Yoga & Hip Injuries: A Physio Perspective

In late 2019 the BBC published an article entitled "Yoga teachers 'risking serious hip problems' ". It was a short article discussing yoga's popularity in recent times, its touted benefits and a warning from a UK Physiotherapist who claims to be seeing an increasing number of yoga teachers with "serious hip problems, many of whom who require surgery". The physio states that yoga teachers need advice on modifying positions to work better for their anatomy.

"People confuse stiffness and pain," he says. "If there is a pinching or blocking feeling in the groin, it shouldn't be ignored. You have to know your limits." 

"People tend to do the same set positions, rather than what's achievable for them."

Let’s break this down, in many ways I agree with what Mr. Matthews is saying and from a physio perspective, I understand where he is coming from in terms of seeing yoga teachers as patients over and over again.

From my point of view one of the main and very important points he is trying to get across is that yoga is an individual practice. Everybody's anatomy is different, and how my head of femur sits in its socket will be different to yours, the laxity in your ligaments different to mine and our natural flexibilities will not be the same. For this reason health care must be patient centered because regardless of diagnosis the same treatment will not work for everyone. I completely agree with the fact that many (not all) yoga teachers perform a pose as it is traditionally seen, whilst disregarding what their body is telling them.

It is a bit of a catch phrase in yoga ' listen to what your body is telling you' or 'let your mind and body become one'. But it is another thing to actually accept it. Why is this? I have multiple theories and like variations in anatomy, attitudes to listening to our body is probably slightly different from teacher to teacher. The theories that spring to my mind and are truthfully from my own personal experience are: social media, inexperience, lack of confidence and ego. Some being the very thing yoga teaches us to leave behind, but how can we do so in a world that values the likes you get on a photo? The right variation of a pose may be in fact not be as visually desirable. The world of yoga Instagram is a crazy place and many of the hand standing queens have worked for years to be where they are, the insane flexibility some show off is often hyper mobility being pushed to its limits, or paused videos showing a pose that was in reality held for only a moment. It often does not show the hours of work, the failed attempts, or poses that a person cannot do. There is a disproportionate amount of extreme poses and the pressure to show these to students can be overwhelming, almost a show off, a personal endorsement.

As a physio and a yoga teacher this can be dangerous because the prevalence of extreme poses on social media can encourage students to do the same, something that because of their personal anatomy and physiology may not be possible.

From my personal experience, I have had yoga students who previously (being hyper mobile) have been told to push into their flexibility, and how lucky they were. As a physio that shocked and scared me. The increased flexibility in the joint can often cause pain, muscle spasm, or even injury. Strength to stabilize around their joints - that can be found through yoga whilst staying in an appropriate range of motion - is what these students needed and pushing into their flexibility can in this case do more harm than good.

Yoga is about leaving your ego at the door and accepting ‘what is’ and sometimes understanding ‘what isn't’. Is it wrong to want to gain flexibility? No absolutely not, but I truly believe that (more times than us yoga teachers would like to admit) the drive to want that flexibility is coming from a place of comparison. I myself have definitely felt this and for this reason I am sure others have as well. It is a hard thing because without being the best physically on Instagram, many people will just ignore you. It sucks, it's not right, and it's not everyone. I believe the more knowledge you can bring to the class the happier and more understood your students will feel and in the long run they will return. (I also think you can still achieve poses within your limits that look absolutely amazing for an amazing photo).

However, I feel the BBC article dramatized the fact that some needed hip replacements as a result of having pushed their hips into these positions. I don’t mean to belittle the seriousness of these instances, but personally feel it was most likely a combination of factors rather than the yoga specifically.

Nonetheless, I agree with Mr. Matthews overall and the onus should be put on the teacher to have the knowledge and understanding of their own and of their students’ anatomy, contraindications and variations, while being able to truly encourage listening to their body. 

Sadly, not every individual (regardless of profession) is as qualified as he or she would like to think and as a yoga student you need should bare this in mind. Many teachers are great and deliver exceptional classes, but issues can arise when showmanship and ego are prioritized over student safety. This is why in my own practice I strive to encourage students to listen to their body, provide alternative pose variations and clear descriptions of class levels for Made by Movement on demand content. 

I have embedded links to the BBC article and a research article on hip dislocations in yoga following hip replacements. The article is a good read and highlights why it is important to understand movement restrictions following orthopedic surgeries.

What do you think?