Yoga and impingement of the hip

About 18 months ago I experienced pain in the left hip joint. After walking for only 30

minutes I had to sit down, and each day it got worse, so that I couldn`t manage stairs at all. I even needed to take pain killers so as to sleep at night.

Sitting for any length of time was also a problem, I often had pain afterwards. The muscles of the whole area were affected, the right hip too. Practicing Asanas became difficult. A lot of the standing poses where painful, as was walking up stairs.

I experimented with Asana practice. Adho Mukha felt good, especially with a partner holding a belt over the sacrum then in the groins creating a slight inner rotation and being widened and pulled back. This caused immediate relief, but didn`t help for long.

Medical Diagnosis

After some weeks with no change, I visited the doctors to be examined. An X-ray was taken and some tests which involved taking the leg out, which was painful, and taking the leg in which wasn´t much better. The doctor diagnosed arthritis and a ganglion of about one centimeter in the left hip joint. The right hip was seen as healthy. But to make sure of the diagnosis I was sent for an MRI. The doctor who read the MRI told me that I had an impingement and a damaged cartilage and also a small ganglion but no arthritis. Then I was sent back to the first doctor who wanted to operate and didn´t give me any other option. He suggested shaving some of the femur bone off and taking the rest of the cartilage away and then planting some new cartilage which is then supposed to grow back. It would take about three months for me to recover. I was shocked and thought it sounded like a medical experiment. The whole situation depressed me and I thought about how long I’ve been practicing Yoga and how many people I have helped to avoid operations and decided that it was now time to help myself. I knew it wouldn`t be easy to see my own patterns, as it is always easier to see those of others.


I needed to see myself from the outside, so I observed in a mirror the differences in the

two sides when lifting one foot up. When I lifted the right leg up I was sinking into the left hip and hadn´t felt it, but could see it. I tried to adjust, but couldn´t manage it. I also

observed my feet with the legs up on a wall. With the feet passive I saw that the right foot was more centred and the joint a bit stiffer than the left. The left outer foot was higher up, so the muscles were not even. Rooting the inner left foot standing I felt the connection to the hip joint. This also helped to bring the pelvis more centred.

In Tadasana I created space in the hip joints by thinking both femur bones out to the sides and rooting the feet, especially the inner left foot and the outer right foot. The pelvis was also slightly twisted so I took the left femur slightly back to make the pelvis even. However this was a long term pattern and would take some time to change. These adjustments were quite small and hardly noticeable from the outside, but it felt right, so I continued. I practiced this in daily life and not only on the mat.

Arnika worked quite well for the pain instead of Ibuprofen. I massaged both hips as the right hip was also muscularly affected. Also rolling the buttocks on a tennis ball, helped. The feet needed massaging regularly as the muscles were quite tight. I visited an Osteopath as it was good to be sometimes passive and observe.

I left off all the Asanas which involved shifting the weight to one side, which meant most of the standing poses, especially the Trikonasana Cycle, which I had had trouble with in the past. I avoided swinging the legs up into handstand etc. I started to feel inside the groins with my hands, slowly and carefully massaging any soreness away. I practiced Uttanasana and Padottanasana with my hands in the groins creating space while moving into the poses.

Sitting in soft chairs didn´t help at all, it caused pain which came afterwards because of the upper body sinking into the hips and not being able to root. So I avoided cushions. After some weeks I could sit in Sukasana and gently bend a little forward to stretch the buttocks.

I practiced the Asanas in which I felt centred

These were Adho Mukha, Tadasana, Utkatasana with a block between the thighs connecting to Apana Vayu. Uttanasana and Padottanasana keeping the hands in the groins to create space.

As I live on the first floor I couldn`t avoid stairs altogether. I took it very slowly, rooting the inner left foot, especially the toe, to lift the back leg. This was quite strenuous at first, but soon became easier and the stairs were no problem anymore. Now I walk up to the fourth floor with no pain.

All inverted poses were good. Just to have the pelvis up was a relief.

Leg stretches

I practiced at first with a partner taking a belt around the groin and down around the

partner´s heel, the belt then being pulled away and down, this had to be done slowly and carefully, so as to create space in the joint. (pic2) Later on I practiced leg stretches alone, with a Thera band instead of holding the foot with the hand, so as to create space and not to crush the joint, taking the femur bone on the same side away from my head but also down towards the ground.

The doctor had mentioned, after the tests that my left leg was longer, which sounded

strange to me as I always hem my own trousers and have never noticed any difference.

However, the tests were taken from a lying position to sitting and so I realized that maybe the femur bone had a tendency to come a little further out on the left side in this test. I repeated the test for myself and found it to be the case. The hip joint felt better when the femur bone was drawn in a little in these positions.

Eka Pada Supta Virasana was the first one sided pose I practiced, keeping the knee up and sucking the femur bone into the joint. I used the feet to keep the pelvis centered.

In Trikonasana, I stayed higher up and watched carefully the differences between the two sides and noticed that when the right leg was the back leg it wasn`t rooted so well as when the left leg was at the back, therefore I was falling slightly into the left hip. This was hardly noticeable from the outside, but once I could feel it, it was clear that the right foot needed to take more weight and the left foot work more to bring the pelvis in a slightly different position, keeping the hands in the groins to keep them soft. Using the connection of the feet to the pelvis was helpful in all standing poses.

Sitting poses were a bit difficult at first, because of the unevenness in cross legged positions. I sat in Virasana on a block and noticed that my sitting bones where not even, the right one being more rooted.

Again I looked in the mirror – sitting with one leg in Upavishta Virasana and the other in Baddha Konasana. Here the differences were very noticeable. With the left leg in Baddha Konasana I was sinking into the hip joint. Therefore I needed to sit higher, so as to bring the weight more onto the right side. Both feet and hips needed readjusting. The sitting bones became more even by slightly rotating the left thigh in and also taking the groin in and back.

Rooting the feet and practicing Apana Vayu, first on the left side only, then in the middle became effective.

Uddiyana Bandha

When releasing Uddiyana Bandha I noticed that the belly would fall more to the right side. So I shifted the awareness to the left and leaned over a little to the right side, then the other side and then again in the middle. This helped me feel more what was happening from the inside, I could feel some holding on the left and more space on the right. I started practicing Apana Vayu and Samana Vayu on one side only and found in both cases the right side stronger. So now I just practice on the left and then in the middle. The connection between rooting the big toe of the left foot and Apana Vayu on the same side became clear.

The muscles around both hips especially the left where still too tight. More massage was needed for the hips and the feet. Malasana became possible without pain as I felt something start to release at the back of the left hip. Release felt good, but I also needed to strengthen the weak muscles. I continued practicing Utkatasana with a block between the thighs connecting to Apana Vayu and the inner foot.

After some months I started to practice Eka Pada Uttanasana from Uttanasana. I watched carefully what happened when I took one leg back. Here again the two sides were different. I worked with rooting the left foot, so as not to sink when the right foot lifted.

Virabhadrasana I and II were difficult poses at first. I needed to be careful not to fall into the old pattern. Placing each foot carefully I practiced Apana Vayu and Samana Vayu on each side separately. Again I stayed higher up to get the connection from the foot to the hip, keeping the hands on the groins so as not to harden or fall forward.

After about six months of practice Parsva Padmasana was possible again, and became quite a help, especially when the right foot was in the left groin it helped to root the femur and to create space.

The biggest challenge was twisting in standing poses. I kept both legs straight to feel even and stayed upright at first using the feet to keep the pelvis squared and not fall into the hip when twisting. Then I tried very carefully to bend forward to Parivrtta Trikonasana not going too far. I am still very cautious here as this was the pose in which I had had pain in the past, especially in the Trikonasana Cycle.

Now I can practice most poses again, with very few exceptions. Walking has become a

pleasure again, although I walk a little slower just to stay aware of rooting my feet. In fact it was the feet which needed the most attention and they still do.

I have the feeling that devoting myself to finding the balance again and being confident that the body (when given the chance) will heal itself were the main ingredients.

What seemed like a disaster at first, has taught me so much about myself, the structure and patterns of my body and how often in everyday life I have been drawn away from the centre. Keeping centred has become part of my practice, and not only on the mat. I can be grateful.

The following suggestions could be helpful for anyone with hip pain. I have practiced

them with yoga students who have been in pain. For further information and private tuition please contact.

1. Adho Mukha

Have a partner hold a belt over the sacrum then in the groins and between the legs creating a slight inner rotation. The belt should be widened and pulled back. This should give immediate relief. Connect the right hand and left big toe to Apana Vayu and vice versa. This can be practiced while standing and walking, especially walking up stairs, concentrating mainly on the feet.

2. Leg stretches

Take a belt around the groin and down towards the ground, then around the partner´s heel. The belt should then be pulled away and down, this has to be done slowly and carefully, so as to create space in the joint. It should feel good.

3. Roll on a ball

Lie on the back and take the weight on the feet, roll the buttocks on a tennis ball, or another softer or smaller ball. Then lie flat with the feet standing for a few minutes. Then practice Sukasana.

4. Sukasana leaning forward

Sit crossed legged and bend forward slowly until the finger tips touch the ground and then push the weight onto the sitting bones with the hands and feet. The buttocks muscles should stretch. If the crossed legged pose is still painful, use a support under the thighs or knees.Then sit up straight and twist to the right keeping the left groin soft and rooting the left sitting bone and vice versa.

5. Eka Pada Supta Virasana

Let the knee lift up when leaning back onto the hands or elbows. Keep one hand on the lower back to make sure that the spine doesn`t bend. Practice Samana Vayu and at the same time suck the femur towards the belly, into the hip joint. If the foot pains too much, take a support under it, e.g. a rolled up sock. There should be an inward movement of the groin, keeping it soft. Also make sure the pelvis stays straight, not tilting or turning to one side.

6. Feet

Roll the foot on a tennis ball or a softer ball if it feels too hard.

Then stand in Tadasana. Check if the weight is evenly spread on the two feet. Root the middle of the heel and the big toe, not letting the small toe lift. When yielding the inner foot, observe a possible tendency to collapse and keep the inner heel lengthened.

7. To strengthen the feet

shuffle the feet from the back of the mat to the front. To do this lift all three arches, rooting the big toe drag the heel forward, then release the foot, it should now be further forward than the other. Walk in this way to the front of the mat.

8. Utkatasana

To strengthen the ankles stand with the feet parallel, lift and lower the heels slowly, repeat 10 -20 times . Then stay up with the weight on the big toes. Slowly bring the shins forward keeping the heels up as long as possible. With the fingers in the groins, make sure they are soft and moving inwards. Eventually lower the heels to Utkatasana. The lower legs should be working more than the thighs!

9. Balance on one leg

Look in a mirror and observe any movement in the pelvis when lifting one foot off the ground, com paring the two sides. The pelvis may slide to the side when the weight is on the a ffected side. If so, try to stay centered and notice how much the foot needs to work. With the feet together, focus on the center and just bring one shin forward and the knee upwards so as to avoid a sideways movement of the pelvis .


10. Eka Pada Uttanasana

Stand with your back to the mirror about half a meter away. Practice Uttanasana with the feet apart and check if the head is centered. Now bring the feet together and lift one leg up towards or on the mirror , Eka Pada Uttanasana , and observe how much of the face you can see. If the body is centred it should be half of a face on each side. If on one side you can see more of the face, you are not centered. Then use the standing foot and the opposite hand to center the pelvis. This can be very useful, so as to recognize what could be happening in some of the standing poses.