Why write a long narrative history of my hip pain, going back to the beginning? Because I think it is an interesting case study in how difficult it is to get a proper diagnosis of one’s physical problems, and because it also shows the strengths and weaknesses of various approaches to treating those problems. And also because it has consumed a tremendous amount of my time and energy over the past two decades, but almost nobody is interested in listening to me talk about it. That’s why I have a blog, right? But really, because I hope this will be useful for other people facing a similar journey to understand and manage their own pain.
NOTE: I am not a professional physical therapist or personal trainer, I am just someone who has struggled to manage their own hip pain, but over the course of my research I have learned a lot, and I wanted to share those lessons with everyone. Please don’t take any of this as professional advice and see a doctor before trying any of the solutions discussed in this series.
It is really impossible to know when the problem first started. In some ways I believe the problem was always there, since childhood. Perhaps it would be more accurate to say that certain imbalances in my movement and posture simply never got corrected, and eventually caught up with me. I first began to be aware of having chronic pain in my late twenties. That is a bit earlier than most people, but almost everyone I know started to have some issues with their joints or their spine before they hit forty.
My problems started in the late nineties, while I was studying Chinese in Taiwan. At the time I was sleeping on a thin Taiwanese mattress. I somehow convinced myself that if I could train my body to get used to sleeping on such a hard surface. Most people in the world do, why should I be any different? But when I started having problems walking I realized my mistake and switched to a box spring mattress. My hip problems got a bit better after the switch, but it was around this time that I first developed issues in my neck and shoulders.
Eventually the problem spread to my jaw. I was grinding my teeth at night and needed to sleep with a mouth guard so I didn’t damage my molars. Finally, I went to one of the top sports medicine doctors in New York City. He sent me to a physical therapist. I immediately knew something was wrong after about five minutes with the therapist. That’s because she started by commenting on my hips, having noticed that they were uneven, but when I asked if we would be working on that as well she said “no” since my script was only for my neck and shoulders. This made no sense to me. Doesn’t everyone know that “The hip bone’s connected to the backbone” and “the backbone’s connected to the neck bone.” etc.?
I tried the physical therapy for a few months, but even though I got complements on being a good student who did everything I was told, it didn’t help very much with my neck, which continued to trouble me. Finally I gave up and decided to try something else. In early 2002, about five years after my problem first started, I took up Iyengar Yoga. A lot of people who start yoga to deal with chronic pain go with Iyengar. That’s in part because the teachers are particularly well trained, with a rigorous certification process that makes it unlikely they will ask you to do anything that might injure you. It is also good for people who lack the flexibility to do some other forms of yoga because they teach you how to use props like blankets, blocks, chairs, and straps to modify the poses to better suit your own body.
Initially my experience with yoga was very positive. After about six weeks of regular practice my neck issues started to go away, and they continued to improve dramatically over the next few years, till I no longer needed to worry about grinding my teeth at night. (Completing my dissertation in 2005 helped as well! Nothing like removing a major source of stress to help with chronic pain…) But I was never able to make the same kind of progress with my tight legs and hips that I made with my upper back. Despite going to class regularly, attending workshops, and reading books about yoga and anatomy, none of my teachers was able to tell me why I was unable to make any progress on those muscles.
It would take me another decade before I finally gave up. No one can say I didn’t try! I now think that yoga itself is the problem. Let me preface this by saying that I still think yoga can be very beneficial for many people. However, it does have its limitations, and isn’t going to be the right practice for everyone. Let me explain.
First, as well trained as most Iyengar yoga teachers are, most are not physical therapists. It is unfair to expect them to be, or treat them as such. Yes, many yoga poses are useful, as evidenced by my quick recovery with my neck and shoulders once I started, but some yoga poses should be avoided by people with certain conditions, and most teachers are not really qualified to tell you which is which. (Some are, and some have enough knowledge that they could be, but those are the exceptions.)
Second, there are a huge number of yoga poses and there is only so much time in the day. Over the years I was told of so many different things that I should be doing every day that if I did all of them I would be spending a good three hours a day doing yoga. Maybe that would have worked, but it just wasn’t reasonable. Ideally everyone’s yoga practice should be personally tailored for their own needs, but few yoga teachers are qualified to do that - they just don’t have the medical training required to properly diagnose your problems. And even if they did, group classes make it hard to give students that level of individual attention.
Third, many students simply lack the strength or level of muscular control necessary to do many of the poses. Take my gluteal amnesia, for instance. No matter how many times the instructor says to engage my glutes, and no matter how hard I try, the muscle simply won’t fire. The only way to fix this is to put my body in situations where the muscle has to fire. Doing the same thing a hundred times won’t help. You need to stop and do functional exercises that target that particular movement before returning to the yoga pose you were doing wrong.
Fourth, as I will talk about more in later posts, there are more efficient forms of practice that will see people make more significant gains in terms of strength and flexibility where it matters most. It is true that these other forms of practice are less accessible and often more expensive than yoga, but I think over time we will see them coalesce into something more standardized. Part of the purpose of this series is to help people understand what they should be looking for.
None of which is to say that people shouldn’t do yoga. I’m glad I spent nearly eighteen years doing it, I learned a lot and I might take it up again in the future. Still, one should be careful. If you have chronic pain I strongly urge people to see a doctor or physical therapist before taking up yoga. Unfortunately, few doctors and physical therapists have a deep enough knowledge of yoga to give you specific advice about what you should or shouldn’t be doing. To better explain what some of the issues are I will end this post with three examples of poses that were either useless or outright harmful for me, given my condition.
One of the first poses yoga students learn is vrikshasana, or “tree pose.”
This is actually very good for your hips, if done correctly. The problem is that I you have gluteal amnesia (as I do), you simply won’t be able to engage your glutes in this pose. For eighteen years I never made any progress and didn’t understand why. Only now, after two years of working on my glutes, can I finally begin to do this pose correctly. Just telling people to engage their glutes won’t make it happen. You have to put your body in a position where your glutes don’t have any choice but to engage. See, for example, the one leg glute bridges I shared in my previous post.
The other exercise I shared in my previous post was the dead bug, which works your lower abdominal muscles. A yoga pose which targets these muscles is paripurna navasana, or the “boat pose.”
If you have hip flexor trouble, this is actually worse than vrikshasana, because instead of engaging your abdomen, you will likely be relying on your hip flexors to do this pose. Again, it is a situation where only once you have fixed the problem can you really do the pose designed to fix that problem.
Third, one pose that several yoga teachers specifically recommended for my hip flexors is eka pada rajakapotasana, or “pigeon pose.”
This is probably the worst offender. Unless your hips are already sufficiently open, you should not be doing this pose. Yes, there are many ways to modify the pose for tight hips, but I am more and more convinced that any version of this should be avoided if you have hip flexor issues. In a later post I’ll talk about my preferred practice for opening up the hip, but for now I just want to give this as an example of a pose that many yoga teachers told me I should be doing which actually made things worse. I think a big problem is that most yoga teachers already have fairly open hips, and so they don’t fully understand the problems faced by someone who does not.
Like I said, I don’t want to discourage people from doing yoga, but I do want to issue a word of caution. People who have specific needs might not be getting them addressed in a yoga class. Moreover, while most of the poses are generally beneficial, some of them should definitely be avoided and you need to be careful because your yoga teacher might not know enough to tell you which is which. In my next post I will talk about how getting an x-ray eventually led to me abandon yoga for a combination of other practices that finally helped me get better.