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in reply to: Labral tear (hip) #6955
Thanks, Gabrielle…I’d love to share some of my thoughts on this.
I think you’re absolutely right about preparing a joint before pushing to quickly – I’m sure we’ve all done it, and it’s not totally without value – I think it’s can help us gain some insight into our behaviors outside the yoga studio. It’s also true that improving flexibility requires a level of what will generally be perceived as discomfort, if not pain.
Alignment is something I’ve been thinking about a lot – in yoga, we talk a lot about “proper alignment” and finding flexibility and strength through proper alignment. But anatomically, we’re all different, meaning what we think of as the ideal alignment, can’t be the same for everyone. Certainly balancing soft tissue bulk/flexibility over time, will help many people conform to this ideal…but not everyone. When the variation is in something other than soft tissue (bone) there is a problem that stretching, weight training, etc. isn’t going to address in a healthy way.
Some common examples are variations in acetabular and/or femoral structure. Take femoral retroversion (rare, but a good example). For these individuals, the external hip rotation or deep flexion of poses like king pigeon or frog, will likely never be possible. But they don’t know they have it and neither does their teacher – they go to class and try with all their might to “open” their hips…for them, this means bone-on-bone, not just soft tissue stretching. No matter what they do, short of dislocation or breaking the rim of the acetabulum, the hips aren’t going to open; they’re just going to impinge, tear labrums, beat away at the articular surface.
I can’t ever remember hearing a teacher say anything but things to the effect that over time, with proper alignment, patience and hard work, hips will open. But that’s just not true for everyone. Unfortunately, it’s only after they’re injured that they get some imaging studies and find out that the pain wasn’t getting them closer to full expression of the pose, just closer to a damaged joint.
I’m not suggesting an abandonment of the entire alignment paradigm….but maybe more teaching around understanding our own structure, possibilities, and sadly, our limitations, and then making our practice our own.
Thoughts, anyone?
JB
in reply to: Labral tear (hip) #6848Hi Gabrielle,
I’d just like to add to your post about the mechanism of labral tearing – impingement is most often what causes them. Not always; in their absence, heavy load-bearing things like deep squatting with weights can certainly result in tears. They can also be idiopathic. So what causes the impingement? It can be congenital – bony deformations/joint abnormalities (such as acetabular retroversion, like in Legg-calve Perthes disease or simply abnormal acetabular coverage of the femoral head)..most likely, there is some element of this structural-predisposition which becomes symptomatic with repeated movements that reach the extremes of range of motion…ie; yoga. In the physical sense of the practice, yoga is about creating impingement.
I’m a physician, I’m also a dedicated…and now seriously injured yoga practitioner. I’ll probably need surgery, though trying desperately to avoid it. Having a lot of pain – but the physical is really nothing compared to the sadness of losing this part of my life. There is absolutely no question, however, that these injuries are the direct result of yoga. Ask any orthopedic surgeon in the US who practices in a city with lots of yoga, like NYC. They’ll tell you that the popularization of yoga in the past 5-7 years has done wonders for business. I love it no less, but it’s foolish to ignore the problems that, despite the dogma of the yoga therapeutics community, are inherent in the practice.
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