Friday Practical Pointers Who Should Avoid Certain Hip Movements

by Baxter

Wendy Sansjo, Age 55, of Adaptive Yoga Scandinavia
 (photo by Lars Iverson)

Today let’s take a look at who needs to avoid certain movements of the hip, more specifically the way the upper leg bone (femur bone) moves within the hip socket. The hip has six basic movements, which can be combined in various ways as you do yoga poses, sports, or movement arts, or simply move about the world:

1. Flexion: Moving your leg in toward the front of your lower torso or bringing the front of your lower torso toward your leg (a forward bend in your hips). For example, lifting your leg up in Standing Hand to Foot pose (Hasta Padangustasana) or Reclined Standing Hand to Foot pose (Supta Padangusthasana), stepping one leg forward and bending that knee as in Warrior 1 (Virabrdrasana 1) or tipping the hips forward over the leg Pyramid pose (Pasvottanasana). 

2. Extension: Moving your leg back toward the back of your lower torso or bringing the back of your lower torso toward your leg (a backbend in your hips). For example, when you step your back leg back into Warrior 1 or lift your legs up in Locust pose (Salabasana). 

3. Abduction: Moving your leg to the side, away from the midline of your body. For example, when you step both legs out to the sides from Mountain pose (Tadasana) into the wide-leg stance for a standing pose such as Triangle pose (Trikonasana).

4. Adduction: Moving one leg across the other, as in Eagle pose (Garudasana), or moving a leg that was out to the side back toward the midline of the body, such as stepping back into Mountain pose from a wide-leg stance. 

5. External Rotation: Turning your leg out within your hip socket so the leg turns away from the midline of your body. For example, when setting up your front foot position for Triangle pose, you externally rotate your front leg as you turn your front foot out to 90 degrees before entering the full pose. This movement is almost always combined with one or more of the others listed above.

6. Internal Rotation: Turning your leg in within your hip socket so the leg turns toward the midline of your body. For example, when you are setting up your back foot position for Triangle pose, you internally rotate your back leg as your turn your back foot slightly inward. This movement is almost always combined with one or more of the others listed above.

Cautions

Now let’s look at who should avoid or minimize certain hip movements. Keep in mind, however, that we want to maintain as much of our full range of movement of the hip joint as possible. So, in many instances, my caution will not mean “don’t” or “never,” but rather approach cautiously and stop if the movement worsens pain. In general, you should avoid or minimize any hip movement if you have:

1. Acute painful injury to the hip area that gets worse with that movement.
2. Chronic issues that flare with that movement, such as those with hip arthritis, joint replacement or surgically repaired hip fractures, or labral tears of the hip joint.

Now for the specific movements. Who should avoid or minimize the following movements?

Flexion (Forward Bend)

1. Those with certain types of hip replacement (check with your surgeon) may have to avoid flexion beyond 90 degrees from standing position.
2. Those with acute hamstring tears, especially those at the attachment at the sitting bone, at least for several weeks.

Extension (Backbend)

1. Those with acute tears of the uppermost part of quadraceps muscle (the rectus femoris), acute strain of the psoas, iliacus, or the other front groin muscles (as in a “groin pull”).

Abduction

1. Those with acute muscle strain to the inner thigh muscles (the known as the adductors), which get stretched via abduction.
2. Those with separation of the pubic symphysis, a rare situation sometimes seen in post-partum women or cases of severe trauma to the pelvis.
3. Those with acute trauma or surgical repair to the perineum/pelvic floor.

Adduction

1. Those with acute bursitis of the outer hips (greater trochanter area).
2. Those with large hernias in the groin area if adduction causes pain.
3. Those with a hip replacement that could become dislocated by this movement (check with your surgeon) or a history of dislocating hips. 
4. Those with painful compression of the soft tissues caused by scissoring of the legs past one another (more common for men than women)

External Rotation

1. Those with a hip replacement that could become dislocated by this movement (check with your surgeon) or those with a past history of dislocation with this action.

Internal Rotation

1. Those with an older, posterior approach method of hip replacement (check with your surgeon) or those with a past history of dislocation with this action.

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Effective And Natural Hip Pain Relief Options

By Harry Tye Pro

People often discover that various parts of their body are subjected to more extreme and prevalent forms of pain than others throughout their lives. The joints that comprise the human anatomy are essential for movement and the completion of even the most basic of daily tasks which is why such consideration is placed on ensuring issues are fully resolved when present. People that are dealing with this type of issue should know the most effective and natural hip pain relief options to ensure they are able to deal with their issues in an appropriate manner.

The hip is a ball and socket joint that connects the legs to the upper body and provides walking and standing movement. People that are suffering from difficulties in this part of their body are usually reliant on chiropractors to ensure their relief efforts are successful and professionally guided. Natural forms of guidance are usually the most common that people are interested in for their particular needs.

Consumers in most areas are offered chiropractic relief options when trying to work through this issue. Many people are unclear about what factors are actually best to weigh in when making sure they are able to find the relief they require for this concern. Understanding what is offered with the use of the professional is quite helpful in making a successful recovery decision.

Patients are initially offered adjustments for their joints when working through their areas of discomfort. Much of the discomfort that is felt in this joint is created by misalignment with the remainder of the body which is usually what creates areas of soreness in surrounding parts of the body. Each process is highly effective and completed without the use of medication.

Consumers are also offered strength training exercises to help prevent future difficulties from occurring. Strength building programs are designed on the premise of ensuring the health of the joint is maximized to ensure that the weight of the body is fully absorbed by the joint. Programs are effective from a prevention standpoint and are typically designed around the needs of the patient.

Dietary and prevention guidance options are also provided to consumers in need. The foods ingested on a daily basis along with the physical activities that people perform can create significant discomfort for the joint over time. Consumers are guided through making appropriate and healthy decisions as needed.

Braces are also provided to people suffering from hip pain. The braces and devices that are used in this part of the body are designed to help alleviate sources of sharp pain which are typically helpful to people that are still required to lead an active lifestyle. All braces and support options are suited to the size and needs of each patient.

About the Author:

Harry Tye Pro is an author writing about how to be healthy. Would you like more information regarding healthy living? More information regarding hip pain can be found at this website http://www.northhillspachiropractor.com.

Friday Q A Helping a Student with a Hip Replacement

Hip Joint from Behind

Q: I am a relatively new yoga instructor that teaches Gentle Hatha to (mostly) seniors.  Recently, a gentleman came in with bilat hip replacements from 10 and 12 years previous. He rides his bike and is in pretty good shape for a gent in his 60's. His hips were replaced by a posterior approach. How cautious do I need to be with this man? Do we modify mostly in the early days after the operation? Of course, I've modified the asanas to his ability and told him to not push it to the extreme. So is it fresh post op that we worry mostly about or for decades following? Thanks!

A: This is a great question and I am glad you asked it. In most cases, the hip replacement should outlast an individual’s lifespan. The literature states that total hip replacements typically last from 15-to-20 years after the initial surgery, but in some instances they can last over 30 years. But this is neither a guarantee nor assurance, for the simple reason that life is unpredictable.  Many factors affect the future of a hip replacement, such as accidents, fractures, late infections, and deterioration in overall health. Also, how well you take care of yourself down the road is something the surgeon cannot control. The longevity of a hip replacement thus depends on many factors, including the following:

• Surgeon skill in implanting the components
• Known history or track record of the implants
• How well you take care of yourself and your health
• Understanding and respecting the limitations of a prosthetic lifestyle
• Your activity level and body weight
• Avoiding high impact or extreme sports

Medical literature states that the most common reasons for individuals needing subsequent hip replacement surgery include:

• Loosening of the implant. 
• Dislocation of the implant
• Infection, such as staph infections either around the time of surgery or later through the introduction of the bacteria into the blood stream.

It is believed that the most common reason why hip replacements fail is because the weight-bearing surface wears out and the prosthesis begins to loosen. So, what is hip replacement loosening? When a hip replacement is placed into the body, it is either press-fit into the bone or cemented into position. Either way, it is fit tightly into the bone of the thigh (femur) and pelvis so that the implant cannot move. Hip replacement loosening occurs over time, and can cause problems with the normal function of the hip replacement prosthesis. When implants loosen, the hip replacement can begin to move small amounts. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thighbone or due to thinning of the bone around the implant.

Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed. Signs that the joint has become loose include pain and feeling that the joint is unstable and that there is increased loss of hip mobility. Another operation (revision surgery) may be necessary, although this cannot be performed on all patients.

Both physicians and patients are very concerned about the problem of hip replacement loosening because a hip replacement revision surgery (replacement of a joint replacement) is a much more difficult operation and hip replacement revisions are often not as successful as the first operation. After revision operations, patients tend to recover less overall motion of the joint. Also, the longevity of the implant decreases with each revision. Therefore, physicians tend to avoid joint replacement surgery until absolutely necessary, and try to get as much mileage out of each replacement as possible.

In about 1 in 20 cases, the hip joint can come out of its socket. This is most likely to occur in the first few months after surgery when the hip is still healing. But, unfortunately some people’s hips will dislocate very distant to the original hip replacement. My advice here is that a hip doesn’t typically dislocate without warning signs. Pain that increases as an activity is continued is the most prevalent symptom.

So how cautious should you be with your student? The surgical hips will have a certain degree of motion that is limited by their soft tissue, hip capsule, how the prosthesis sits in the acetabulum, and so on. Start by checking your student’s range of motion while he is lying in a supine position. Test all the movements of the hip (hip up toward chest with knee bent, same knee position but bring it out to side for abduction, and turn the hip out in abduction for external rotation by bringing the bent knee up toward the armpit. Then look at his hip mobility while standing: hip flexion, abduction, external rotation and extension. You should also see if he tolerates adduction by having him sit on a chair and cross one leg over the other. If he can't do this, then any pose that has internal rotation must be modified significantly. You should have your student do this for both hips to get a sense of how it feels to his hip and see if there is any pinching or grabbing. Then you can modify the asanas accordingly.

If you ask a surgeon if his patient has any precautions after three months post op, he will generally say no, but he will modify his statement telling the patient to “use your own judgment.” So do we continue with precautions forever? Well, that is an area of disagreement. I err on the side of moderation saying, “If it makes you anxious or causes pain, discomfort, pulling, or pinching, please stop.” A student can have the potential of dislocation forever if they are not mindful on how they move and move repeatedly into discomfort. And remember the combined positions of flexion, abduction and internal rotation are the holy triad. If your student can tolerate the movements separately then you can find his limits and slowly challenge his hips, but both you and he must be aware of how the hip feels. NO PAIN should be elicited from asana and that means soreness after class or the next day. Learning how to ask how a movement feels is tricky because not everyone will say something hurts, so this includes learning which words your student uses to describe sensation changes.

So for your student, keep making sure that he observes his body’s limits and doesn’t push beyond his current activity. And congratulate him for coming to your class and investing in his continued health!

—Shari

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Featured Sequence Dynamic Reclined Hip Stretches Rerun

by Baxter

Last week I introduced some thoughts on low back pain and yoga (see here). As I mentioned, the majority of episodes of lower back pain are related to short-term issues of muscle strain or spasm, or other soft tissue and joint situations that usually resolve in six weeks or so. However, it is possible that a regular yoga practice or a special sequence directed at the lower back area can speed up that process and get you back on track a bit sooner. I have frequently observed that for students who come to class for the first time, acute low back strain often requires only a few sessions in my Back Care Yoga class before the student is well enough to return to or advance to a regular yoga class. In this setting, the variety of poses that may be helpful is a bit larger than with more serious lower back injuries or conditions. For example, you can be a bit more comfortable with some twisting and forward bending poses, which often have to be modified in the other situation.

This week I would like to give you a very brief sequence of poses to try when addressing low back pain. 

My intention is to add to this sequence over the next few weeks. I have found that it is better to start with shorter practices and advance as you are ready. 

The Reclined Hip Stretches sequence allows you to gently release tension around your hip joint and hamstrings, which may help relieve lower back pain. This sequence is a good general warm-up you can do at the beginning of any asana practice. It takes your hip joint through most of its range of motion, so it could be helpful for conditions from mild joint stiffness to arthritis. It is also a great way to begin stretching your hamstrings, and because your arms move up and overhead at the start of the sequence, it can help loosen up tight shoulder joints. 

Caution: If you have significant lower back problems, make sure to take your knee across your mid-line slowly and keep it on the easy side for a while. Allow your lower back and pelvis to stay flat on the floor.

1. Start by lying on your back, with your legs straight. You can set yourself up near a wall, so your feet can press into the wall. 

2. Inhale and raise your arms overhead and back toward the floor.

3. Then exhale and bend your right knee to your chest, bringing your hands to meet the knee. 

4. Inhale, and gently guide your right knee toward the right using your right hand. 

5. Exhale, and guide your knee back to center, then, changing to your left hand, guide your knee 6-12 inches over to the left.

6. Inhale, and guide your knee back to center. Then exhale, and holding onto the back of your leg, straighten your leg toward the ceiling as much as you can. 

7. Inhale, bend your knee, release your foot to the floor, and straighten your leg along the ground.

Repeat the entire sequence on your left side. After that, if you wish, you can repeat the sequence on both sides a few more times.

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