December 22, 2018
Practicing Yoga With An Artificial Hip Joint
By Stephanie Scavelli
Yoga can be a relatively gentle healing modality compared to other more rigorous styles of fitness. Yoga is viewed as a safe form of exercise for those with an artificial hip joint. However, there are some important things to know in order to have a safe yoga practice.
There are postures within yoga that pose a risk of hip joint dislocation for those who have undergone full or partial hip replacement, more so for full hip replacement. Of first order, these students should not practice yoga until cleared by their physician. Secondly, the type of surgical entry (posterior vs. anterior) determines the types of movements contraindicated during the first few months to years after the surgery.
Posterior Hip Replacement Surgery and Contraindications in Yoga
If the surgery was done with a posterior entry to the hip then the following movements risk hip dislocation: adduction (e.g. crossing the knees), flexion at the hip (e.g. forward folds), and internal rotation (e.g. turning the thighs in). “Combinations of these actions are worse than any single one alone” warns Iyengar Yoga Instructor and physiology researcher Dr. Roger Cole (http://rogercoleyoga.com/) (1).
The following asanas in full expression should be avoided or be modified by a person who underwent a posterior entry hip replacement surgery:
Uttanasana (standing forward fold) due to flexion and internal rotation
Garudasana ( Eagle Pose ) due to adduction and flexion
Gomukhasana (cow face pose) due to adduction and flexion
Balasana (Child’s Pose) due to hip flexion
Note that simple postures like knees into the chest while resting on the back or Child’s Pose are the most risky for possible hip joint dislocation from a posterior surgery. In the spirit of recovery the legs should not be crossed for three to six months after surgery and the knee kept below a 90 degree bend at the hip for the first year. These movements will continue to be risky even after the initial recovery period.
Yoga poses that are safe are backbends and wide-legged postures because the actions required are external rotation and abduction. Setu Bandhasana (Bridge Pose) can even strengthen the hamstrings and glutes to help prevent hyperextension. Poses like Utthita Trikonasana (Extended Triangle Pose ) and Virabhadrasana II (Warrior II ) pose can be practiced safely when not to their fullest extent. Modify these postures by having the front foot facing a similar direction as the back leg to minimize the need for hip rotation. In Eagle Pose the arms can be crossed, but don’t cross the legs. Child’s Pose is taken upright with the arms and head resting on a chair and in seated forward folds the body is kept upright.
Anterior Hip Replacement Surgery and Contraindications in Yoga
If the hip replacement surgery was via anterior or anterolateral entry into the leg then the actions most likely to cause dislocation are abduction (eg. moving the leg away from the side-body), hyperextension (eg. back-bending at the hip), and external rotation (eg. turning the thighs out).The following yoga postures are contraindicated for students who have had an anterior or anterolateral entry hip replacement:
Utthita Trikonasana (Extended Triangle Pose ) due to abduction and external rotation
Virabhadrasana II (Warrior II ) due to abduction and external rotation
Virabhadrasana I (Warrior I ) due to hyperextension of the back leg
Backbends due to hyperextension of one or both hips
Baddha Konasana (Bound Angle Pose) due to external rotation and abduction
Rajakapotasana (Pigeon Pose) due to back leg hip extension
Within the first year of recovery from a hip replaced via an anterior surgical approach, a conservative yoga practice would entirely avoid hyperextension of the hips as in Warrior I and backbend poses, avoid sitting postures that turn the thighs out, do not cross the ankles and no wide-legged abduction in standing poses like Warrior II. After the initial first year of recovery introduce these poses with caution. However, Navasana (Boat Pose) modified with a block between the legs to encourage strength building in the hip flexors and adductors may be a beneficial pose after this surgery.
Regain Functional Movement with a Replaced Hip through a Modified Yoga Practice
The yoga practice should encourage a range of motion which is functionally useful for daily living. Meaning full expression of the yoga poses is not the goal but a fuller expression of living is, all the while preserving the longevity and function of the artificial joint. Practice yoga using modified postures to gain its benefits but avoid any “extreme” action on the hip joint. “Extreme actions can cause dislocation, or make the shaft or head of the artificial femur impinge on the rim of the hip socket, damaging the joint” explains Dr. Roger Cole (1).
A yoga practice can serve to benefit a person with a replaced hip. The practice should focus on strengthening the muscles that overlay the hip joint in order to create greater stability in the hip. One-legged standing poses are where we practice hip stability. For example, a simple Vrksasana (Tree Pose) with the bent leg placed lower down by the ankle builds strength in the side hip of the standing leg.
For yoga practitioners with an artificial hip it is important to always remember to avoid any of the contraindicated actions that risk dislocation. Upon learning that a student has undergone a hip replacement surgery, yoga teachers should ask the student how long ago was the procedure and by which surgical approach (anterior or posterior), and proceed by offering modified postures that make the yoga practice safe and accessible to the student.
For an extensive article on total hip replacement and yoga with additional resources read “Yoga After a Hip Replacement” (March 23, 2010) by Level 2 Ananda Yoga Teacher and Teacher Trainer Maitri Jones found at: https://www.expandinglight.org/free/yoga-teacher/articles/yoga-therapy/yoga-after-a-hip-replacement.php
About the Author
Certified Yoga Instructor Stephanie Scavelli practices a plant-based diet and traditional herbal medicine. She laughs endlessly at the adventurous whit of the animation series Rick & Morty. She wears minimalist, barefoot-inspired shoes and her favorite dessert is her sister's Oatmeal Crusted Vegan Pumpkin Pie. Stephanie lives in Westchester County, NY with her daughter Juniper. For yoga classes and workshops near you visit www.yogaforager.com.