Is yoga a causative factor in hip pain and surgery?

The New York Times published “Women’s Flexibility Is A Liability (in Yoga)” discussing the link between

yoga and femoral acetabular impingement (FAI). What is FAI and how can you maintain your yoga practice while dealing with a hip dysfunction?

Femoral Acetabular Impingement (FAI)

FAI means there is abnormal contact between the acetabulum (hip socket) and femoral neck/head (top of the thigh bone). FAI can be a cam impingement, pincer impingement, or a combination of the two.

Imagine looking at someone’s left hip and the acetabulum makes a “C” shape. With the cam impingement, the increased surface area on the femoral neck bumps up against the covering of the acetabulum, or top of the “C.” With the pincer impingement, the “C” overhang is more pronounced.

Gradually with wear and tear, the socket gets deeper and the “C” overhang keeps getting more and more prominent. These impingements lead to degeneration of the labrum (cartilage).

Not everyone with the diagnosis of FAI needs surgical intervention. Eliminating the mechanical triggers of pain and optimizing muscular activation patterns with a physical therapist may put off surgery for years.

Eliminating Mechanical Triggers

How do we eliminate mechanical triggers? Allow for accommodation of the hip.

If you are born with hip dysplasia (acetabular retroversion), your hip socket will face back.

If you are born with femoral neck retroversion, your femur has a decreased angle and you walk with your toe out. (This could also be indication of capsular or muscular tightness.)

Don’t try to force your hip to do what it does not want to do.

Practicing Yoga with FAI

How does this information translate into your yoga practice?

Be careful when transitioning from plank or table into a forward lunge. Allow the knee to point out and bring your foot further away from midline. You may only be able to get the hip to 90 degrees comfortably without getting a pinch.

In this case, transition through a tall kneel, bring one foot forward and concentrate on the tilt of the pelvis rather than aiming to get your chest to your thigh. Practice child’s pose with open knees and use a cushion between your chest and thigh to open your hip angle.

In my video Your Pace Yoga: Relieving Pelvic Pain, I instruct my student to perform a rock back in the second flow. Here is the starting position of the rock back:

 

Start of rock back yoga posture

Start of rock back

rock-back

Middle of rock back

Starting from table, rock back keeping your back flat and return to table. The rock back is a great way to encourage a posterior (backwards) glide of the hip. Rock back only to where you are able to maintain a neutral spine.

Like other activities and repetitive tasks of daily life, yoga injuries do happen. Be mindful of how your body feels and work within your limits. If you take a class where your teacher pushes your body physically or insists you do postures a certain way, say om and run away!

(Note: As always with any exercise program, please consult your physician and physical therapist before self-treating hip dysfunction.)

Reference

Broad,William J. “Women’s Flexibility Is A Liability (in Yoga).” New York Times (November 2, 2013). Accessed November 3, 2013.

Kaplan KM, Shah MR, Youm T. Femoroacetabular Impingement Diagnosis and Treatment. Bulletin of the NYU Hospital for Joint Diseases 2010;68(2):70-5.

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This article was originally published on Yoga on 11/3/13.