Monday, November 25, 2013

Revolutions’ PT, Mark McMahon authors an interesting article about hip health and the practice of yoga to lessen the pain and tension of certain yoga poses.

Solving the hip yoga puzzle the FMT way

by  Mark McMahon, DPT, OMT
Yoga Instructor in the Iyengar tradition

This NY Times article by William Broad puts the spotlight on the potential risks of yoga practice, especially regarding  women’s hip health. The author uses primarily anecdotal evidence from respected orthopedists and yoga teachers to show an apparent recent trend of hip injury among women yoga practitioners. The doctors theorize that some yoga poses which emphasize fully folding or twisting the hip joint, along with women’s natural flexibility toward these poses, contribute to pinching and unnecessary degeneration of the tissues around the hip. After describing the problem, the experts make some common sense suggestions: practice gently, avoid poses where the hip is fully folded, and don’t push through pain. This is sound advice, given that a primary principle of yoga practice is to cultivate nonviolence.

I would point out modern American life has wreaked havoc on hips, it’s been proven: the US has the highest per capita rate of hip replacement in the world. Sitting, driving, and other sedentary lifestyle issues are probably much worrisome factors in the epidemic than the few overaggressive yoga practitioners! In general, even Mr. Broad acknowledges, yoga probably helps more people maintain joint and body health than get injured doing yoga. So it’s likely that the problem with yoga injuries lies not with the poses themselves, but in how they are (or not!) being instructed.

The primary safeguard from developing an injury in yoga is to find a good teacher and attend classes regularly. A good teacher should be able to give verbal and/or touch cues to guide a student to a proper alignment in a pose. If that’s not possible then they should be able to give a modification which allows the student to experience the essence of the pose with less strain. Classes in which poses move very quickly from one to another, or in which few alignment cues are given, should be considered for advanced practitioners. Instructors who encourage competitive straining or “pushing through the pain” are to be avoided. Finding the right class and intensity level for you is key. Those with significant injuries or other concerns about their musculoskeletal health might do best with private instruction at first from a qualified teacher, before getting into general yoga classes, OR entering into a course of physical therapy with yoga goals in mind.

Here at Revolutions in Fitness we commonly work with all kinds athletes of all levels, with all kinds of goals. Our physical therapists work with the the principles of Functional Manual Therapy (FMT), as taught by the Institute of Physical Art (Gregg and Vicki Johnson, co-founders), in which treatment is guided by the overriding goal of enhancing function through the entire system, not just the injured body part.  Given its central location in the body and how it transmits force from leg to torso and vice versa, a strong, stable hip is key to any athletic pursuit. The hip is just like the shoulder, it has its own "rotator cuff" system which often needs to be strengthened to ensure the health of the joint. Whether you’re walking, running, cycling, or holding a yoga pose, an efficient hip helps. What does efficient mean? According to FMT, an efficient joint has a) good mechanical alignment and mobility, b) sufficient strength, endurance and power for the desired activity and c) good control of movement and position throughout the range of motion of the activity. So in yoga for instance, a very flexible woman may need to be trained to NOT fold the hip all the way during a forward bending pose! This takes strength, control, and awareness. All of these qualities can be assessed, trained and enhanced with the FMT approach in a physical therapy setting.

So if you’re a yogi or yogini and your hip is bugging you, don’t ignore it. Consider a consult with one of our expert PTs to help sort things out. Or if you’re happy with your yoga and just want to keep it that way, we can help you identify and improve weaker areas that can lead to problems in the future. Yoga practice can be a wonderful laboratory for self improvement and integration of body and mind. Wishing you safe movement and happy hips.