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September 9, 2018

How to Avoid Destroying Your Hips in Yoga

yoga hip injuries, hip injuries yoga, hip injury, hip injuries in yoga, yoga mentor, yoga mentorship, yoga podcast, yoga anatomy, yoga injury

yoga mentor, yoga mentorship, yoga podcast, yoga anatomy, yoga injury

Francesca Cervero kindly invited me to be a return guest on her podcast, The Mentor Sessions: Support and Strategy for Yoga Teachers to talk about HIPS, specifically yoga hip injuries. (If you missed the first episode on anatomy-informed yoga, you can listen here).

Francesca and I both experienced major hip injuries, as in the kind that require surgery, after we started teaching yoga. 

Although our injuries were not directly caused by yoga asana, we discuss the ways that yoga culture and cuing can both help and harm the hip joint (among others). And we both want to bring this important conversation to the forefront.

Here’s part of why:

Yoga Injury and the Shadow

Before I delve into the substance of the podcast episode, one of the “shadow” sides to any physical endeavor is the potential for injury.

Yoga asana is widely considered to be therapeutic. We regularly hear about yoga healing someone’s back pain, or helping prepare someone for childbirth. Because of its healing reputation, injury from yoga or related to yoga can be a source of shame. This shame makes telling your personal story of yoga injury (or sometimes any injury) complicated, and inadvertently furthers a culture of physical extremes.

Here are things that real yoga practitioners have heard over the years when facing injury:

“If you injured yourself, then you were not practicing real yoga”

“You must have been out of alignment / not listening to your body / not breathing correctly”

“You were not practicing with devotion”

Whether intentionally or not, holding the physical practice of yoga (that has increasingly looked like contortionism and gymnastics or just plain overly repetitive) as infallible is shaming. And silly. “Yoga” is taught and shared and practiced by humans with human bodies and human faults. Injury happens because life happens.

As a physical therapist, I’m present with that reality every day that I treat clients.

Injury can be random, or can be an opportunity to examine what you might do differently — now that you know differently. It’s not an opportunity to imply that someone is a lesser yoga practitioner and to create unmeasurable markers to hold against them.  

I don’t mean to imply that there is no guidance or way to practice that is safer. There are many concepts that can lead to a more informed, less injury-prone yoga asana practice. (Listen to the podcast episode for a number of gems for the hips and keep reading).

The first task toward a safer practice is to ask more questions, such as “Does my front leg really have to bend to 90 degrees?“. The second is to be open and honest with our experience, for example, “Shoulderstand never feels good for me, even though my teacher says it is the ‘queen’ of all poses“. The third is to recognize vast genetic differences among yoga practitioners, as in “Some bodies will more easily take on this shape than others, but not only that: some bodies will never take this shape without incurring damage“.

Story as Guru

Most importantly, stories are powerful gurus. From the Sanskrit, “guru” means “one who dispels the darkness and takes towards light”. Sharing an injury story sheds light on our bodies and will help us to create more healing, more wholeness — not just in our our own bodies but in this collective yoga space.

I hope that you will not only listen to this episode, but also share your injury story if you have one, begin to question cues, and fully recognize the ways in which your body is unique to you.

Hips, Injury and Yoga

To read here more about the nuts and bolts of hip labral tears and FAI (I discuss it in the podcast episode as well), check out this blog post I wrote a few years back.

In summary, there are two main injury categories to the hip joints:

  1. Soft tissue injuries (to the labrum, tendons, ligaments, etc)
  2. Boney changes – Cartilage loss/ arthritis at various stages

In general, severe cartilage damage begins to be visible on x-ray beyond ages 50+, and soft tissue “damage” (like what Francesca and I experienced) occurs beginning in ones 20s and 30s. One or both can exist without symptoms (see this study here), and one or both may simply be part of the aging practice, a.k.a. this great gift of time on in this body.

The athletic population, including yoga asana practitioners, is more prone early in life to soft tissue injuries than age-matched peers, but rates of hip injury are fairly level across a variety of sports and not higher in dancers (see study).

Hip osteoarthritis later in life, is extremely common in both sedentary and non-sedentary populations, and more difficult to pin on a yoga practice than soft tissue injury because of the factor that it takes time to develop. More than 1 in 20 80 year olds in the US have had a hip replaced (see study here).

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.

Prevention of Yoga Hip Injuries

The short answer to preventing hip injuries in yoga involves building general, versatile strength in the legs, and specifically:

1) strength building in glutes + recruiting the glutes in backbends

2) avoiding extreme end ranges in the hips, including the splits

3) stop excessive passive stretching (ex: supine pigeon, excess hamstring stretches, etc).

There is a lot to unpack around hip injury prevention, but in the meanwhile these preventative practices may help:

Posterior Chain Awakens: 5 Poses to Overcome Yoga Butt

A Wake-Up Call for Your Posterior Chain

More resources:

Join my online course, co-created with Yoga Journal, Yoga for 3D Hip Stability

Take our weekly classes, especially Hips Happy Hour, to practice regular strengthening of your hips applying principles of physical therapy to yoga.

Listen in and watch my webinar with Yoga Journal on healthy hips

Stunningly beautiful podcast conversation on Jill Miller’s hip replacement at age 44.

Cranky Hips Therapy – 15 minute practice video

Smart Hip Stability and Mobility – a 40 minute practice video

Have you experienced a hip injury related to yoga? I’d love to hear about your experience in the comments below.

23 Comments on “How to Avoid Destroying Your Hips in Yoga

Aga
October 23, 2018 at 4:44 pm

Yes. Practicing only Ashtanga yoga my hips have become weak and I started to get pain in left hip which made walking difficult. I realised that this method doesn’t include poses that strengthen hips and legs. I was practicing primary series for 3 years and after that I started to experience these symptoms.

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DrFoster
October 23, 2018 at 5:17 pm

hi Aga, I’m sorry to hear that. I hope you can see a good physio / physical therapist and get strengthening ideas!

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Nat
December 18, 2018 at 8:19 am

I had hip arthroscopy last month for a Labral tear in right hip, after doing about a year of yin yoga (stopped once I had the pain – in saying that did not attribute the injury to yoga).

My orthopaedic surgeon said he has fixed many labral tears due to yin yoga. Most likely over time the hip has been over extended (think poses like sleeping swan/pigeon) & in the end the labrum was fully away from the bone.

My healing is still continuing & I am to avoid squatting, lunging, running or jumping for at least 6-12 months. I have some gentle exercises for the hip & also for the lower back to help the hip out.

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DrFoster
December 18, 2018 at 4:21 pm

Thanks so much for sharing your experience. I don’t believe in yin yoga, and recommend people stay away from it. Here’s a video where I go into detail about why: https://www.youtube.com/watch?v=-ck2XqA0-Ko&t=2s (i get into it around minute 41). Please keep up with physiotherapy to stay strong!

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Edith Raphael, PhD
March 19, 2019 at 5:02 pm

Just finding this blog post now while I’m doing informal research on hip injuries in yoga. As a former ballet student in my childhood and teens, I have FAI and early osteoarthritis. I have found that many yoga poses are absolutely detrimental to my hip health. I would really like to connect with you to discuss engaging in some research to help the yoga community be more conscious of the perils of excessive hip opening.

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DrFoster
March 19, 2019 at 6:10 pm

I’m sorry to hear you have early (presumably) osteoarthritis. Make sure to follow and soak up all the resources at the bottom this page and if you have any specific questions, let me know.

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Anna
December 30, 2019 at 2:37 am

Such a great article and many times an overlooked issue! I have (a supposedly cured) congenital hip dysplasia and like a lot of people I know of with a similar history, have a hard time opening my hips in a bunch of yoga poses-could this be due to hip dysplasia or should I not attribute it to that issue? Thanks for any comments or suggestions!

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DrFoster
December 30, 2019 at 10:48 am

I recommend 1) examining what you mean by “opening the hips”. Many times yoga glorifies excess range of motion without strength. If you had surgery to correct dysplasia, then you may not have access to excess range of motion and that is a GOOD thing! 2) if this is a true problem — i.e. you can’t get comfortable seated normally on the floor, then I recommend an evaluation by a physical therapist.

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Natalie
January 2, 2020 at 12:55 am

I love yin yoga (and been going to classes consistently for at least couple years), but I ended up with a shoulder labrum tear and a hip labrum tear within last 6 months. They are fairly small tears, but I attribute it to the poses. In both cases I didn’t feel any pain or anything unusual while doing the pose I had done many times before. I am 48 y.o. and very active and use yin as a method to stretch in addition to using a foam roller.

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DrFoster
January 2, 2020 at 9:52 am

are you saying you still practice yin even though you suspect it gave you two labral tears?

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Natalie
January 2, 2020 at 11:22 am

I had a labrum tear in my other shoulder from gym climbing 4 years ago, which was fixed through PT, so tearing the other good shoulder in the yin class was just strange (tear was much smaller by comparison and the shoulder is much better now after 6 months). However, getting a hip labrum tear from the pigeon pose the other day made me look up “labrum tears due to yoga” and your blog came up. Also getting old sux!:(

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DrFoster
January 2, 2020 at 11:39 am

IMHO use your time to focus on strengthening, not stretch (i.e. no yin) and avoid extreme ranges of motion. Hanging out in end ranges of motion is what will tear a labrum.

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Wendy
December 21, 2020 at 4:09 am

I only started doing yoga regurarly this year and earlier have suffered from tight hips and hip pains and hip bursitis when I was younger. A year I’ve been trying to ”cure” my tight hips with yoga only to find situation getting worse to the point I am totally stiff the next day. I have been totally clueless of this matter- because the pain is not actually on when doing the pose /strech – for example supine pigeon! This was most helpful. I really will pay attention to streches and not do them to extreme and all the way even if I could. After a year of practicing you would think it would have made good for my hips but it has not. Basically more flexible I am more pain next day and trouble even walking normally.
Many yoga instructers don’t pay attention to the fact asanas and poses can cause hip problems especially if person is flexible in some poses without even trying. Over streching is real risk. I worry how can I tell which poses are safe ? But this instruction given here helps a lot ! It’s a good start. Also good to know what I should work on, meaning the glutes.
Thankyou so much!

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Dr. Ariele Foster
December 22, 2020 at 4:16 pm

hi Wendy, Sorry you’ve been through so much. Yoga certainly can engage a larger range of motion, which in theory is great for reducing tightness. However, in practice, the quality of how we move into larger ranges of motion matters most. It’s nuanced, and not formulaic. I speak to this a LOT in my Online Yoga Anatomy Mentorship — which has a new cohort starting up again in January. For starters (and just for starters) glute work is really helpful. Let me know after a month or two how you are feeling after incorporating this!

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Diana Mehran
January 26, 2021 at 7:01 am

Thank you for this article
I have dedicated a large portion of my life to yoga, spin, ballet, etc.
My left hip needs attention. During the pandemic I thought this time of rest from practice would heal the injury. It is worse which now includes aches and pains in hands and other hip. Crazy as it sound, I want my active life back! Is there a well known hip and arthritis specialist in Palm Desert or Newport Beach for athletes that is open to visit and fix these issues?

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Dr. Ariele Foster
January 26, 2021 at 10:27 am

Diana,
I’m so sorry you are in pain. You are not alone. Unfortunately I am thousands of miles from Newport Beach and Palm Desert and don’t know any specialists out there. I would highly recommend seeing a physical therapist WITH hip knowledge before anything else (try more than one if the first one isn’t a good fit). I see a lot of patients with hip labral tears and hip arthritis, have done a massive amount of continuing education around hip health specifically, have overcome FAI myself, and been teaching hip health for years. If you want to see me on telehealth, booking is online at https://happyandwell.janeapp.com . I also highly highly recommend taking the most recent online course I taught with Yoga Journal: Yoga for 3D Hips – https://bit.ly/3jY3UqU. It’s 5 hours of total video content + PDFs. 3 of the 5 hours is evidence-based lecture about how to move in ways that reduce pain for hips, and improve strength. The rest is 4 30 minute hip health practices. All for about the cost of 1-2 sessions with me.

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Mary Munson
March 7, 2021 at 3:51 pm

I have been doing yoga for 17 years and 4 years ago started doing Yin Yoga (which I no longer do) in conjunction with a flow class and a Yoga Attunement class. After doing Yin for about 2 years I experienced right hip pain and was diagnosed with hip bursitis and SI Joint Dysfunction. About 2 months ago I developed intense right groin pain and was diagnosed by a PT with a right hip labral tear. I am fairly certain all of my issues are related to my Yin practice. I am currently doing flow classes, Energy Medicine Yoga, and Yoga Attunement but have had to back off significantly on many of the poses.
For 10 days I did not do any yoga but just did all of the exercises prescribed by my PT and started to feel better. Since restarting my yoga classes the pain has returned even though I continue with my PT exercises. Would you recommend I take a longer break from yoga to heal more thoroughly?
What poses should definitely stay away from?

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Dr. Ariele Foster
March 7, 2021 at 5:12 pm

Hi Mary, I’m so sorry about the injuries. Yin yoga could certainly contribute, but there are other components in vinyasa yoga, etc, that may also contribute to hip injuries. I cannot give any individualized advice here, but for less than the price of an eval with me, you can take my online course, Yoga for 3D Hip Stability and get 5+ hours of all the do’s and don’ts detail and 4 30 min. practices: https://bit.ly/3jY3UqU

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Mary Munson
March 8, 2021 at 12:00 pm

Ok, thank you I will look into that.

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Sara
March 7, 2021 at 9:48 pm

I have ankylosing spondylitis. So many fellow AS ppl say yoga helps them, but for me, my hip becomes inflamed, and bothers me all through the night (it doesn’t hurt during the yoga workout). I don’t know what poses bother it, but I’m thinking all the forward folds… it stinks, because I love it! I’m going to try to not go as deep in my poses, and see if that helps. Any other ideas would be much appreciated! I have had a hip arthrogram, and I know there is no evidence of any underlying problem. Doctors think my hip pain is transferred pain coming from my SI joints (the AS).

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Dr. Ariele Foster
March 7, 2021 at 10:40 pm

AS is tricky, and probably experienced very differently person to person. So I can’t say exactly what would help you, but I give loads of ideas in the online course Yoga for 3D Hip Stability with Yoga Journal ( https://bit.ly/3jY3UqU ) about how NOT to go deep into forward folds. And how to build strength safely, which should also help the SI joints. A good manual based (hands-on) physio / physical therapist is also essential.

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Michelle
August 10, 2021 at 9:44 am

I was unfamiliar with pigeon pose and the second time i tried it…… Seriously injured although I didn’t feel pain at the time. next day it hurt to walk. It took months to be able to walk normally without intense pain. A year later i am able to tree pose in basic position on that leg. More flexibility than strength. I so wish that people wouldn’t give general advice on yoga poses as a panacea without any specificity. I listened to a well known yoga teacher say it was the best hip opening pose.

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Dr. Ariele Foster
August 10, 2021 at 12:21 pm

I’m so sorry this happened to you, and am doing my best to educate yoga teachers to not say these things in the future. I hope you have found a good physical therapist / physio to work with to get you pain-free, walking normally, and strong again.
Every Friday I teach a hips strengthening class, — if you are ready to re-build strength, definitely join that one — and last year I filmed an online course, Yoga for 3D Hip Stability with Yoga Journal that is excellent and covers a lot of what went wrong for you, and how you can avoid it in the future. Best wishes as you continue to heal!

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