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:
- Soft tissue injuries (to the labrum, tendons, ligaments, etc)
- 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: