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May 2022

yoga and hip pain

Many people ask their physiotherapist or physical therapist ‘Why does yoga hurt my hips?’.  This blog will look at 3 key reasons why yoga hurts your hips and what to do about it and 3 popular yoga poses that aggravate hip pain. We outline why these yoga poses might be irritating your pain and the hip conditions that are most likely to be aggravated by these poses.

Yoga hurts my Hips – what must I stop?

At Hip Pain Help, we aim to keep people active and doing the exercise they love to do. For this reason, we suggest that instead of thinking about which yoga poses to avoid with hip pain, you try to modify your yoga poses before considering removing them from your yoga practice or stopping yoga altogether.  After all, there are lots of benefits to yoga practice.

Yoga is an ancient practice that has been around for thousands of years, only really coming into western culture in the late 1800’s, rising dramatically in popularity in the last 50 years. This is not surprising given that’s its cited benefits include increases in strength and flexibility, improved sleep, reduced stress and increased relaxation. Yoga has also been recommended for assisting in managing pain in musculoskeletal conditions, including in the more mature population. However, some conditions associated with hip pain may be irritated by certain poses. Our second blog in this series will provide simple  ways to modify these 3 poses, but let’s first talk about why.

The 3 poses we will focus on are:

  1. Warrior Pose
  2. Tree Pose
  3. Twisted or Revolved Lunge Pose

If you experience hip pain during or after other yoga poses, we encourage you to keep reading this blog to help understand how the different parts of the body and their position in each of these poses might impact on your pain. This can help you build a good picture of what might be going on with  other yoga poses that you feel are hurting your hip.

Before looking at the individual poses we will look firstly at:

  1. 3 key reasons why yoga can hurt your hips and what to do about it
  2. Is it ok for my hips to hurt in yoga? How much hip pain is ok?

3 key reasons why yoga can hurt your hips and what to do about it

A study of 2260 yoga practitioners found some common themes in people who reported their hips hurt during or after yoga.

  • Either they pushed themselves too far or they felt they were pushed too far by a teacher’s adjustments
  • They were doing the full, more advanced practice of a pose (pushing to the limits), rather than a modified version
  • They were practicing within a group, or guided class, rather than during self-practice.

This information provides some important general strategies to ensure your hips don’t hurt when practising yoga.

Strategy 1: Don’t push yourself too far or let yourself be pushed further than you are comfortable

Strategy 2: Focus on technique and getting the pose right, from the start to the finish of the pose. Don’t progress to a more advanced pose until you have the basics perfected.

Strategy 3: Practice like no-one is watching. Being overly competitive or simply trying to keep up, can led to people pushing themselves too far. Run you own race, keep yourself safe.

Is it ok for my hips to hurt in yoga? How much hip pain is ok?

Other common questions we get asked about yoga  are whether some hip pain is ok during yoga and how much pain is ok to continue with? Good questions. Some mild awareness is usually ok, as long as it is relieved as you hold or repeat a pose. If pain increases during your session or after your session, you may need to modify not only your general approach to yoga practice, but some specific poses.

If you’d like to read more about how much hip pain is ok during exercise, click here to read our blog all about this topic.

So with some clear other considerations in mind let us move on to look at some common yoga poses to avoid with hip pain, or to modify.

Now, let’s move on to explaining some specifics about why yoga might be hurting your hips.

Three yoga poses that might hurt your hips

Three yoga poses that might hurt your hips

Why does the Warrior Pose hurt my hips?

Warrior Pose and Hip Pain

The Warrior Pose is a yoga pose that focuses on strength and power.  It is a pose that opens up the front of the body.  There are 5 variations, but we will focus on poses 1 and 2.  In these variations the back leg is extended backwards to open up the front of the hip and body, with the back foot turned outward from the hip. Hip pain in both the front and back leg can be irritated for differing reasons. Let’s look at this a little more closely.

Pain at the front of the hip with Warrior Pose in Yoga

Pain at the front of the hip during Warrior Pose, is most commonly felt in the hip of the back leg. Turning the back foot out and lunging into full hip extension can put a lot of pressure through the structures at the front of the hip joint, , including the capsule, ligaments and the labrum. Pushing too hard into the lunge and sustaining this position may potentially irritate these structures, particularly if you already have hip pain.

The hip flexor muscles, including the iliopsoas (iliac and psoas muscles and the tendons that join the muscles to the thigh bone), are on full stretch, wrapped around the front of the pelvis and the head of the femur (ball of the ball and socket joint). As it wraps tight, the iliopsoas tendon can become irritated and painful, or indeed irritate the hip joint structures underneath, including the psoas bursa (a soft cushion under the tendon) and the labrum.

A lot of people choose this posture to help with the feeling of “tightness” in this region, often not realising they may actually be putting more stress and strain, known as “load”on this area. In the long run, too much stretching may be hindering rather than helping. Turning the foot outwards away from the pelvis or twisting the pelvis forcefully away from the back leg, bringing your pelvis to face the front increases the load placed on these structures.

Why Warrior Pose might aggravate your hips
Which hip conditions associated with pain at the front of the hip are most aggravated by Warrior Pose?
  • hip instability associated with
    • acetabular dysplasia
    • hypermobility spectrum disorders or hypermobile Ehlers Danlos Syndrome (EDS)
    • hip overstretching injury
  • labral tears or degeneration
  • hip osteoarthritis
  • iliopsoas related pain including iliopsoas tendinopathy
  • other hip flexor issues
  • following hip surgery (hip arthroscopy or anterior approach total hip replacement)

Pain at the back of the hip with Warrior Pose in Yoga

The extended and turned out position of the back leg may “open” the front of the hip, but in the same way it “closes” down the back of the hip region.  This can potentially increase the risk of impingement at the back of the hip, where structures can abut and possibly become painful or irritate structures in that region that are already painful.

Which hip conditions associated with pain at the back of the hip are most aggravated by Warrior Pose?
  • posterior femoracetabular impingement (FAI)
  • ischiofemoral impingement.
  • deep gluteal syndrome

YOU CAN LEARN MORE ABOUT DEEP GLUTEAL SYNDROME AND HOW TO MANAGE IT IN THIS GREAT COURSE “”Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica” – CLICK HERE or THE GRAPHIC BELOW TO LEARN MORE

Recovering from Piriformis Syndrome, Deep Gluteal Syndrome or Hip Related Sciatica

Why does the Tree Pose hurt my hips?

Tree Pose and Hip Pain

Tree Pose is a standing pose used to improve balance, as well as for calming and relaxing the mind.  It is a pose often used with beginners to help gain postural and body awareness. The pose focuses on balancing on one leg, while placing the opposite foot on the inside of the stance leg and turning the knee outwards away from your midline.

To achieve an optimal position and to balance in the Tree Pose, requires a reasonable amount of strength and control around the hip and pelvis on the stance leg. If this is lacking there may be impact on the structures around this hip  and this can potentially irritate pain. On the opening leg that is off the ground, if the hip is forced back into an extreme position, this may have impact on both the front and back of this hip.

Hip pain in the stance leg during Tree Pose in Yoga

To balance on one leg well requires the ability to control the pelvis over the thigh bone. If there is not enough strength or control to keep the pelvis relatively centred over the leg, some structures may be overloaded. If for example, the pelvis moves forwards excessively  then the hip becomes relatively “extended.” If you have any irritable structures at the front of your hip, this may mean that your hip hurts during or after this yoga pose. This extended position is similar to what we discussed above for the back hip in the Warrior Pose. When your pelvis is shifted excessively forward, you will usually note that you are carrying a lot of weight through the ball of your foot, compared with the heel.

If the pelvis moves excessively out to the side rather than being over the foot, this may put increased load on the structures of the outside of the hip, including the muscles and tendons (gluteal muscles, gluteus medius muscle, iliotibial band etc) but also on the outside of the hip joint, including the labrum.

Hip pain in the non-stance leg during Tree Pose in Yoga

The hip of the leg that is off the ground may also hurt during or after the Tree Pose. Pushing the knee back forcibly and opening this hip up, can be similar to what we found back hip in the Warrior pose above.  Although non-weight bearing, so not as aggressive as with the Warrior pose, this can still cause issues for people who are more sensitive to this excessive joint position.

The turned-out position of the hip can also cause an impinging, or abutting, of some of the structures around the back of the hip and can squeezeone of the major nerves in this region – the sciatic nerve. For some people, if the position is sustained, this may cause irritation of buttock pain, which can also extend down the leg to the foot.

Why Tree Pose might aggravate your hips
Which hip conditions associated with pain at the front of the hips are most aggravated by Tree Pose?
  • hip instability associated with
    • acetabular dysplasia
    • hypermobility spectrum disorders or hypermobile Ehlers Danlos Syndrome (EDS)
    • hip overstretching injury
  • labral tears or degeneration
  • hip osteoarthritis
  • iliopsoas related pain including iliopsoas tendinopathy
  • other hip flexor issues
  • following hip surgery (hip arthroscopy or anterior approach total hip replacement)
Which hip conditions associated with pain at the side of the hip are most aggravated by Tree Pose?
  • gluteal tendinopathy (this includes bursitis), sometimes called Greater Trochanteric Pain Syndrome
  • labral issues
Which hip conditions associated with pain at the back of the hip are most aggravated by Tree Pose?
  • posterior femoracetabular impingement (FAI)
  • ischiofemoral impingement.
  • deep gluteal syndrome

Why does the Twisted or Revolved Lunge Pose hurt my hips?

This is a standing pose that requires you to drop down into a lunge position and then twist the spine. It is a pose that opens up the front of the trunk and rotates and lengthens the spine.  Due to the manner in which the front of the trunk is opened up this is a

There is a large rotation component in this pose, where the pelvis needs to rotate over the hip..  Rotation can often be a more demanding movement to control, which can make it difficult to get this pose technically correct.  To manage the pose well also requires a fair amount of movement through the hips which, with certain conditions such as femoroacetabular impingement or arthritis, may be challenging.

Pain at the front of the hip during the Twisted Lunge Pose in Yoga

In the Twisted Lunge Pose, the front hip is brought into a position of deep flexion (thigh close to the chest), and internal rotation, due to the pelvis twisting towards the front leg. In addition, the elbow option ends up pulling the thigh across the body (hip adduction) in an attempt to drag the trunk into rotation. This combination of deep flexion, internal rotation and adduction bring the bones at the front of the hip close together, naturally resulting in some bony impingement. Those with certain bone shapes or sensitive structures at the front of the hip may experience pain at the front of the hip or groin, during or after this poseHolding this pose, or repeatedly moving in and out of the pose can add to load placed on the hip joint.

Pain at the back of the hip during the Twisted Lunge Pose in Yoga

As we discussed in the Warrior Pose, when one side of the hip joint is in an extreme ‘open’ (stretched) or ‘closed’ (compressed) position, the other side is placed in the opposite extreme. In the Twisted Lunge Pose then, when the front of the hip is in an extreme closed position (flexion, internal rotation, adduction), the back of the hip capsule and deep rotator muscles are on maximum stretch.  For most people with good bony support at the back of the hip, this is not an issue.  However, for some people this extreme opening up of the back of the joint can be very challenging for the hip.  For example, those with acetabular dysplasia may have a more shallow hip socket or may have a socket that doesn’t provide as much bony coverage over the ball of the femur. Lack of bony support may result in overload of the joint capsule and ligaments and the deep rotator muscles at the back of the hip. Lastly there are people with more flexible ligaments, who may similarly struggle to control this opening up of the back of the hip.

Why Twisted Lunge Pose might aggravate your hips
Which hip conditions associated with pain at the front of the hip are most aggravated by the Twisted Lunge Pose?
  • Femoroacetabular Impingement
  • Acetabular dysplasia/ Hip Dysplasia
  • Labral tears
  • Hip Osteoarthritis (OA)
  • After hip surgery (hip arthroscopy or anterior approach hip replacement)
Which hip conditions associated with pain at the back of the hip are most aggravated by the Twisted Lunge Pose?
  • Femoroacetabular Impingement
  • Acetabular dysplasia /Hip Dysplasia
  • Acetabular Retroversion
  • Hypermobility disorders
  • After hip surgery (posterior approach Total Hip Replacement)

What can I do to stop my hip hurting during or after yoga?

Now you understand some key concepts around why your hip may become irritated when you:

  1. Sustain an extreme ‘open’ or stretched position of the hip, or
  2. Sustain or repetitively move into an extreme ‘closed’ or compressed position, a position of hip impingement.

The next question is what to do about it – at Hip Pain Help we are passionate about keeping you moving. It may be that you don’t need to completely avoid an exercise just because it hurts.  You may be able to modify the exercise until the pain settles and you can then build back up into doing the exercise fully again.  Some people may  need to modify certain movements for the longer term and on the odd occasion it may be sensible to cease an exercise, instead replacing it with something less irritating at least in the short term.

We have provided some good general strategies for reducing hip pain during yoga above, but in our next blog we will provide further detailed information on ways you can modify the yoga poses we have discussed above.  So make sure you visit again next month or join our mailing list to be notified when the next edition of our blog is available.

You can also head to our “Find a Professional” directory, full of Hip Pain Professionals  that know hip and pelvic pain! Remember that you can easily arrange a video consult if you live too far away to make a face-to-face visit to the professional you would like to see.

Check Out More You Can Read on Self Help Ideas at HipPainHelp:

  1. Ways To Reduce Hip Pain At The Gym  Learn ways to adapt and modify commonly used lower limb exercises affected by hip pain.

  2. Which gym exercises should I avoid for hip pain? Take an in depth look at some key lower limb gym exercises, which conditions may become irritated by the exercise and why.
  3. Can stretching Make Hip Pain Worse? In this blog we will provide you with a summary of the areas and types of hip pain that may be made worse by stretching. Understand which hip stretches

  4. Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling Learn ideas for how you might reduce your pain when sitting, a position you need for doing so much in life.

  5. Top Tips on Hip Pain Relief Sleeping – Learn How Sleep is essential for wellbeing. Yet hip and pelvic pain can leave you struggling to find a comfortable position – we will help you with a few simple ideas.

  6. I have hip pain – What is the best activity for hip pain or is rest best? In this blog we will discuss how much you are doing of something and is that too much or too little!

  7. 3 Simple Strategies to Reduce Hip Pain with Walking and Running In this blog we share 3 simple strategies to reduce pain when running or walking that we find helpful for people with many different hip conditions

References

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