your wide-legged standing poses, such as Extended Side Angle pose and Warrior 1. Try not to force rotation by causing your pelvis to move more than is comfortable over your stable legs. And don’t be afraid to line up your front heel with your back heel if that gives you more a sense of freedom in your hip joints! Turning one joint surface too much in relationship to another (the femur turning in the cup of the acetabula) will put stress and strain on the hip joint capsule and the ligaments that keep the hip within the socket of the acetabula.

 Some rules of thumb for standing poses:

1. Any pain in the groin or knees need to be respected. Please back out of the position.
2. Pay attention to pain in any body part, especially when doing single leg positions (balancing poses) and try to modify to avoid reproducing the pain. It is really important to learn how to use your muscles (which need to contract on both sides of the joints ) and bones to support your weight rather than depending on the ligamentous structures inside the joints to provide stability. Pain can come from compressing the pain sensitive structures inside joints (ligaments, tendons and capsules) or from moving beyond the joints limits of mobility (see Range of Motion: Yoga's Got it Covered).
3. Try to avoid overly stretching the front of your thighs close to your hip crease in your back leg in poses like Warrior 1, Triangle pose, etc. And for lunges, avoid going into your end range with your back leg and “hanging out” there. 

Now on to seated poses! Whether you are sitting in a straight leg position like Staff pose (Dandasana) or in a bent leg position like Seated Crossed Legs (Sukasana), Cobbler’s pose (Baddha Konasana) or Lotus/Half Lotus, it is really important to sit with your knees below your hips. If you have limitations in your hip external rotation, you definitely need to sit on a prop (folded blankets or bolster). And if you can’t lift your pelvis up over the front of your hip joints (this will look like a slumped position), again pleased sit on a prop to allow some space so you can lengthen up and bring your spine back into its natural neutral curves.

Sitting on a Prop

Remember the spine has curves for a reason—they serve as a means to distribute weight through the spine along the vertebral bodies. If you sit in a reversed or slumped position, you change the weight-bearing forces onto the facet joints and the soft tissue structures of the back (muscles and ligaments and discs). When you sit with your bones providing the support, you will tire less and breath better!

Finally, in bent leg positions, you may need to support your outer legs to prevent the sensation of hip pain. You can place folded blankets or blocks under your knees to keep your legs from hanging in space.

Sitting in Hero pose (Virasana) is a different hip position—internal rotation. Depending on the degree of internal rotation that you have, it may or may not be possible for you to sit with your knees together. In this case, try sitting on a higher support so your pelvis can be over the heads of your femurs (thigh bones) not behind them, and allow your knees to separate but not roll out. Align your thighs with your hip joints. Try palpating your hips in Hero pose and experiment to see if changing how close together your knees are helps to make the pose more comfortable. Reclined Hero pose (Supta Virasana) is also a different hip position because internal rotation is now superimposed with a backbend and if your hips can’t move into internal rotation, then your lumbar spine and sacrum will try to compensate for the lack of movement which can also cause pain and discomfort. This is especially the case for women because our sacroiliac joints may not lock down in weight bearing in this backbend so there can be an uneven distribution of weight in the back bend position. Learning how to prop for both Hero pose and Reclined Hero pose is really important, and you may need a teacher to help you with these alignment issues.

The bony structure and joint orientation of your hips in the acetabulum of the pelvis are variables that cannot be changed. Bones can only move in certain ways due to form and function. We may try to compensate for our immobility by excessively overusing our soft tissue ligaments and joint capsules to try to gain flexibility that we lack. Or, we may inadvertently try to make our hips move beyond their anatomical possibilities by the sports that we do or the yoga that we practice because we think the goal is more flexibility. This certainly can cause excessive wear and tear of the hip joint leading to cartilage deterioration and arthritis. So the issue really is our perception of what a pose is supposed to look like. How a pose feels is very individualistic, and it is not good to struggle with a pose that always causes pain. Sometimes for some of us certain poses aren’t attainable in the classical sense, but I believe that if we can recreate the feel of the pose we can get the benefits. For example, Dancer’s pose (Natarajasana) is a challenging balancing backbend in which you raise one bent leg behind you and reach overhead with one bent arm to hold the toes of your raised foot. However, modifying this pose by reaching your straight arm back to hold your foot instead of up overhead will allow you to recreate the beauty and concentration of the classical pose.

For healthy aging, I believe that struggle may not always be the best way to go; instead, learning to be less aggressive and more adaptive is a best way to approach asana. Mental focus and alertness with concentration on using the breath to create asana is more satisfying than trying to force oneself into contortions that may not be possible for one’s innate physical structure. This is how we balance and protect ourselves from injury during the physical asana practice.

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Late-Onset Scoliosis is Common in Older Adults

by Nina

Reclining Nude, back by Henri Matisse

A recent New Times article Scoliosis Can Hit Well Past Adolescence by Jane Brody confirmed something I have been observing in the yoga community: late-onset scoliosis is quite common in older people. I developed the problem myself in my fifties, so I’m quite aware of the condition, and I’ve noticed a large number of other older yoga practitioners with the same problem. Here’s what Jane Brody said about this:

"Although scoliosis is generally thought of as a problem of adolescents, who often require bracing or surgery to correct the curvature, the condition is actually far more prevalent in older adults. In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had spinal deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees."

Even a mild version of scoliosis can result in chronic pain of different types. While your pain could be in your back, it might also be in your hip (because scoliosis can make your hips uneven) or even your leg and/or knee (because scoliosis can make one leg “virtually” shorter than the because that hip is higher).

Baxter, who teachers Yoga for Back Care, has already written about scoliosis (see Friday Q&A: Scoliosis). But I decided to write about it today because I think it’s important for us all—students and teachers alike—to realize what a common problem this is. And if you (or a student of yours) are having mysterious back pain, hip pain, or leg pain, it’s worth being checked out to see if this is causing the problem. Some people just don’t think of it! I personally know of two cases of women with pain who didn’t realize they had scoliosis. In one case, the yoga student’s teacher casually mentioned, well, of course, you have scoliosis, because it was visible to his sharp eyes. She had no idea! And in another case, it was I myself who noticed it while I was assisting a fellow student doing a backbend. I just asked her, “Do you have scoliosis?” She was surprised I had asked, but we when talked afterward, it turned out she was having quite a lot of pain, including in her hip. So I encouraged her to get checked out by a health professional, and sure enough, she did have scoliosis.

Getting checked out is not necessarily a big deal. A health professional can do a visual test that is quite simple (he or she will watch your spine as you come bend into a forward bend), although in same cases, if your scoliosis is very mild, you may need an X-ray to detect it. But it is worth knowing the source of your physical problems because, yes, yoga can help. Even Jane Brody had a yoga pose recommended to help her:

Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat.

That pose sounds like Vasisthasana (aka Side Plank pose) to me! And there are whole lot of other yoga poses you can do to strengthen your back and balance your curve. So if you’ve been diagnosed with this condition, seek out a yoga for back care teacher who understands scoliosis, take a Yoga for Scoliosis workshop, or check out Elise Browning Miller’s web site (she’s a long-time yoga teacher who uses yoga to manage her own scoliosis) for info on her books and DVD and other resources.

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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

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