As many of you may know from personal experience or from observing others as they age, the most common age-related problem for the hips is the development of arthritis in one or both hip joints. Before discussing this condition—and how yoga can help—let’s start by taking a look at the hip joint so you have a deeper understanding of how the joint works and how arthritis affects this very important joint.
The hip joint is a “synovial joint,” a type of joint that connects two bones together with a joint capsule, a sock-like sleeve of connective tissue that holds the two bones relatively close together. In the case of your hip joint, this means that your pelvic bone and your thighbone (femur) connect to each other through the hip joint capsule. The inner lining of this capsule is lined with the synovial membrane, a specialized tissue that secretes a lubricating liquid, not unlike the oil in your car engine, to allow the bones to move over each other more smoothly. In addition, the ends of the bones themselves are coated with a layer of cartilage—also a kind of connective tissue—that acts as a tough barrier for shock absorption, and is smooth and slick, so the bones again can glide over each other more easily. Finally, the inner surface of the acetabulum, the hollowed out part of the pelvic bone that the head of the thighbone fits into, has an additional cushion of cartilage lining it called the labrum. The labrum provides a better fit for the two bones as well as additional shock absorption.
Now that you have some idea of how the hip joint is constructed, we can talk a bit about how arthritis can develop there. As with arthritis anywhere in the body, there are two basic types: osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA), which is the most common type, is the age-related, wear and tear type of arthritis. In this, the cartilage covering on the ends of the bones is worn away gradually, exposing sensitive raw bone, which, when rubbing against another raw bone, leads to inflammation inside the synovial joint described above. This results in swelling, stiffness, tightness, decreased movement, and pain. Osteoarthritis can be caused by repeated movements over a long time or some old trauma, infection, or injury to the joint.
(Rheumatoid arthritis, on the other hand, is an autoimmune disease that is not age-related. In an autoimmune disease, your body mistakes part of itself—in this case, the joint lining—as a foreign invader and mounts an inflammatory response to fight it off. And this inflammatory response damages the cartilage at the ends of the bones. We won’t be addressing this type of arthritis today.)
So how do you know whether you have arthritis of the hip joint? As we mentioned above, osteoarthritis in a joint causes swelling, stiffness, tightness, decreased movement, and pain. And typically people with osteoarthritis of the hip will notice that stiffness and reduced range of motion in their hip joint. They may also experience a “catching” or “clicking” in the joint. Of course, feeling pain in the hip, including in the groin, the side of the hip, the back of the hip (the buttock) and even in the knee, is also common. This pain often worsens after climb a lot of stairs, stand for long periods, walk long distances, or possibly after doing a vigorous yoga practice. However, if you are having any of these symptoms, we recommend that you see your physician for a thorough examination to get a final diagnosis.
If you do receive a diagnosis of hip osteoarthritis, your doctor will typically make the following two recommendations: resting and stopping any activities that could be straining your hip joint or the area around it. The doctor may also recommend that you see a physical therapist for exercises that will improve your hip joint’s range of motion and strengthen muscles that support it. This is also a good time to take look at what you are already doing in your yoga practice to see if any of the poses or vinyasa practices you do now could be contributing to your pain and dysfunction. Do you feel pain while doing certain poses, such as in the front leg hip joint in a Lunge pose? Do you have a flare of pain in your hip after a yoga class or the next morning? If the answer to any of these questions is yes, consider avoiding the offending poses or practices, at least temporarily.
However, this is also a good time where yoga can fit into your healing regimen. And, in fact, it is not uncommon for a person to start yoga in the first place because they have heard it could help their arthritis. In this setting, we recommend that you begin at the beginning, with a gentle practice as your entry into yoga. A one-on-one session would also be a good way to start.
For those with persistent pain, we recommend that you start with our Dynamic Reclined Hip Stretches, which gently move your hip joint through many of the movements it allows.
Next, try Dynamic Snow Angel Legs. Start by lying on your back with your legs close together. Inhale and spread your legs wide on the floor, without rolling your thighs in or out. Exhale and return your legs back to center.
Finally, try Dynamic Locust pose. Start by lying on your belly. On your inhalation, as you lift your chest, lift one leg off the floor without bending your knee. On your exhalation, release your chest and the lifted leg back to the floor. Repeat on the other side.
These three poses will give you a better sense of the range of motion of your hips—right and left—as well as movements that cause immediate pain, which will be very useful information as you explore other poses in different positions.
In general, keeping your hip joint as mobile as you can and the supporting muscles as strong as possible will help you stay functional and prolong the time before surgery has to be considered (surgery is not inevitable, by the way). Because you can do many yoga poses without bearing direct weight on your hip joints, including prone or supine poses, seated poses, and inversions, yoga provides many ways for you to work on both joint range of motion and strengthening. For example, Reclined Leg Stretch (Supta Padangusthasana) with all four variations, help both mobility and strength. And when full weight on the joint needs to be avoided, you can even do the standing poses in a fairly weight-free manner if you support your pelvis on a chair, including the chair versions of Lunge, Warrior 1 and 2, and Extended Side Angle pose. I understand that yoga is even being taught in swimming pool settings, where weightlessness is beneficial for arthritic hip joints. Sounds potentially helpful, but I’d skip the inversions class!
As always, using yoga pain management techniques, such as breath work and meditation can help you in reducing the pain you are experiencing (see Yoga for Pain Management: The Big Picture).
When your symptoms are milder, you can try adding vinayasas, such as Sun and Moon Salutations, to your home practice. Do these practices slowly, mindfully, and with the idea of soft foot landings.
Your yoga practice can diminish your pain, improve your mobility, and delay any invasive treatments, so you’ll be getting your money’s worth! And the equanimity that is a result of a balanced yoga practice can hopefully support you through any difficult decisions you may need to make about your hip.
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