10 Actions That Could Leave You With a Yoga Injury – Part 3

We practice yoga because we think it’s good for our bodies. And it is. Or—it can be. As I like to say, “Yoga is a powerful practice. Powerful practices can have powerful benefits—or be powerfully injurious.”

Having an understanding of which actions can be injurious to which specific parts of the body, why that is so, and what to do about it is important. This knowledge will help you maximize yoga’s benefits while minimizing risks. The list of actions in this series is not comprehensive but it’s an excellent resource to help you begin to make educated choices.

Risk #3 – Excessive External Rotation of the Hips. (Especially When Combined with Knee Flexion!)
Tight hips with restricted range of motion (ROM) make us more prone to knee injuries. (They make us vulnerable to other types of injuries too but that’s another blog post.)

So–if tight hips are the problem then the solution should be easy. Just practice hip openers, right?

Well, not exactly.

Unfortunately, it can be a Catch-22. We do need to open tight hips but the bad news is that actively stretching tight hips can also jeopardize the knees. We tend to think of “hip opening ” as being synonymous with external rotation of the hip. Which it’s not. Hips have a range of motion that also includes flexion, extension, adduction, abduction and internal rotation.

When a hip doesn’t have adequate ROM in external rotation, the knee will often try to be a “good helper” and pick up the hip’s slack. In these cases the knee overly rotates–jeopardizing the meniscus and cruciate ligaments. This is particularly true when the knee is bent. That’s why knee pain is a common complaint in poses like Lotus and Pigeon, and why  aggressive hip openers like Lotus Pose are making knee surgeons rich.

Knees do have a modest ability to safely rotate–but not nearly enough to singlehandedly carry the load of deep hip openers. To keep knees safe, we need to both back off aggressive external rotation of the hips and stabilize the knees.

Help students facilitate greater stability of the knee by instructing them to:

  • Actively reach the inner edge of the foot forward
  • Pull the outer edge of the foot back
  • Draw the outer ankle bone in toward the midline
  • Active the outer shin muscles

These actions are demonstrated here in Pigeon but are consistent for all of the externally rotated hip openers.

Pigeon with the front foot misaligned (note the sickling of the ankle):
Pigeon Foot Misaligned

Pigeon with the front foot aligned (notice that working the foot correctly lifts the outer ankle bone of the front foot up away from the floor a bit):
Pigeon Foot Aligned

We can and should decrease the weight bearing load on the knee by having students modify on their back where appropriate:
Figure 4
Some students–particularly in the case of acute injury–may not be able to combine external rotation of the hip with knee flexion at all.  

It’s not just knees we have to be careful with. Excessive external rotation of the hips can also overstretch sacral ligaments, destabilize the sacrum and create a world of misery. In my opinion this is one of the very most common yoga injuries. It’s one I’ve experienced firsthand and it sucks. To rehabilitate this injury we need to back off extreme external rotation and stabilize the sacrum by toning the pelvic floor and lower abdomen.

What external rotation of the hip means for yogis:

  • Poses like Lotus, Ankle-to-Knee, Gomukhasana, Baddha Konasana and even Pigeon can be hazardous for the knees. These poses should be taught in appropriate stages.
  • Explain goals and risks to students. Clarify what they should and shouldn’t be feeling—a stretch in the outer hip but not in the knee.
  • Stretching the knee is not a goal. Teach students to question any and all sensation in the knee. 
  • Teach students how to work their feet correctly by reaching through the inner edge of the foot and pull back on the outer edge.
  • Teach students to draw the outer ankle bone in toward the midline to activate the outer shins in order to provide more stability for the knee.
  • Modify Pigeon by instructing students to lie on their backs, and cross an ankle over the opposite knee.
  • If you must teach Lotus—and I don’t think anyone must–teach it only during advanced classes with meticulously sequenced preparation.
  • Open the hips through a full range of motion–not just external rotation.

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2 Responses »

  1. I have been talking a lot about the feet and just last night had the discussion of how the foot should look in pigeon. Thanks for the affirmation. Love these posts!

  2. Hi Bernadette,
    I hate to ask this question because it feels like asking for something I should be paying you for information on but . . . I’m desperate so here goes. . . you mentioned overstretched sacral ligaments, destabilized sacrum and misery related to that. I think I have that problem. My lower back has gradually tightened up on me over the last 2 years and nothing I do helps. Chiro says its an unstable sacrum. What yoga can I do (or avoid) to help stabilize it again? Are there specific poses you would recommend?

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