HIP THERAPY PRACTICE - a personal experience
June 2016 – Sep 2018 : Yoga Therapy For The Hip.
Hip arthritis was confirmed in 2013. At the time tightness around my lower back, above the affected hip and sore buttock were present. I continued with my full teaching schedule and own practice, as well as remedial massages to assist with tightness. Restrictions progressed through the years with sensitive and tight hip flexors.
Hip restrictions in the last 2 years prior to the THA were; external rotation in the front leg standing asanas, thigh abduction (Upavistha Konasan, Prasarita Padottanasan) and hip weakness. Forward bends were unaltered and still deep, inversions were fine, but could no longer lift with both legs and some backbends were still manageable. During this time I modified my yoga practice to support my hip, exercised in my pool in spring and summer and hopped onto my stationary rower and bicycle. My primary focus was to avoid inflammation, to keep my joint aligned, mobile and stable as much as possible.
During 2019 my hip deteriorated. I could not run, the hip would hurt within 30 minutes of walking and I had lost muscle mass and strength in both legs. In December 2019 I had a hip replacement and I was back teaching mid January 2020.
My interest in health and healing as well as my work as a clinical hypnotherapist and counsellor led me early in my yoga path to search for therapeutic ways. Practical studies in Thai Massage and Stretch Therapy (Kit Laugling) and the work of H David Coulter, Gary Kraftsow and later Lois Steinberg inspired me and supported my yoga practice and teaching. Healthy Aging from Suza Francina was very inspiring and Heal Your Hips from Robert Klapper and Lynda Huey was very helpful before and after my hip replacement.
Weekly therapy kept my motivation high and kept me interested in my practice. I learnt a lot under the guidance of Stephanie and it gave me the freedom and confidence to innovate. I applied the teaching to my needs, taking and practising what worked best and dropping what did not. I adjusted my practice and find new ways that worked for my body and its new limitations.
Various prop supports were used to work on the groins and the affected hip joint to either open or contain. Props were also used to reduce weight bearing on the affected hip. Some of the poses necessitated assistance in order to position and hold or traction body parts. Adjustments and modifications were informed by my feedback. The photos below demonstrate without assistance and not all props are shown.
This is a very personal practice and may not suit everyone. Many subtle adjustments were made on feedback. Practice progressed through the months from passive poses, prone, supine and seated poses (Supta Tadasana legs tied and block between legs and 2 small straps at top of thighs pulled inwards, Dandasana legs tied with 2 belts and blocks in between legs, Supta Padangusthasana II, Janu Sirsasana etc) to active poses using assisted traction and gravity. Some poses also addressed a tight lower back.
Around 70 different asanas and variations were practised during the therapy period. Below is the list of the main asanas and their variations that I retained and practised as I felt they were most beneficial:
Most poses were held 5 to 10 minutes.
Adho Mukha Svanasan (rope hang)
Uttanasan (rope hang)
Prasarita Padottanasan (rope hang) Utkatasan (rope hang)
Supta Padangusthasan II (prone knee bent)
Supta Padangusthasan II (prone)
Supta Padangusthasan II
Utthita Trikonasan (supported)
Ardha Chandrasan (leg supported on the horse, not shown)
Utthita Hasta Padangusthasan II (supported)
Utthita Hasta Padangusthasan II (knee bent)
X Bolsters Setu Bandha
I would like to stress the fact that no two hips are the same. Yoga practitioners with hip arthritis may each have a complete different experience of their hip. Hence the practice must address their individual experience.
Whilst I was still able to enjoy deep forward bends and backbends my friend, whose hip degeneration was at about the same stage as mine and who had her THA a few months after mine, could no longer practised them. She still had good external rotation and I was very restricted. Going uphill was painful for me, going downhill was painful for her. She had deep inner groin pain, I did not. Angular Uttitha Trikonasan worked for her, but not for me. Our adjustments for poses involving the hip were different. Another example is an 85 year old long time student of mine. She has restricted range of hip movements and buttock pain but no groin pain.
Although after a while I was able to work most poses unassisted using various props, the assistance of an experienced therapy yoga teacher is certainly a better option because you can relax while body parts (leg/hip) are being positioned, held and tractionned. Also you are able to obtain more subtle and precise adjustments as you direct your assistant to modify the pressure, traction or positioning as you need.
Adho Mukha Svanasan (10 minutes)
When standing the belts are right into the groins and lifting. This variation pulls up the hips rather than back (as when using bottom ropes). My lower back had gone tight so this was a great traction for my back, as well as for my hips and it created a sense of space and stretch to my hip joints.
10 minutes is a long time so I suppose you could support your head.
Uttanasan Next came Uttanasan. (5 minutes).
Here again you could support your arms/head on a chair.
Prasarita Padottanasan Then Prasarita. (10 minutes).
The wall variation (photo 2) was great because the hips are pulled right up. I was able to re-center my pelvis without hurting because the belts and traction created a lot of space in my hips. The stretch was really good. Also with slight adjustments I could stretch the inner groin without hurting.
Utkatasan (2 minutes)
Passively hanging down against the belts pulling up - very pleasant!
Prone Supta Padangusthasan II
Bent knee (5 minutes each side)
This was great to release my lower back. A blanket can be placed under the bent knee. A long fold blanket is placed under straight leg side to level the hips. Weight is placed on bent knee hip/buttock to release down and away from the lower back. Abdomen revolves away from the bent knee. Belt pulls top thigh away from the hip creating space.
Leg straight (5 minutes each side). Block under the foot pressed to wall. Belt draws top thigh down to keep space in hip joint. A blanket is placed under belly and another one under thigh of raised leg. Abdomen revolves away from side leg. This variation opens the groin quite intensely - it was not my favourite!
Supta Padangusthasan II (5 minutes each side)
In photo 1 the focus is on the raised leg hip.
In photos 2 and 3 it is the arthritic hip AH (supine leg) that's being worked and is best performed with an assistant. This variation was really good for me.
With an assistant
Hold the foot of the supine leg outside the AH with a sand bag or other weights. Align raised leg foot to hip. Start with the knee bent then press the foot into wall to straighten the leg (this opens the hip and press the femur head into the socket). The AH and groin of the supine leg are being stretched.
The assistant will pull a rope that has been placed around the top of the supine leg and at the same time will press the outer AH with his foot (where I have placed a block).
Photo 2 shows the same manoeuvre but unassisted and with minimal props (not as efficient).
Unassisted - photo 3
I loved this variation and wanted to stay longer in the pose. I found the way to replicate much of the action of pull and traction with a belt and the rail, which worked quite well, and practised unassisted. It allowed me to stay in the pose much longer - 5 minutes.
Utthita Trikonasan (2 minutes)
I used this variation for the AH, forward leg only.
The belt is to the AH. Here the pull on the hip is back (toward the wall instead of upward) creating space and support. The front hip is aligned with the rope anchor. The front heel in line with the arch of the back foot.
In photo 1 I am holding the top rope, reducing the load on my hip. In photo 2 I am using my bottom hand and back foot for support.
Utthita Trikonasan backing the wall variation (2 minutes each side)
I practised this version with my back to the trestle. The alternative is a wall, which works as well provided that the rope pulls the AH upwards which is how the belt is placed on the trestle. Also the leg of the trestle will block the back foot which gives extra support, but if you have a corner wall, you can press the back foot into it and you will get the same effect.
With the AH lifted I had support and space. It also allowed me to spread my legs more. When the AH leg was forward, the load was reduced by the lift of the back hip.
Photo 2 shows an arm variation which is great to elongate the side waist.
NOTE: action of the AH forward leg in order to avoid tension in my knee:
Heel pressed down toes up allowed for the heel to pivot freely so the whole leg could roll out according to the movement of the hip. Knee straight and leg is contracted.
Utthita Hasta Padangusthasan II (3 minutes on AH)
Photo 1 - Using a belt to contain arthritic hip. Same principle as prone Supta Padangusthasan with assistant. Revolve trunk away from raised leg. Foot of standing leg slightly out of the hip. Belt around the arthritic hip, using the foot to traction the belt to press the outer hip in (similar action as Supta Padangusthasan photo 3). Raised foot aligned to hip, buttock pressed in.
I also practised with my back to the wall.
Photo 2 - Bent knee version. I initially practised a straight leg variation, with the foot pressed to the wall and on a stool as in photo 1 (without the belt).
I discontinued the straight leg version when my knee started to hurt when walking. I never had knee issues so I was concerned. I figured out that my knee was being torqued so I then practised with the foot away from the wall, but I still had some torquing. In order to disengage my knee joint I decided to set up with my knee bent (as in photo 2).
Props were brought to rest the foot of my bent leg. My thigh is held in place with a sticky mat under it. A block between my inner knee and the wall. A belt placed around the top of the thigh and front groin is pulled up and back, externally rotating the thigh. Standing leg is in Tadasan.
It is best to have an assistant to position the limb correctly so that the hip and inner groin are kept open. The knee is moved back and the buttock pressed forward. The mat should hold the leg in place so that when you rotate the trunk nothing is being disturbed.
In this variation I am facing the wall, so I could use my right hand to assist with the rotation of my trunk.
The knee pain went away.
Baddha Konasan (5 minutes)
A block can be placed in between the feet to create more space to the hip joints.
The belts are anchored directly behind the hips and around the front groins. Placing the blocks behind my back created traction for my hips, which felt great for my lower back and my hips.
The belts can also be anchored slightly outside the hips, which would stretch the inner groin.
This can be practised with an assistant if you do not have a low anchor. The assistant would sit behind you, place his foot to your lumbars and pull onto the belts to create traction.
Upavishta Konasan (3 minutes)
Elevate the heels above the hips to drop femur head down into socket.
You could also sit on a blanket or bolster.
X Bolsters Setu Bandha with leg-hip levelled (5 minutes)
Viparita Karani on 2 bolsters and belt around hips (5 minutes)
Savasan I also practised Savasan with legs on chair with block and belt. (5 minutes)