Arthritis of the Hip Joint

In past posts, we have shared with you poses that can open tight hips, as well as discussed hips in a few specialized settings, but we have not addressed perhaps the most common aging concern for hips: the development of arthritis in the hip joint. The hip joint is a synovial joint, meaning the pelvic bone and the femur, or upper leg bone, connect with one another via a closed system. A sock-like sleeve of connective tissue holds the two bones relatively close together via what is called the joint capsule. The inner lining of this structure is lined with a specialized tissue called the synovial membrane, which secretes a special liquid, not unlike a lubricant such as oil in you car engine, to allow the bones to move over each other more smoothly. In addition, the ends of the bones are coated in a layer of cartilage—also a kind of connective tissue—that acts as a tough barrier over the bone for shock absorption, and is smooth and slick, so the bones again can glide over each other more smoothly. Finally, the inner surface of the acetabulum, the hollowed out part of the pelvic bone that the head of the femur bone fits into, has an additional cushion of cartilage lining it called the labrum. This provides a better fit for the two bones and a lot more shock absorbing potential.

Now that you have some idea of what makes up the hip joint, we can talk a bit about arthritis of the hip. As with arthritis anywhere in the body, there are two broad types. The wear and tear type of arthritis, which could be a result of repeated movements over a long time, or complicated by some old trauma, infection or injury to the joint, is called osteoarthritis (OA). In this, the most common form of arthritis, the cartilage covering on the ends of the bones is worn away gradually, exposing sensitive raw bone, which, when rubbing against another raw bone, leads to inflammation inside that closed synovial joint described above. This results in swelling, stiffness, tightness, decreased movement and pain.

The other main type of arthritis, rheumatoid arthritis (RA), in an auto-immune disease, meaning your body mistakes itself (in this case, the joint lining) as a foreign invader and mounts an immune response to fight it off. This response is an inflammatory one, resulting in damage to the ends of the bones, sometimes even at a young age. It is quite a bit less common than osteoarthritis, but still seen enough to be aware of it. 

It almost goes without saying that this condition can be painful. What other symptoms would you look for? Because of the damage to the cartilage, people with arthritis may feel as though their hip is stiff and their motion is limited. Sometimes people feel a catching or clicking within the hip. The pain usually gets worse when the hip joint is strained by walking long distances, standing for a long time or climbing stairs. The pain is usually felt in the groin, but also may be felt on the side of the hip, the buttock and sometimes into the knee.

Here in the US, we start to diagnose the condition via the history and physical exam, with the aid of X-rays, which often reveal diminished space between the bones. If surgery is being considered, an MRI of the joint will also likely be ordered. Treatment offered by your family MD or arthritis specialist could include medications for pain and inflammation, recommendations to change activities to reduce the stress on the joint, a plan for weight loss which also reduces joint stress, assistive devices like a cane if needed, and surgery to clean out the joint or to replace the joint. 

At the start of any treatment regimen, conservative recommendations are made, which include rest and avoiding any repetitive activity that may have strained the joint or muscle, as well as working with a physical therapist who can help increase your range of motion or strengthen muscles to increase stability on the joint. Here is where yoga can fit into your healing regimen. But first, you want to take a good look at what you are already doing in your yoga practice to see if any of the poses or vinyasa practices you do now could be contributing to your pain and dysfunction. Do you get pain while doing certain poses, like the front leg hip joint in a Lunge pose? Do you have a flare of pain in the hip after class or the next morning? Yes to any of these questions requires you consider suspending the offending practice, at least temporarily.

On the other hand, it is not uncommon for a student to start yoga because they have heard it could help their condition. In this setting, you will want to begin at the beginning, with a gentle practice as your entry into yoga. A one-on-one session would also be a good way to start. If you are having chronic, persistent pain, start out by lying on the floor and moving through our Dynamic Reclined Hip Stretches, in which you take the joint through many of the movements it is capable of. Add to this Snow Angel Legs, where you are lying supine (on your back) and you spread your legs wide on the floor, without rolling your thighs in or out, and then bring them back to center. Follow this with by Dynamic Locust pose, which is done on your belly, lifting one leg up off the floor without bending your knee. Lift up on your inhale and lower down on your exhale. These three explorations will give you a better sense of the range of motion of your hips, right and left, as well as movements that cause immediate pain. This is very useful information as you explore other poses in different positions. 

It is considered important in arthritis care to keep the joint as mobile as you can and keep the supporting muscles as strong as they can be in order to keep you functional and prolong the time before surgery has to be considered (surgery is not inevitable, by the way).  Since you can do many yoga poses without bearing direct weight on the joint, either prone or supine poses, seated poses and inversions, yoga provides lots of opportunity to work on range of motion and some strengthening of the joint. The pose Reclined Leg Stretch (Supta Padangusthasana) and its variations are good example of both goals being met.  Each time you lift your leg straight up to begin the pose, you are strengthening the quad muscles and the psoas, for instance. And even the standing poses can be done in a fairly weight free manner if your do them with your pelvis supported on a chair. Poses like Lunge, Warrior 1 and 2, and Extended Side Angle, all have chair variations that could be helpful when full weight on the joint needs to be avoided. And as always, breath work and meditation can be helpful with pain management, as well as yoga nidra.  I understand that yoga is even being taught in swimming pool settings, where weightlessness is beneficial for arthritic hip joints.  Sounds potentially helpful, but I’d skip the inversions class!

When your symptoms are milder, movement practices like Sun and Moon Salutations done slowly, mindfully and with the idea of soft foot landings might be safely added to your home practice. If your yoga practice can diminish your pain, improve your mobility and delay any invasive treatments, you’ll be getting your moneys worth! And the mental equanimity that is a result of a balanced yoga practice can hopefully guide any difficult decisions you may need to make about your hip toward the best outcome.