Healthy Hip Joints: Develop a Skillful Yoga Practice

This entry was posted on Jun 8, 2021 by Charlotte Bell.

For decades, my sacroiliac (SI) joint was so completely, chronically out of alignment that at times I literally could not walk. I visited various therapists—a chiropractor, massage therapist and acupuncturist—for regular treatments. All offered temporary relief, but the pain always returned. Finally, I got an X-ray. It showed a healthy spine with symmetrical spacing between vertebrae, healthy discs and beautiful spinal curves—qualities I attributed to a longtime asana practice. My SI joint didn’t look half bad either. My SI problems were due to ligament laxity, not joint damage. But I was shocked to see that there was significant deterioration in both my hip joints, especially on the left side. My practice had not helped me maintain healthy hip joints.

How could this happen? My hips are extremely flexible. My supple quads, hamstrings, inner and outer thigh muscles allowed me to do just about anything with very little stretching sensation. As it turns out, that “exemplary” flexibility—exemplary in the Western yoga world anyway—was probably the culprit. This revelation has completely changed my practice.

Hypermobility and Healthy Hip Joints

A few years ago William Broad, author of the controversial book, The Science of Yoga, an excerpt of which made a humongous splash in the yoga world about 10 years ago, contributed a much smaller, less sensational article to The New York Times. The article draws a correlation between natural flexibility—mostly among women—and hip joint wear and tear that has led, in many cases, to hip repair or replacement. Broad explains that because of ligament laxity in some women, the neck of the femur bone is able to directly articulate with the acetabulum (socket) of the hip joint in a way that can’t happen in less flexible people. Over time, the contact causes wear and tear that includes loss of joint-protecting cartilage.

Hypermobility in the Bones

Ligament laxity may not be the underlying reason we don’t all enjoy healthy hip joints. Our bony structures may also play a part. Heard of hip dysplasia—in humans? This condition is common in certain canine breeds, but people can suffer from it as well. The term refers to shallow hip sockets. (This is the underlying condition in my own hip joints that led to bilateral hip replacements in 2015 and 2016.) Because those of us with shallow sockets enjoy more natural range of motion, we tend to push our hip flexibility. This can lead to ligament laxity. Here’s what Washington DC-based yoga teacher and physical therapist Dr. Ariele Foster has to say about hip dysplasia and yoga:

“Finally, a word on hip dysplasia: Hip dysplasia is shallower-than-normal hip sockets. This shallow ‘bowl’ allows for more range of motion of the hips, and usually means one’s hips have less stability. This can be a recipe for early hip damage and early arthritis. We practitioners of yoga need to be vigilant about not glorifying ‘open hips,’ when in fact there may be simple structural/genetic reasons that a yoga practitioner has very open hips. In many cases, yogis with extreme hip range of motion should avoid using their full range of motion in order to maintain hip health.”

The Gift of a Yoga Injury

After 39 years of practice, I’m absolutely committed to yoga (not just asana, but yamas, niyamas, and meditation). I hope to be practicing in my 90s, if I’m lucky enough to make it that long. But I’m also aware that my practice will probably look very different from the way it looks now. These days, my practice looks very different from what it did 30, 20 or even 10 years ago. I have my unstable SI joint and my sensitive hip joints to thank for this.

I’m grateful for the humbling opportunity to have learned a healthier way to engage with my hips and SI joint. When I felt nary a sensation in hip openers, hamstring stretchers and quad lengtheners I had no idea that I might be causing injury in my yoga practice. But when my cartilage was gone and I was bone-on-bone, I got immediate, painful feedback when I was entering the range-of-motion danger zone. As a result I learned how to forward bend, backbend, twist, extend laterally—all of it—in a way that keeps my hip and SI joints happy. And I can pass this on to my students. I’m a much better teacher because of my injuries. The good news is now that I have two matching, functioning titanium hip joints, my SI joint problems have all but disappeared.

Listen to Your Body, But There’s More

Encouraging students to listen to their bodies helps them become more intelligent practitioners. I’ve said “listen to your body” countless times over the past 35 years of teaching. But I don’t think it’s enough. Here’s why: When I was doing the things that destabilized my SI joints I didn’t feel any pain. Cartilage has no enervation, so you don’t feel injuries until it’s too late. Chronic injuries such as cartilage degeneration, take time to become apparent. We don’t necessarily feel it in the moment, no matter how diligently we’re listening to our bodies.

So what’s the solution? In a word, it’s complicated. Despite what I just wrote, teaching students to listen carefully to their bodies is important. We should be aware not only of stretching sensation, but also of compressing sensation in a joint. This instills healthy habits that will serve their asana practice over the long term. Slowing down the practice would be a huge help. It’s really difficult, if not impossible, to feel anything subtle when we’re only in a pose for a few short seconds. There’s no time to figure out how to adjust to protect our joints.

Vigilance is Key for Healthy Hip Joints

More comprehensive yoga teacher education is crucial. Five hundred hours are a start, but it truly takes years of observing, refining, and most of all practicing, to learn how to practice in a way that’s healing and sustainable. Then teaching someone else who’s living in a body we can never experience for ourselves is a whole other ballgame.

The requisite 10 hours of anatomy in Yoga Alliance’s 200-hour requirements do not even scratch the surface. I’ve taken three semesters of university-level anatomy and plan to do another sometime soon. I’m well aware that I know only a tiny fraction of what there is to know about the amazing human body. It’s incredibly important to understand how our structures are designed to move and how they’re not designed to move, and to learn how to apply that to asana practice.

Healthy Hip Joints and the Point of Practice

Most important though—and this takes a whole lot longer and requires much more of us than taking a course and calling it good—is shifting our understanding of what asana practice is meant to accomplish. Throughout most of yoga’s long history, asana was a means to more comfortable sitting, a way to prepare the body—mostly the nervous system—for meditation. Making yoga about accomplishing fancy poses is a very recent invention, and in my opinion it’s the most common cause of injury. This paradigm shift also involves an ego shift. It takes time. It just does.

One more thing: enjoy looking at Instagram yoga photos, but remember that all our bodies are different. The people in those photos were likely born into bodies that are able to move in ways your body may not be able to. Your asana will never be quite the same as theirs. Asana photos freeze a living practice in time. They turn asana into a concept instead of a process. Asana unfolds in each moment. There’s no moment of an asana somewhere out in the future that’s more important than this moment. Yoga happens in this moment, in your unique body, right now. Be with the process.

And if it hurts, please stop!

About Charlotte Bell
Charlotte Bell discovered yoga in 1982 and began teaching in 1986. Charlotte is the author of Mindful Yoga, Mindful Life: A Guide for Everyday Practice and Yoga for Meditators, both published by Rodmell Press. Her third book is titled Hip-Healthy Asana: The Yoga Practitioner’s Guide to Protecting the Hips and Avoiding SI Joint Pain (Shambhala Publications). She writes a monthly column for CATALYST Magazine and serves as editor for Yoga U Online. Charlotte is a founding board member for GreenTREE Yoga, a non-profit that brings yoga to underserved populations. A lifelong musician, Charlotte plays oboe and English horn in the Salt Lake Symphony and folk sextet Red Rock Rondo, whose DVD won two Emmy awards in 2010.

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