Hip, hip, hooray, today is the day! Today’s blog and practice is all about diving deep into the anatomy of the hip, why our hip health is so important, how to develop a safe and effective practice with stretches and strengthening exercises for the hips and its surrounding structures, and finally how the hips can teach us about self-love, acceptance, and emotion.
Even if you are not part of the large population that suffers from hip pain or dysfunction, hip mobility and strength is important as not only a preventative measure but it also improves posture and offsets tightness after long periods of sitting. Incorporating hip mobility and strengthening protocols into athletes training is imperative because instability and weak mobility, flexibility, and strength in the hip can lead to compensation, overusing, and/or straining other structures which hinders an athlete’s ability to perform to their best capability.
Compensation can create a domino effect in which one strain or tightness in a joint/tendon/muscle often times leads to another, which leads to another, etc. Here’s an example within the hips: tight/weak hip flexors can cause the pelvis to tilt forward which then tightens the lower back, hamstrings, and glutes. This can then cause a person to become “quad dominant,” in which the quadriceps muscles become overactive and when the gluteus muscles are not properly activated, dysfunctions in the Iliotibial (IT) band, the connective tissue on the outer part of the thigh and knee may occur, which can then create pain in and around the patellar (knee) tendon, so on and so forth, in severe cases pain that begins in the hip flexor can make it down all the way to the ankle.
In order to come up with an effective yoga/body movement plan for hip health it is important to consider all of the other supporting joints as well. Your hip joint is made up of the pelvis and the femur (more on this in a little bit). From above the hip joint, you have deep pelvic muscles that support and move the hip- one of these that you’ve probably heard of before is the iliopsoas. The iliopsoas consist of the psoas major and iliacus muscle which are largely responsible for hip flexion. I could dedicate a whole blog post on the anatomy and importance of the psoas muscle but to keep it as simple as possible the psoas originates deep inside the abdominal cavity and run downwards into the pelvis where it then joins the iliacus then attach to the femur. In addition to hip flexion, the psoas also helps stabilize the spine, aid in side-bending, and even plays a role in your breath.
In addition to the iliopsoas, above the hip joint there is also the piriformis which is the muscle that starts at the lower spine and attaches to the upper areas of each femur, it plays a role in the external rotation of the hip. The gluteus medius, minimus, and maximus (butt muscles) all help stabilize the pelvis and create hip extension. Below the hip joint you have the quadriceps muscles, which are a group of 4 muscles on the front of your thighs, since one of those four muscles (the rectus femoris) crosses the hip joint it assists in flexion. The Sartorius muscle, which is the longest muscle in the body, crosses from the side of the hip bone through the thigh and to the middle edge of the knee down to the lower leg, it aids in flexion and rotation of the hip. The hamstring muscles, a group of three muscles that run down the back of the thigh and assist in hip extension. There are many more, some of which we will get into in a little bit but for now I’ll leave you with that.
Here’s my own personal experience and journey with hip dysfunction and why today’s topic is so personal for me. As I stated in my previous blog, I am an exercise addict. While my years of cardio machines certainly didn’t help my hips, it’s actually not the only factor that led to my hip injuries. As Dr. Kang, my hip surgeon told me, “It’s a combination of overuse, hyperflexibility, and the way Mom, Dad, and God made you,” I had what is called a CAM type Femoroacetabular Impingement, labral tears, and early signs of arthritis in both of my hips. These are actually extremely common conditions some people live their whole lives with completely symptom-free and having no idea, while others suffer from severe pain as a result.
The Femoroacetabular Impingement (FAI for short) is what my surgeon was referring to when he said “the way Mom, Dad, and God” made me, because it is something you are born with. An FAI is extra bone that grows along one or both of the bones surrounding the hip joint. The hip is a ball and socket joint (formed by the acetabulum and femoral head), in a healthy hip they fit together perfectly but when one of them is impinged and has that extra bone growth they rub up against each other which can limit that person’s range of motion and make certain movements very uncomfortable. Think about it like this:
A healthy hip as if you were to put a ping pong ball into a red solo cup… if you move the cup in a circular motion the ping pong ball would go around the cup smoothly and perfectly.
An impinged hip as if you were to put a hard boiled egg into a red solo cup… if you move the cup in a circular motion that egg would be bumping into the sides of the cup and not able to move smoothly around every edge.
The three types of impingements are CAM (extra growth around the femoral head that creates a bump on the edge and grinds against the cartilage inside the acetabulum), Pincer (extra growth extending over the rim of the acetabulum), and combined (both present).
The labrum is a fibrocartilage surrounding the acetabulum that helps stabilize the hip joint. A labral tear is when part of the labrum pulls away or separates from it socket, which more often than not occurs over time but can also be as a result of a traumatic injury. In my case, it was a degenerative tear, a combination of the impingement, overuse, and flexibility.
Not surprisingly, hip injuries are extremely common within the yoga community… Sometimes I can almost feel my hip ripping even more just looking at those crazy poses from the “instayogi’s”! My surgeon, Dr. Kang, also told me that labral tears can occur from years of practicing deep hip openers, or, as he put it “being too flexible.” So, with that said always proceed with caution in your practice and honor your body where it’s at. Just because you can get deep into a pose, doesn’t mean you always should. Listen to your body and meet your peaceful appropriate edge but don’t ever go passed it, remember yoga is all about humility.
Aside from impingements and labral tears some other common injuries of the hip include:
Hip Strain- Most often occur as a result of sports activity ; strain occurs when one of the hip flexor muscles stretches beyond its limit, they can range from mild, moderate, to severe (completely torn).
Bursitis- Most common cause of hip pain; bursae are fluid-filled sacs that reduce friction between tissues, major bursae are located next to tendons near large joints. When the bursae become inflamed the condition is known as “bursitis.” Bursitis in the hip can occur in the bursae on the edges of the femur and pelvic bone.
Contusion (Hip Pointer)- Another very common sports injury; it is exactly what it sounds like—a deep bruise to the abdominal muscle caused by an acute injury to the hipbone.
Stress Fracture- Serious injury of the femoral neck of the ball and socket joint of the hip, often caused by overuse.
Snapping Hip Syndrome- A common symptom of a labral tear; clicking and clunking in certain movements of the hip (squatting, lifting leg up, etc.) Can lead to bursitis.
Hip Dislocation- Femur is forced out of hip socket, this takes major force and often occurs with other injuries such as broken bones.
Osteitis Pubis- Another common overuse injury; inflammation of lower pelvis that causes groin pain.
Sports Hernia- Strain or tear in the soft tissue of the lower abdominals or groin area, typically caused by sudden change of direction or intense twisting motion (common with ice hockey, soccer, and tennis players).
Tendinitis- Tendons (hip flexors, groin, gluteal tendons, etc.) become over-strained typically due to overuse.
Arthritis- Severe inflammation of the hip joint.
It’s bad enough we hold ill-will for our hips due to chronic pain but even those who don’t suffer from any types of hip dysfunction can have a strong dislike and even hatred of their hips due to their shape, size, and appearance. Let’s start with the concept of “hip-width distance apart,” I see this all the time in public classes I teach: I tell my students to stand hip-width distance apart and almost all are standing 2-3 times farther than they should be. First off, it is a common misconception that “hip width distance apart” refers to the width of the flesh of the hips, it actually refers to the distance between the two hip joints which is much closer to the midline of the body than people imagine. The sad thing is that, and I’m speaking primarily for women here, they perceive their hips to be much wider than they actually are it shows in their “hip width stance.” Here’s a super easy trick I learned in one of my yoga trainings to get your proper hip width distance apart stance:
Bring your left ankle next to your right ankle horizontally with your toes facing towards the left
Slide your left foot to where your toes just were in that first position
Here’s something else I see and hear all the time that makes me sad, hatred for “hip dips,” that little indent between your hip bones and where the femur (thigh bone) begins has caused such an uproar. Why do some people have hip dips and some people don’t? And Why do the people who do have them hate them so much and dedicate so much time and effort to get rid of them? Hip dips are a common part of anatomy, but whether or not one has them depends on the way your pelvis sits, a higher up and wider pelvis creates the dip between the hip-bones and femur. Often times related to hip-dips are “love handles,” or “the muffin top,” which are the rolls of fat that can develop on our hip bones, and can often times enhance the appearance of hip dips due to the “lumpy” effect it has at the top of the hip dents. So, with that said, since it’s part of one’s anatomical makeup there really is no exercises that will completely get rid of them. While my vote is to just practice self-love over killing yourself trying to fight biology exercises such as clamshells, leg lifts, donkey kicks, and fire hydrants that target the gluteus medius may lessen the appearance of your hip dips.
Last but certainly not least, let’s talk about the belief that one’s emotions are stored in their hips, and that tight hips means you have past trauma stored there that you need to release. There is definitely some truth to that but here’s the bottom line… when you physically open up any part of your body you’re going to have some sort of emotional release with it. My favorite class to teach is The Body Mantra Method: Flow because you spend the whole hour linking your breath and movement to stretch, lengthen, release, and become clear in both the breath, body, and mind. I’ve taught classes where students have been brought to tears by the end because they are not used to moving so freely. Most people spend their everyday lives physically closed off (poor posture, shallow breath, stiff neck, etc.) and their energy becomes stifled, it is not uncommon to become overwhelmed with emotions or feelings you may not understand after dedicating a significant amount of time counteracting that. Whenever something comes up during your practice, do not ever feel ashamed, let your body take over and enjoy the ride!
Hip Health Video Coming this Friday 11/30.