Note from the editor: These are general recommendations for yoga teachers and practitioners. These are not meant to replace the advice of a qualified health professional. Yoga teachers must stay within the scope of their practice. This means they should not attempt to diagnose or treat students or give medical advice.
The hip impingement or Femoroacetabular Impingement (FAI) is a structural and mechanical problem. It has to do with our bones and the way they move. It can cause discomfort or pinching at the front hips, especially after or during yoga. Some people may also have difficulty getting their thighs and their torso close to each other. FAI can cause joint degeneration. If left untreated, it may lead to future joint problems like Osteoarthritis.
Ironically, for those susceptible to FAI, the practice of Yoga, which is so highly regarded as a way to improve joint health and flexibility, can lead to a decline in both. Adjusting our yoga practice and movement strategies may help alleviate discomfort and prevent further hip injury.
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 Positions and Movements That Can Cause Problems
It may be helpful to start by noticing what poses worsen hip pain. Foster says that hips feel more comfortable with slackness or “open-packed” positions. These positions allow more space between the joints. She points out that many positions are “closed-packed,” meaning there is less space between the bony surfaces. Yoga twists can involve hip flexion, adduction, and some internal rotation. These three actions are when the ligaments become tautest. Repetitively holding these positions in this way can lead to FAI.
Closed-packed yoga poses require hip flexion, internal rotation, and adduction. They include marichyasana, parivrtta, parivrtta trikonasana, anjaneyasana (low lunge), and crescent lunge. Closed-packed positions include drawing the knee towards the opposite elbow while in plank or drawing the leg across the body when lying on your back in Supta Padangusthasana.
Some yoga poses are closed-packed, which can be difficult for people with FAI.
Even flexing your hips for long periods or repeatedly can be uncomfortable. Researchers have found that squats , which are a crucial part of human movement but are not a common practice for those with FAI-prone hips, are particularly uncomfortable. Some poses that require hip flexion are utkatasana, malasana, paschimottanasana, and other forward bends. Even gentle poses such as balasana, apanasana, or suptapadangusthasana can cause a pinching sensation at the hips. Foster says that sitting in chairs may be a significant contributor to FAI.
We can increase the angle between the legs and the trunk to avoid the problem zone. In utkatasana, for example, staying higher up may help to make hips more comfortable.
A wider angle between the thighs and the torso can make a pose more comfortable.
Poses that put the hips into more open positions — such as hip extension, which is the position of the hips when they are in Backbends — may feel good. But those with FAI symptoms who have been experiencing them for some time might find that these poses irritate their hip flexors and cause their hips to object. Cofield says that your hip flexors are resentful. When your hip flexors hurt, extension and flexion are both painful.
Closed-packed or not, we can modify or skip any uncomfortable pose. Cofield says, “Falling into uncomfortable poses in the hope of becoming comfortable is not the solution.” This will only make the situation worse. “The longer you wait to treat these symptoms, the worse they will get.”
Closed-packed or not, we can modify or skip any uncomfortable pose.
The TILT that may cause problems
Yogi’s, intent on keeping their spines long, and maintaining the gentle inward curve of their lower back, may do this by overdoing the anterior–forward–the tilt of their pelvis. Foster says that tilting the pelvis forward while sitting or doing yoga poses is “almost certain” to cause FAI. This is especially true if the anterior tilt becomes habitual. Foster says a chronic anterior pelvic position could lead to FAI because of faster bony contact.
Forward folding and anteriorly tilting the pelvis can aggravate FAI.
Some yogis also maintain an anterior pelvic angle when doing a forward fold to keep their lower spines “flat.” Foster says that “constantly folding from the hips” or maintaining the spirit of a backbend while in a front fold creates faster bone contact.
Yoga practitioners should know that the pelvis must tilt backward at a certain stage of a forward fold. When the legs are straight, this can happen when the thighs create a 90-degree angle with the spine, but the amount of tilt required varies depending on the individual. The top of the pelvis should be allowed to slide backward and the lower spine to round when moving from dandasana to paschimottanasana.