Editor’s note: Below are general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their scope of practice: This means not attempting to diagnose, treat, or offer medical advice to students.
Femoroacetabular impingement (FAI), or hip impingement, is a structural and mechanical problem concerning our bones and how they move. Those with it may feel a pinching sensation or discomfort at the front of their hips during or after yoga practice and may have difficulty bringing their thighs and torso close together. FAI is implicated in joint degeneration; unaddressed can lead to joint problems like osteoarthritis.
For those susceptible to FAI, a great irony is that the practice of yoga, so often valued for its ability to improve flexibility and joint health, has the potential to lead to declines in both. Fortunately, changing our yoga practices and movement strategies can help relieve discomfort and possibly prevent further hip damage.
Physical therapists Shante Cofield, better known as “The Movement Maestro,” and Ariele Foster, founder of YogaAnatomyAcademy.com and creator of the online course “Way of the Happy Hips,” weigh in about how to reconfigure our yoga practices and repattern our movements to alleviate the “pinch.”
THE MOVEMENTS AND POSES THAT MAY CAUSE PROBLEMS
A good first step may be noticing which poses aggravate our hip symptoms. “Our hips are more comfortable in positions with more slack, ‘open packed’ positions,” Foster says, referring to positions that allow for spaciousness in joints. However, as she points out, many positions are “closed packed,” in which there is the least space between bony surfaces. “Yoga twists often involve deep hip flexion, hip adduction, and some hip internal rotation. The combo of those three actions is when the ligaments are the tautest, and repetitively spending time in these positions can contribute to FAI and related conditions.”
Yoga poses that are closed-packed and require flexion, adduction, and internal rotation of the hips include:
Marichyasana C (Marichi’s twist).
Marietta utkatasana (revolved chair pose).
Marietta trikonasana (revolved triangle pose).
Twists from anjaneyasana (low lunge) and crescent lunge.
Drawing a knee toward the opposite elbow from the plank or a leg across the body while lying supine in supta padangusthasana (hand to big toe pose) is also closed-packed.
Many yoga positions are “closed packed,” which may cause difficulties for FAI patients.
Simply flexing the hips repeatedly or for long periods might be uncomfortable, too. Despite being a vital part of human movement vocabulary, some researchers singled out squats as particularly problematic for many whose hips are susceptible to FAI. Common poses requiring hip flexion include utkatasana (chair pose), malasada (squat), paschimottanasana (seated forward fold) and other forward folds, and humble warrior. Even gentle poses like balasana (child’s pose), apanasana (knees to chest pose), or supta padangusthasana (reclined hand to big toe pose) may prompt a pinch at the hips. Foster adds that even sitting in chairs is probably a major contributor to FAI symptoms.
In addition to steering clear of any of the poses above, if they cause discomfort, those of us with FAI may want to skip any poses in which we feel bones bumping against each other–the front of our hips coming into contact with our thighbones–by not going as far or as deep: We can try increasing the angle between our legs and our trunk to stay out of the problematic zone. For instance, staying higher in utkatasana to keep the thighs and the spine farther apart may make our hips more comfortable.
Widening the angle between the thighs and the torso might be enough to make a pose more comfortable.
Poses that allow the hips to be in more open positions, among them, hip extension–the position of the hips in backbends–may feel good, but those who have had FAI symptoms for some time may find that their hip flexors are irritated, and their hips object to these poses, too. “Your hip flexors hold a grudge,” Cofield says. “When your hip flexors are unhappy, extension and flexion can hurt.”
We can skip or modify any uncomfortable poses, closed-packed or not. While some yogis may persist in slightly uncomfortable poses, hoping to eventually become comfortable, Cofield says, “Pushing through the pain is not the answer. It will only make things worse. The longer you try to push through it, the longer these symptoms will be resolved.”
We can skip or modify any uncomfortable poses, closed-packed or not.
THE TILT MAY CAUSE PROBLEMS
Yogis, intent on keeping their spines long, and maintaining the gentle inward curve of their lower back, may do this by overdoing the anterior–forward–tilt of their pelvis. Tilting the pelvis anteriorly while sitting–or practicing yoga poses–is “almost certainly” more likely, according to Foster, to lead to FAI than tilting the pelvis posteriorly, especially if that anterior tilt becomes habitual. “A chronic position of anterior pelvic tilt could contribute to FAI due to faster bony contact between the front rim of the socket and the femoral neck,” Foster says.
Forward folding while working to anteriorly tilt the pelvis may aggravate FAI.
Additionally, to keep their lower backs “flat,” some yogis may think maintaining an anterior pelvic tilt when going into a forward fold is virtuous. “Constantly ‘folding from the hips’ or maintaining the position–or spirit–of a backbend when in a forward fold” creates faster bony contact, Foster explains.
Yogis need to recognize that at a certain point in a forward fold, the pelvis does need to move into a posterior tilt. (When the legs are straight, this may happen when the thighs and the spine create a 90-degree angle, but the degree at which the pelvic tilt must change varies from individual to individual.) When moving from dandasana (staff poses) to paschimottanasana, the top of the pelvis must be allowed to move backward and the lower back to round.