Friday Q&A: Opening Your Hips without Knee Pain

Q: I have a question about hip openers. I teach to mostly middle-aged and older populations. Some folks are more physically active than others, but almost all of them spend a lot of time sitting, either in a car or at a desk. Many of them experience tightness in the hips and a smaller sub-set also have issues with painful knees - arthritis, meniscus issues, etc. I was taught that externally rotating the leg can be problematic for the knees, especially if they are already vulnerable. However it seems as though most of the best and most direct hip openers involve external rotation. Do you know of any postures that effectively stretch and release tension in the gluteals and the external rotators of the hip without compromising the safety of the knee?

I searched the blog but wasn't able to find anything that addressed this issue, though perhaps I didn't search effectively. I'd be grateful for any insights you can share, from previous posts, or in the future.

A: Thanks for this question! I want to begin by reminding all of us that in yoga circles “hip opening” sometimes gets reduced to the combination of hip flexion, abduction and external rotation of the femur bone (thigh bone) in the hip socket, as in Cobbler’s pose (Baddha Konasana) and Lotus pose (Padmasana). But the hip obviously moves in many other directions, so “hip opening” should reflect the improvement of the full range of motion of the hip joint! So, in general, for yourself and your students, focus on good overall hip opening, which will have positive impacts on posture, locomotion, balance, and agility.

Opening the Front of the Hip Joint

To open the front of the joint—the area your sedentary and seated students need mostly—you want to stretch the front thigh muscles, such as the quads and the psoas by extended the joint, so High Lunge (Vanarasana), including the classic and chair versions, and the Dropped-Knee Lunge, and Warrior 1 (Virabradrasana 1) for the back leg can effectively work those areas. 

Opening the Inner Hip Joint

To open the inner aspect of the joint, you want to lengthen the adductor group of muscles via poses that take your legs wide apart, such as Standing Wide-Legged Forward Bend (Prasarita Padottanasana), Pyramid pose (Parsvottanasana), Triangle pose (Trikonasana) and Extended Side Angle pose (Utthita Parsvakonasana), and Wide-Angle Seated pose (Upavista Konasana).

Opening the Outer Hip Joint 

To open the outer hip joint, you want to adduct the hip joint via poses that bring your leg across the midline of your body. You can do this movement with Reclined Leg Stretch (Supta Padangusthasana), bringing your lifted leg across the midline.

Standing Forward Bend (Uttanasana) with one leg crossed in front of the other can also be helpful. 

Opening the Back of the Hip Joint

To open the back of the joint, stretching the hamstring stretch muscles by flexing the joint with straight legs is very helpful. Some poses that stretch the hamstrings effectively include Standing Forward Bend (Uttanasana), Reclined Leg Stretch Pose (Supta Padangusthasana) Version 1, and Pyramid pose (Parsvottanasana). 

Combinations of Movements

To address combinations of movements, especially those that include external rotation of the hip joint, which is necessary for poses like Cobbler’s and Lotus poses, Thread the Needle pose is a great way to release tension in the deep external rotators of the hips.

If you hold onto the top shin and stretch your bottom leg along the floor, you are essentially doing upside down Pigeon pose without as much potential strain on the knee joint for you folks with knee issues. Sorry I don’t yet have a picture of this variation! 

In fact, regular Pigeon pose (Kapotasana) is one to avoid for those with knee issues, as it tends to put too much pressure into the front bent knee, especially when doing the forward folding version.

You can also get a nice stretch of the posterior gluteal muscles in all your Downward-Facing Dog (Adho Mukha Svanasana) variations, even Half Downward-Facing Dog at the Wall. 

If you then bend your left knee a bit toward the wall and press your hips a bit to the right side of your mat while keeping your right knee straight, you can get a deeper stretch of the lateral gluteal muscles and the deep external rotators of the right hip. And it is easy on the knees! Of course, do it on both sides!

Also, the twisting version of Reclined Leg Stretch pose pictured above is also a good one, as are these versions of Marichyasana 3:

 If there is any knee pain when you try this one, you can move your bent knee foot slightly away from the hips. 

All this should keep you and your students busy for a while!

—Baxter

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Featured Sequence: Dynamic Reclined Hip Stretches (Rerun)

by Baxter

Last week I introduced some thoughts on low back pain and yoga (see here). As I mentioned, the majority of episodes of lower back pain are related to short-term issues of muscle strain or spasm, or other soft tissue and joint situations that usually resolve in six weeks or so. However, it is possible that a regular yoga practice or a special sequence directed at the lower back area can speed up that process and get you back on track a bit sooner. I have frequently observed that for students who come to class for the first time, acute low back strain often requires only a few sessions in my Back Care Yoga class before the student is well enough to return to or advance to a regular yoga class. In this setting, the variety of poses that may be helpful is a bit larger than with more serious lower back injuries or conditions. For example, you can be a bit more comfortable with some twisting and forward bending poses, which often have to be modified in the other situation.

This week I would like to give you a very brief sequence of poses to try when addressing low back pain. 

My intention is to add to this sequence over the next few weeks. I have found that it is better to start with shorter practices and advance as you are ready. 

The Reclined Hip Stretches sequence allows you to gently release tension around your hip joint and hamstrings, which may help relieve lower back pain. This sequence is a good general warm-up you can do at the beginning of any asana practice. It takes your hip joint through most of its range of motion, so it could be helpful for conditions from mild joint stiffness to arthritis. It is also a great way to begin stretching your hamstrings, and because your arms move up and overhead at the start of the sequence, it can help loosen up tight shoulder joints. 

Caution: If you have significant lower back problems, make sure to take your knee across your mid-line slowly and keep it on the easy side for a while. Allow your lower back and pelvis to stay flat on the floor.

1. Start by lying on your back, with your legs straight. You can set yourself up near a wall, so your feet can press into the wall. 

2. Inhale and raise your arms overhead and back toward the floor.

3. Then exhale and bend your right knee to your chest, bringing your hands to meet the knee. 

4. Inhale, and gently guide your right knee toward the right using your right hand. 

5. Exhale, and guide your knee back to center, then, changing to your left hand, guide your knee 6-12 inches over to the left.

6. Inhale, and guide your knee back to center. Then exhale, and holding onto the back of your leg, straighten your leg toward the ceiling as much as you can. 

7. Inhale, bend your knee, release your foot to the floor, and straighten your leg along the ground.

Repeat the entire sequence on your left side. After that, if you wish, you can repeat the sequence on both sides a few more times.

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