Millie came to me two years ago with a recent diagnosis of osteoarthritis in one hip. She had visited a chiropractor and an orthopaedic consultant and the prognosis was a hip replacement in the next 15 to 20 years if the osteoarthritis of the hip continued to progress. Millie, who is just over 50, wanted to try yoga therapy because she was interested in a holistic approach that would give her increased flexibility.
Millie felt pain in one hip after some activities but mainly experienced stiffness. Especially while sitting the hip would become increasingly tight. Every long car journey was difficult, during as well as after the drive. Upon waking in the morning the hip felt tight and a dull feeling sometimes woke her up at night.
Osteoarthritis of the hip
Osteoarthritis usually develops as joints age and the cartilage (the protective, well-lubricated covering at the ends of bones) is damaged and worn down. This ‘wear and tear’ of a joint can be caused by misalignment and/or repetitive movement patterns, but also by an injury, old trauma or genetic factors.
Unfortunately, there is no cure for osteoarthritis, although looking after one’s weight and diet, and engaging in various forms of exercise can slow down and in some cases even reverse the deterioration of the joint.
What yoga therapy can do
Yoga can help increase our flexibility, lubricate the joints and increase their range of movement. When used in yoga therapy, the practices will be tailored to the individual and will tend to be gentle. Creating more flexibility around the joint reduces the side effects and pain that comes with the tightening of muscles around the arthritic joint. Apart from keeping joints mobile, yoga therapy also aims to:
- Strengthen the muscles to support the joint.
- Improve alignment (thus reducing wear and tear due to postural imbalances).
- Improve body awareness, so yoga can be used off the mat.
- Reduce stress.
As arthritis.org.uk puts it: “yoga is very popular with people with arthritis for its gentle way of promoting flexibility and strength in mind, body and spirit”. I like the “strength in mind, body and spirit” because in the face of adversity, this kind of resilience is exactly what we need. As our thoughts quieten during a yoga practice, and we can observe thoughts and feelings without engaging with them, we are more able to find this peace and strength.
To read more about osteoarthritis of the hip, this previous blog goes more in depth and gives a range of movements that encourage hip flexibility. The current blog will focus on Millie and the movements she has found particularly helpful.
Tailored yoga therapy for Millie
For Millie, the hip arthritis manifests as the tightening of hip abductors, glutes and hip flexors. We have worked on releasing and strengthening these muscles but also on general flexibility, improving posture and core strength. Initially, some stretches for the hip abductors were slightly painful. After a few weeks of yoga therapy, however, Millie felt increased flexibility and mentioned that she felt “longer”.
My student is serious about healing her hip and looking after its flexibility and health on a daily basis. Over the course of 2 years, Millie has practised yoga conscientiously every morning because it makes a huge difference to the way she feels during the day.
Millie has also taken her yoga off the mat. With an increased awareness of what feels right and when she has to be careful, Millie has learnt that wearing high heels and shoes with flat, thin soles result in pain. She also makes sure to sit on firm chairs with a good posture and to have frequent “movement breaks” to prevent the hip muscles from tightening.
If she has to stand or sit for long periods, Millie avoids the hip muscles from tightening by interrupting the activity for some stretches. In situations when she cannot lie or kneel on a mat, she will find a place where she can circle the hips in a standing position and stretch her back in a supported forward bend.
Despite the adjustments she has had to make in her life, Millie has experienced an increased freedom to do the activities she likes. For example, she recently hiked up and down a mountain without experiencing pain afterwards. She can also drive long distances without developing the pain and discomfort she used to feel (see this blog for stretches to do during car journeys). Apart from her daily yoga, Millie walks at least an hour every day.
Millie’s poses for osteoarthritis of the hip
Millie will always include gentle hip circles in her daily practice, on all fours or lying on the back. Also various leg stretches are essential to keep the big muscle groups around the hip (hip flexors, quads, hamstrings and inner thigh muscles) flexible. Her favourite poses include frog pose, queen’s rest and pigeon.
I’ve included this pose in an earlier blog as one of the ‘fabulous poses’. Many students love the restfulness of the pose, the stretch for the back and the inner thighs. I love how we can feel the breath all along the back: inhale and feel the ribs expand up and to the sides. Maybe you can feel the subtle expansion all the way down to the sacrum. Exhale and feel the head and hips release more. There is no need to “do” anything: just observe the movement of the trunk as you breathe.
If this pose is difficult for the feet, you can use a rolled towel under the ankles.
If your back feels too tight in this pose, try kneeling in front of a raise (a sofa for example) and rest the chest and head on it.
Pigeon is one of those poses that look very impressive and seem to require huge flexibility, but it is more accessible than it looks. The importance is your alignment and not hurting yourself. This pose is not good for people with arthritis of the spine, nor for those suffering from sacroiliac joint pain. Please always come out of the position if it hurts.
-Start on all fours.
-Slide the right knee forward between the hands.
-Lengthen the left leg behind you and check it is straight.
-Keep the hips square, i.e. don’t roll over towards one side.
-Move the right foot over to the left groin.
-If it feels ok you can also move the right knee over to the side a little.
-Start with the arms straight.
-If all feels good, lower yourself to the elbows and maybe all the way down. Stay for 60 to 90 seconds.
-Repeat with the other leg forward.
This restorative rest position requires many bolsters and blankets but is worth the effort! The opening effect for the chest is uplifting and may improve breathing. Yoga therapists recommend this pose for insomnia, pelvic health, mood swings, headaches and digestive problems…
-Use one long bolster or similar shape cushion or towel.
-Place a block or lower cushion in front of the bolster.
-Have cushions ready for the head, the arms and legs if needed.
-Sit on the block and lie down on the bolster. If this is not relaxing for the lower back, please take 2 blocks (or a higher cushion) for the pelvis.
-Check if the head feels supported or would be more comfortable with a cushion.
-If the shoulders feel too stretched, support the arms with cushions.
-Place the soles of the feet together and the knees apart.
-For tight hips it is much better to place high cushions or bolsters under the knees or rolled towels under the ankles: when the body feels supported it can relax more.
Finally, Millie says: “ Working with Bene on a weekly basis and practising yoga daily at home, has really improved the feeling and flexibility within my hip. When I first received my diagnosis, it was a diagnosis given as very much doom and gloom, with the outlook of a hip replacement within 20 years. I was determined that this would not be the case and now I know that not only has yoga hugely increased the flexibility within my hip, but I am also pain free. Also, I have developed a huge love for the practice of yoga and also for my weekly sessions with Bene! I count my blessings the day I found her and started my yoga journey.”