Karma Yoga Opportunities

by Nina

Yoga for Healthy Aging Subscriber Tama Blough by Corey Nguyen

3.3 In this world, O Arjuna, a twofold path of Sadhana has been stated by Me in the past. The path of Self-knowledge (Jnana-yoga) for the contemplative,
 And the path of unselfish work (Karma-yoga) for the active. —Bhagavad Gita

Although the Yoga Sutras describes an eight-fold path of yoga that focuses on contemplative practices (see Ashtanga Yoga: Following the Eight-Fold Path), the Bhagavad Gita presents a second path to enlightenment, the path of karma yoga, which means “unselfish work” or “action of the Yogis.” In his post Caregivers: The True Karma Yogis, Ram defines karma yoga as a path of yoga that allows for an individual to carry out his/her duties selflessly as a service without looking to reap any benefits from such service. He also has written that:

"Any individual can achieve mind-body awareness and ultimately attain enlightenment by practicing self-less service (seva), without expectations for service provided. As a result, the practitioner’s heart and mind become pure, the ego is subdued and the light of divinity shines through them."

I actually really surprised a friend recently by saying that Mohandas K. Gandhi was the greatest yogi of the 20th century because of his work for social justice. In my friend’s mind, unless you were following the path described in the Yoga Sutras, including asana and meditation, you weren’t practicing yoga. But Gandhi referred to himself as a “yogi.” And he called the Bhagavad Gita his “mother” because he was guided by the Gita in his practice of karma yoga. (He did his own translation of the Bhagavad Gita, and it’s worth reading his essay in that book on the Gita's message. You can also find Gandhi’s essay in Stephen Mitchell’s translation of the Gita.)

I’ve been thinking about karma yoga the last week because I’ve been involved in helping a friend, Tama Blough, who is a subscriber to this blog. Tama has terminal cancer, and because she lives alone and can’t work, she needs financial assistance for living expenses and caregiving. One thing I’ve learned about myself over the years is that even though I’m a great believer in social justice, I’m just not the kind of person who’s going to lead protests, go off to Africa to help take care of people with Ebola, or even spend time volunteering at my local food bank. Sure, I give money to causes I believe in. Honestly, I can’t say I like this about myself—that I'm not out there in the trenches—but I’ve come to realize that I’m just better at helping individuals who I know. I don’t live close enough to go over to Tama’s apartment and give her hands-on help very often, so for Tama, I created a fundraising site at Give Forward, and then used my mad social media skills to spread the word. And I’m very happy to say my team and I are well on our way to raising enough money to help keep Tama comfortable in her own home as long as possible.

I recently read that your station in life tells you many important things about your karma yoga duties. If you are a son or a daughter, a brother or sister, or a parent, then you should fulfill these roles well. Obviously, the same goes for being a friend. And Ram has written in his post Caregivers: The True Karma Yogis that "a sister, brother, parent, relative, friend, or neighbor who provides care and assistance to a recipient without receiving any payment for such services" is a true karma yogi.

So, if you're interested, please visit the fundraising site for our subscriber, Tama. Another good way to practice karma yoga this week would be to join the Veterans Yoga Project that Baxter described in his post Supporting Our Veterans: Veterans Yoga Project. Or, you can simply take some time to figure out what skills and talents you have to contribute, and then look for opportunities that best fit your station in life as well as your personality.

And I’d love to hear from you in the comments section or on Facebook about the kinds of karma yoga that you are practicing—or intend to practice.

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Friday Q&A: How Can Yoga Help with Shingles?

Supported Child's Pose

Q: A friend of mine has just learned that she has shingles (front rib area). I understand that it is quite painful. She does yoga. Please let me know what types of postures would suggest. The only reference that I found in your blog archive was the posting about Baxter’s granny’s arthritic hands, a result of the aftermath of shingles.

A: For those of our readers not familiar with shingles, let’s start with a definition from the Mayo Clinic web site:

“Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. While it isn't a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.”

For those desiring more information, see the full article on their website.

Although I have my own ideas about shingles and yoga, I actually was mentioning this question to a yoga colleague of mine, Caryn Dickman, and she shared with me her experiences with using yoga to address shingles in her own life. So I thought I’d let her share her story with you directly:

“I first dealt with shingles when I was 51 years old, 14 years ago. The first sign of shingles is the nerve pain. Mine felt like a knife being stabbed repeatedly into my organs on the left side. It went from the front midline (under the breastbone) to my thoracic spine. The rash broke out a few days later. It felt as if a million mosquitoes bit me at once. 

The nerve pain along with the blistered rash lasted for a long time. It was difficult wearing clothing and it was difficult not wearing clothes as even the air made the pain stronger. The only thing that comes close to describing it would be a very bad sunburn that itched all the time and burned all the time. 

I used my yoga practice as my medicine. I was a newbie to yoga and truthfully didn't have enough experience or knowledge to know exactly what to do. So I practiced everything I knew including taking a workshop that was quite vigorous. My attention to the movement seemed to take my attention away from the persistent nerve pain. As I was aware that my organs only "felt" like a knife was going through them and there was no real knife to worry about, I used this information to calm myself down. I kept repeating, “there are no real knives” and so on some level this pain isn't quite "real." I was then able to use the breath practice to calm myself enough to feel relief while practicing.

In the years since, I have repeatedly had the nerve pain and sometimes the outbreaks return. With more knowledge and experience I realize the nerve pain comes up when my immune system is compromised. Of course, stress plays a tremendous role, too. So now when it comes up (and it has come up this week), I find myself returning to my mat a lot. However, now I am aware that poses that are more restorative and can aid in boosting my immune system are of greater importance than anything else I can do for myself. So Legs up the Wall (Viparita Karani), Queen’s pose (Supta Baddha Konasana), and Supported Child’s pose (Balasana) are the staples of my practice while I'm having flare-ups. 

Legs Up the Wall Pose

Queen's Pose/Reclined Cobbler's Pose

Supported Child's Pose

I also still use the breath practice, breathing into the pain to help alleviate the gripping force when it gets very intense. It takes persistence and faith that I can turn myself over to my practice. It may take a bit before I feel the relaxation effect kick in, but it is there if I just wait for it.” 

I asked Caryn if she had noted anything that aggravates her symptoms when she is in a flare, and she mentioned that nowadays she has to avoid vigorous practices when the symptoms return, especially if they heat her body up. That tends to make her symptoms worse. 

Thanks so much for your help, Caryn!

Note from Nina: By chance, the three poses that Caryn mention make up our Mini Restorative sequence. See Featured Sequence: Mini Restorative Practice for instructions. See Reclined Cobbler's Pose: The Video! for a video of Baxter teaching this invaluable pose. 

—Baxter

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Supporting Our Veterans: Veterans Yoga Project

by Baxter

The Veteran in a New Field by Winslow Homer

The other day at lunch, I reconnected with an old acquaintance of mine, Dan Libby. Dan and I first met when I was attending one of my first ever yoga retreats as a student at the Feathered Pipe Ranch in Helena, MT in 1999. Dan had the great opportunity to work there for nine summers, beginning in his senior year of high school. He went on to become a psychologist who was interested in working with veterans returning home from war with a variety of psychological challenges, with PTSD in the forefront. His strong connection to this community led him to found the Veterans Yoga Project, which is dedicated to improving the health and well being of military veterans. VYP sponsors classes, provides resources, and leads retreats and teacher trainings for yoga teachers interested in serving this particular community.

As we talked, I asked Dan, “Why should people who do yoga for healthy aging care about veterans and VYP’s Veterans Week?” These were his thoughts:

“Numerous studies have shown the psychological and physical health benefits of kindness, altruism, and volunteering, including lower stress levels, increased levels of the cardio-protective hormone oxytocin, and greater feelings of happiness and well-being. Research has even shown that giving support to others is associated with greater longevity.

“Conversely, post-traumatic stress is associated with increased risk of a host of physical, mental, and social problems including cardiovascular disease, depression, homelessness, and suicide. And although the difficulties encountered by the veterans of the conflicts in Iraq and Afghanistan are well-publicized, there are over one million veterans from the American War in Vietnam who are over the age of 60 and are still recovering from post-traumatic stress and all of the associated psycho-social problems that accompany this terrible disorder. In addition, the majority of the 22 suicides per day among veterans are committed by those over 50. Unfortunately, despite a lot of effort by a lot of caring people, the needs of our wounded warriors are not being met. And regardless of our political views or views about war, it is our collective responsibility to take care of those who take care of us.”

Dan then told me about this amazing project happening next Tuesday, November 11th, all around the country. Here are the details!

This Veterans Day, Veterans Yoga Project invites you to do one small act of kindness to support your own well-being, and to support the health and well-being of the men and women who serve and protect us by serving in the US Military. During the week of Veterans Day, there will be more than 90 donation-based yoga classes happening across the U.S. to support the work Veterans Yoga Project is doing to support recovery and resilience among veterans and their families. These events are designed to be an opportunity for communities to come together to honor and support in a tangible way, military veterans who continue to suffer the visible and invisible wounds of war. Please go to Veterans Yoga Project site for a list of all classes being held during Veterans Week and make plans to attend, or to make a tax-deductible contribution.

And for those who might want to reach out to Dan personally, here's his info.

Dan Libby, PhD, RYT
Executive Director, Veterans Yoga Project
veteransyogaproject.org

Contact Us Page: veteransyogaproject.org/contact

Let’s help Dan get the word out about this important work!

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Want to Improve Your Balance? Take Off Your Shoes!

by Nina

Eagle Pose Outside by Melina Meza

“Balance is a complicated equation involving vision, muscle strength, proprioception (the body’s ability to know where it is in space), and attention. As people age, those elements deteriorate.”

Well, if the New York Times can write about falling twice in one week (see A Tiny Stumble, a Life Upended), then so can I! Because after reading part 2 of their series on falling, I have a lot more to say. The main article detailed what can happen after an older person falls, saying, “life is upended in an instant — a sudden loss of independence, an awkward reliance on family and friends, and a new level of fear for those who fall, and their contemporaries.” So, there I was, getting all depressed again. But at least the article end with a quote that confirmed what I wrote on Monday (see Morning Wakeup Call: Preventing Falls with Yoga) about the downward spiral that happens after people fall and become fearful of falling again.

“Dr. Tinetti warned that excessive tentativeness can actually increase the risk of falling. “People who are more cautious cut down on their activity,” she said, “which makes their balance worse, their strength worse, and reflexes that prevent falls worse.”

But it’s the supplementary article on Steps to Avoid an Accident  that really got me upset. (Yes, I feel a rant coming on.) Here is what they recommended:

“Regular exercise classes can help, especially those that include balance drills, such as standing on one foot, or working with Bosu balls, the squishy hemispheres seen at gyms.

"The regular practice of tai chi has also been found to help. Tai chi involves very slow, purposeful movements in coordination with breathing and muscle activity, which in turn affects respiration, balance, and gait.

"Integrating balance and strength work into daily life — standing on one foot while brushing your teeth, for instance, or simply putting one foot in front of the other — can help as well.”

Uh, yes, although they came up with the brilliant idea of brushing your teeth while standing on one foot, they did completely forget to mention yoga. Yoga is particularly beneficial for balance not just because it includes so many balance poses but also because it cultivates muscle strength, proprioception (the body’s ability to know where it is in space), and attention, which the NY Times mention as being needed for good balance. When we work in our all our poses—whether or not they are balancing poses—with careful attention to our alignment, we are developing our proprioception and our attention. (My teacher, Donald Moyer, who always has us work with subtle alignment cues in our poses, has observed how his long-time students have developed very refined proprioception over the years.)

But in the end, there was something else the article didn’t even mention that made me feel rant-y: our feet! I’m a firm believer that exercising with bare feet is the best way to keep your feet healthy, strong, supple and agile, which in turn will improve your ability to balance. Imagine if you wore thick mittens all the time. Wouldn’t it be hard to use your hands effectively? Now think about your poor feet being trapped in their shoes all your waking hours. No wonder so many older people become less agile. I once watched a woman who had been born with no arms eat an ice cream cone and take care of her baby just with her bare feet; they’re capable of so much if we just let them out of their little prisons. That was a lesson to me about the power of our feet that I will never forget.

Of course we do yoga with bare feet. And moving into and out of a variety of yoga standing poses in bare feet definitely helps keep our feet more agile. As a matter of fact, in an early post of ours Friday Q&A: Feet and Comments, we addressed a question from someone who had trouble balancing in Tree pose and who also wore orthotics. Shari actually recommended that the reader spend at least some of her time practicing with bare feet to help her with her balance:

“If you wear orthotics in my mind it might be good to explore in yoga wearing them in some type of non-skid sock so your toes can still feel the floor when you are practicing your balancing poses. It sounds like you have very high arches so to contact the floor without your orthotics will be difficult. I might suggest that you explore doing the balancing poses (such as Tree pose) with your orthotics and non-skid socks, then take them off and try in your bare feet directly afterwards. Sometimes this can work to build muscle memory to teach your feet what to do. I wouldn’t push your feet to hurt your knees though. Be patient and kind to yourself when you try this.”

The NY Times article didn’t even mention how important it is to walk on uneven surfaces! If you’re always walking on a flat surface—especially wearing shoes—your feet and the rest of your body are going to be, well, just plain inexperienced and unprepared to handle any sudden unevenness, like a crack in the sidewalk. Of course, hiking on a dirt trail is effective for training your body to handle uneven surface. But it strikes me now that all those people taking photos of themselves doing yoga out in nature are doing something really good for their feet—and their balance—even if they are torturing us with their selfies. So maybe we should all start experimenting a bit with doing yoga outside.

But if you're not ready for that, in the same post in which Shari stressed the importance of balancing in bare feet, Baxter recommended a very simple yoga vinyasa, Tadasana (Mountain pose) to Urdva Hastasana (Upward Arms pose), to help keep your feet healthy and improve your balance. He said that this exercise can strengthen the foot muscles that are associated with a healthy arch. 

1. Start in Mountain pose.
2. Inhale and lift your heels off the floor as you swing your arms up into Upward Arms pose. Focus on keeping the balls of your feet even on the floor as your rise up.
3. Exhale as your lower your heels down to the floor and release your arms by your sides. Focus on keeping the balls of your feet even on the floor as your lower down.
4. Repeat for at six rounds or more.

Baxter also recommended that practitioners with flat feet should practice their standing poses keeping the balls of their feet grounded as they lifting their toes off the ground. This will encourage strengthening of the medial and lateral arches of their feet.

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Featured Pose: Extended Side Angle (Utthita Parsvakonasana)

by Baxter

Extended Side Angle pose (Utthita Parsvakonasana) is one of my favorite poses. It improves your balance and strengthens your legs and the sides of your body, especially the side abdominal muscles on your top arm side. And when you hold the pose statically for up to a minute, it also encourages bone strengthening in your hips, spine, and bottom hand wrist. In addition to strengthening, this pose increases flexibility by stretching your inner thighs and the shoulder joint of your top arm. The variations described below make it accessible to almost everyone, as it can even be done on a chair. 

Because this pose is energizing, it can help enliven you when you're feeling tired or lethargic. And because it is grounding, it can be helpful for anxiety or stress.

I prescribe Extended Side Angle for:

• osteoporosis
• balance problems
• anxiety
• general weakness and fatigue

General Instructions:

1. Start by standing in the center of your mat.

2. Step your feet wide apart, about the length of your legs. Then turn your right foot out about 90 degrees and your left foot in slightly, so the pinky edge of your left foot lines up with the long edge of your yoga mat. 

3. Inhale and extend your arms out to your sides. 

4. Exhale and bend your right knee toward 90 degrees (but not further), making sure your right knee is aligned with the middle toe of your right foot. If it’s comfortable for you, turn your head to gaze over your right hand (essentially entering Warrior 2). 

5. Keeping your front knee directly over your front ankle, side-bend your torso and belly from your hips out over your front thigh, and place your right hand on the floor to the outside of the front foot or on a block that is snuggled up against your right shin. Try to keep the right and left sides of your chest even with each other, avoiding the tendency to round your spine like a bending sapling over the front leg. 

6. Keeping your hips stable, rotate your upper belly and chest slightly up away from your right leg. Bring your left arm overhead in line with your back leg and the side of your chest. 

Hand on the Floor

Using a Block

7. Traditionally, in this pose, your head (and gaze) turn up to look under your left armpit. But I also like to look straight ahead or turn my head to look down at my right foot. Stay in the pose for 30 seconds (8 breaths), working up to 90 seconds (approximately 16-20 breaths).

8. To come out of the pose, inhale as you straighten your right leg and use your left arm to swing your torso back to center, with your arms out to the side. Then, on exhalation, release your arms and turn your feet to parallel. Then repeat the pose on your left side.

Variations:

1. Tight Hips or General Weakness: For this variation, you stand with your feet a bit closer together than usual and then either use a chair for your bottom hand or place your elbow on top of your thighbone, near your knee, with your palm facing up. If you are using a chair, before entering the pose, place the chair so when you’re in the pose, it will be just to the outside of your front knee. 

2. Arm Strength: You can use this pose to build arm strength by keeping your arms up while you change from your right side to your left. 

3. Balance Problems: If you have balance problems, I recommend you use a wall. You can practice with your back to a wall, with the hip of your front leg touching the wall. Or, you can practice with your mat perpendicular to the wall, and your back foot against the wall. This is a good way to get a clear sense of the straightness of your back leg. Either position the entire outer edge of your back foot flush against the wall or have just your heel against the wall, with your back foot turned just slightly in. 

4. Shoulder Tightness: For those with shoulder tightness, taking the top arm overhead in line with your side body can be challenging at first. Instead, take your top arm straight up in the air, as in Triangle Pose. Then, gradually, over time, you can bring your arm closer to the full position.

5. Chair Version: For those who cannot stand to do this pose, start by sitting on a chair as you normally would. Then swing your right leg so it is parallel with the front edge of your chair and your right buttock and part of your right thigh are supported on the chair seat. Then extend your left leg back away from the right, as in the full version of the pose. If your left hip is tight, you can move your left leg a bit forward of the chair to make sure the sole of your left foot is grounded. Inhale your arms up to your sides, and and then side-bend over your right leg, placing your right elbow in your right thigh, palm facing up. For this variation, take the left arm up towards the sky as in Triangle pose. If your shoulders are more open, you can move your left arm in line with your side body and back leg. To come out of the pose, inhale as you bring your torso back over your hips and your arms to your sides. Then, exhale and release your arms down and swing both legs to your starting seated position. Repeat on the other side.  

Cautions: If you have knee problems, don’t bend your front knee quite as deeply. Make sure it stops just shy of being over your front ankle. In addition, standing with your feet a bit closer than the 4 to 4 1/2 feet apart can also help. And if your knee is acutely painful, you could sit on a chair with your front thigh supported by the chair seat. This will take all weight off your front knee. Those with lower back pain on one side or sacroiliac pain on one side should try the higher versions described above for hip tightness. And, as with all held standing poses, those with high blood pressure should stay for much shorter periods of time, such as 4-6 breaths. You should work with a qualified teacher to advance your timings appropriately.

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Morning Wakeup Call: Preventing Falls with Yoga

by Nina

Baxter Balancing by Melina Meza

“As the population ages and people live longer in bad shape, the number of older Americans who fall and suffer serious, even fatal, injuries is soaring. So the retirement communities, assisted living facilities and nursing homes where millions of Americans live are trying to balance safety and their residents’ desire to live as they choose.” —NY Times

When I sat down for breakfast with Brad this morning, he told me about an article in the New York Times Bracing for the Falls of an Aging Nation that he had just finished reading, saying, “You should write about this today.” So as I started to drink my morning tea, I read through the fairly long article, and the more I read, the more depressed I got. Because after presenting all the terrible statistics about the numbers of people over 65 who have died after falling (nearly 24,000 in 2012, the most recent year for which fatality numbers are available — almost double the number 10 years earlier), the article described all the measures that retirement communities are taking to keep their residents safe. But the problem that I saw right away was that many of the safety restrictions for residents, such as keeping floor surfaces completely even and requiring walkers, would cause the residents to become even less mobile and less able to balance, in a downward spiral of inactivity in the name of safety. And the really sad thing for me was that even though these facilities offer optional exercise classes—even classes specifically focused on improving balance—people were not going to them. As the article said:

“But many residents do not, or refuse to, recognize their own gradual deterioration, leaving them vulnerable despite efforts to protect them. Institutions offer sessions on avoiding falls and Improving balance and fitness. But some residents will not go near them – until after they have fallen.”

At one point in the middle of the article, I said to Brad in despair, “I can’t write about this—it seems totally depressing.” It was only when I reached the end of the article that I saw a glimmer of hope:

“Though the risk of a fall increases significantly once people reach their 80s, researchers have found that people 85 and older in excellent health have no greater risk than someone 20 years younger.”

Yes! That’s what I like to hear. As we have written about in several posts (see Winter Ice, Fear of Falling, and Yoga), yoga is especially helpful for enabling you to maintain and/or improve your ability to balance. So if we’re all practicing yoga asana regularly—especially standing poses and balancing poses—we’re going to be much better off than the old folks in the article, who have become practically immobilized in attempt to keep them safe. Granted, it is sometimes difficult to motivate yourself to take preventative measures. As the article said regarding the older people’s lack of attendance in the optional exercise classes:

“It is not so much laziness that accounts for the limited attendance, but denial. A sluggish foot, eyesight that fails to catch a step down, slowed reflexes – these creep up slowly, often imperceptibly. This helps explain why people tend to pay scant attention to their risk for a fall until it happens.”

So that’s our wakeup call for the day! Let's all "brace" for future falls by practicing yoga instead of retreating into immobility. I don’t know about you, but I practice balance poses several times a week. If you’re not doing the same thing already, give Baxter’s Easy Balance Practice a try. And if this is too challenging for you—or you’re working with someone who is weak or shaky—take a look at Regaining Stability for Free and Starting to Move Again. Even just a few wide-legged standing poses, with your back to a wall if you’re feeling nervous about balance, can be a great start.

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Friday Q&A: Modifying Poses for a Hip Replacement

Pose to Avoid for People with Posterior Lateral Hip Replacement

A reader left this question on our post Featured Sequence: Dynamic Reclined Hip Stretches (Rerun).

Q: What adaptation would you use for someone with a hip replacement?

A: To answer this question, we need to consider the type of hip replacement the yoga practitioner has had. Which type of replacement person has had is going to affect their asana practice.

To review from our post on total hip replacements and yoga, the basic categories of total hip replacement are:

1. posterior lateral approach
2. anterior lateral approach
3. anterior approach
4. minimally invasive anterior approach or minimally invasive posterior approaches

These are all different, but as far as hip precautions go there are no hip precautions for the anterior approaches.

In general, everyone who has a hip replacement should ask their surgeon what their post-operative physical limitations are and for how long. Make sure you learn how to safely get up and down from the floor so you don’t dislocate your new hip. And make sure that you learn the specific precautions associated with your category of hip replacement. The key is that you learn to identify what position your hip is in when you do your poses. Think of both legs when you do each side (don’t just focus on the surgical side).

In the more traditional posterior or posterior lateral approach there are limitations on hip flexion, adduction and internal rotation. That means that if you combine these three positions you are more apt to dislocate your prosthetic hip because the muscle support is weakened by the surgical procedure. Poses you might want to not do for approximately six months would be: Standing Forward Bend (Uttanasana), Eagle pose (Garudasana), Cow-Face pose (Gomukhasana), and Child’s pose (Balasana). Gentle backbends generally are okay for posterior/posterior lateral hips.

For anterior lateral hips the precautions will be very different. Typically hip extension and hip abduction will be affected and you don’t want to be aggressive in these combined movements. So start thinking about your backbends and standing poses. Remember that the position of the front and the back legs are very different in the standing poses. The front hip may be placed into positions of flexion and external rotation and abduction but the back hip may be in extension with external rotation.

For anterior hip replacement surgeries the doctor will typically tell you that you have no restrictions but that doesn’t mean you are going to jump back into your asana practice. The hip is going to be sore and painful because of the surgical trauma (though it is less in this procedure than some of the other ones I talked about because there is no actual muscle cutting in this procedure but the muscles are certainly stretched as they are moved for the surgery).

Now to Baxter's sequence, Dynamic Reclined Hip Stretches: To answer this question I combined hip surgeries into two categories; anterior and posterior approaches. That’s because functionally there isn't a whole lot of difference in precautions for each subcategories within the two main categories.

1. Deep Hip Flexion. 

Flexion Greater Than 90 Degrees

All four poses in the sequence involve deep hip flexion. The reason hip flexion works for low back discomfort is that the ilium rotates posteriorly when the knee and hip are flexed, and, conversely, the lumbar spinal curve is reversed and the back flattens. This often feels good because those tight low back extensor muscles are stretched.

However, with a hip replacement, flexion beyond 90 degrees often causes a "pinching" sensation in the groin region. If the hip replacement was an anterior approach there is no fear of dislocation but discomfort can certainly arise. However, with a posterior lateral approach, the position of deep hip flexion is not recommended due to dislocation risks. (Unfortunately there is no time when a hip replacement will not dislocate, but typically the high-risk time is 0-90 days post-operatively).

As a modification, you could try using a chair. Place your top leg on the chair so your calf is resting on the chair seat, and your hip and knee are bent at 90/90. Lengthen your bottom leg underneath the chair seat. This makes the pose more passive and this gentler approach might be the safer way to go. (I don't like teaching my students to “deeper” into a pose using overpressure with their arms because I think this is a potential way to cause injury. I believe that for muscle release to occur, you should take the joint to its pain-free position and breathe while statically holding the pose.)  

2. Hip and Knee Flexion with Abduction and External Rotation 

Position 2 in this sequence is a red light for a posterior lateral approach because two of the three dislocation movements are present: hip flexion beyond 90 degrees and, for some approaches, external rotation being limited due to how the hip might be fixed within the joint. So for this type of hip replacement, you could modify the pose with a chair, as recommended for position 1. After placing your top leg on the chair so your calf is resting on the chair seat, let your knee and thigh roll outward.

3. Knee to Chest Moving Over the Midline.

For a posterior lateral hip replacement, Position 3 should never be done! This is the full rendition of dislocation position, which is flexion with adduction and internal rotation. To get a similar stretch (the tensor fasca lata, lateral hip abductors or piriformis) I suggest a Jathara Parvartanasana variation. This pose is a reclined twist, with, in this case, two bent knees. Before coming into the pose, either place either a folded blanket between your thighs and legs down to your ankles or place a foam block between the knees. And place a bolster on the floor to support your legs after you come down so your legs don’t go all the way down to the floor.

Finally, the key concept is that regardless of the type of surgical approach, you need to learn to respect your hip and never push into pain. Posterior lateral hip replacements are more dislocation-prone than anterior hip replacement procedures but end-range overpressure will cause discomfort in anterior hip replacements. And, unfortunately, if the prosthesis is sized improperly, even trying to do the modifications I’ve recommended might still be uncomfortable. In that case, go back to your surgeon—or ask your student to go back to their surgeon—for some frank discussions on the specific dos and don'ts for their hip replacement.

—Shari 

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