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When Yoga Hurts

When Yoga Hurts

Laurel_leg_behind_headThe pain in my left hip began in about eight years after I was first introduced to yoga in 1992. I was three years into a very serious 2-3 hour daily ashtanga vinyasa yoga practice. At the time, I was told by my famous ashtanga teacher, that my pain was being caused by too much Primary Series (too much forward bending) and that I needed to do Second Series (backward bending).  So, like a good yogi, I did what my teacher said:  I practiced the Second Series with tapas and gusto.  Another teacher told me it was my psoas, so I got rolfed.

Except that my hip pain didn’t really get any better.  Or, I couldn’t really tell. Some days it seemed worse; others better.  It was mysterious, coming and going unpredictably. I could bear and manage the pain as I was very good at enduring suffering (no pain no gain, right?) and also skillful at releasing my own trigger points with self-massage.  I would always find that the attachments of rectus femoris/sartorius were a troublesome area. But I quickly developed an accupressure release technique that worked consistently to remove the hip “popping” that accompanied the pain.  Oddly, I rarely had pain during my practice; it was usually the next day when I felt very sore, with a dull and persistant ache. I also learned to use isometric muscle action to pull myself off my range of motion.

Yet, nothing seemed to work with any consistency or constancy!

Tapas Turned Turbo
Except…the unthinkable.  Doing nothing. Resting.  Whenever I stopped DOING—yoga, running, biking, or anything physical— I got relief.  But given my Pitta nature, doing nothing wasn’t a good option! I was driven by a burning desire to be a good yogi, to test my limits, to be disciplined in my practice and to “practice what you preach, practice what you teach.”

I would not allow myself to rest for very long for fear of being out of alignment with the standard that daily practice was the measure of anyone wishing to be considered a teacher of integrity. Never mind that teaching was a necessity— my full-time livelihood—without which I would be without a roof over my head.

Oddly, the more people I asked for help —respected yoga teachers, doctors, muscle activation therapists, chiropractors, physical therapists, orthopedists, accupuncturists, energy workers, etc.—the fewer answers I got.  The message seemed to be that if I just did more yoga, or more aligned yoga, the pain would fix itself.  One person told me the pain was coming from my mis-tracking knee.  Another said it was some muscles in my lumbar that had probably atrophied years ago due to a low back injury.  A rolfer told me it was a tight psoas. And yes, my psoas was tight, and she worked on it, but it always got tightened up the next time I did any yoga.  No wonder. There was mechanical damage inside the joint capsule!

To get to the bottom of things, I turned my yoga practice in a new direction.  I invested myself wholeheartedly in a yoga method that was strongly grounded in therapeutics training.   I followed my teacher with faith.  She herself had moved from being an ashtangi to a hatha yogi because she, too, had an injury.  And her newly found hatha yoga path had healed it.  I was hopeful that I would get the same miraculous resolution.

Unfortunately, I wasn’t so lucky.

Ultimately, I was unable to find the answers from any of my beloved teachers or healers. I kept looking outside for answers, when somewhere, deep inside I already knew.

Yoga wasn’t going to fix the problem.  But no one was willing to say that. No one, and especially not me!

Then, if things weren’t already bad, in 2007 my right hip started hurting, presenting the familiar pain patterns as the left had done for years.

But I was lucky, or so I thought. I had a super strong sense of tapas.  I would not be deterred by pain.  Pain is for wimps.  And I am not a wimp!  It never occurred to me that the pain was a warning sign that something had gone wrong structurally.  I was way too young for arthritis!

At the same time, a lot of my yoga students were dancers.  A number of them had reported to me having an injury known as a labral tear, for which they were having corrective surgery.   I listened to their stories intently, with a vague sense of knowing that this was indeed exactly what I was suffering from.  Yet at the same time, their pain and suffering seemed far greater than mine! It just couldn’t be so.  And so I convinced myself that I couldn’t be suffering from the same condition.

Still, deep down, I knew that it was no coincidence I was attracting a lot of students who embodied the same injury I myself was dealing with. The longer you are in yoga, you see that this is a common pattern.  The student mirrors the teacher and vice versa.

The Breaking Point
I figured I would know when things got really bad and I could wait til then to do something.  It was the winter of 2011 when I was taking a class with a teacher I myself had trained, doing a posture I had long ago learned took me into boney compression—badda konasana, bound cobbler–a skeletal limitation I had discovered in studying with Paul Grilley.  But I had designed a way to do it where I experienced no compression and a lovely adductor stretch.

Yet on this day, when it was time to come out of the pose, I couldn’t!  My left leg would not move. Something in the left hip was broken, stuck in the joint!  I had to manually move my legs to get out of the pose.  I crawled out of class, scared for the first time.

Femoral Acetabular Impingement Syndrome
I will never know if the tear happened that day, or if I already had a tear that had just worsened. There is a pain pattern that can exist without tears known as Femoral Acetabular Impingement (FAI).

About the same time, one of the students enrolled in my teacher training made a post linking to a story about a yoga teacher with FAI and labral tears.  James was an acquaintance of mine, someone I had attended advanced Anusara trainings with, without knowing it. In his article, he explained how he tore both his labrums.

That was the moment when I knew I had a labral tear and could no longer avoid dealing with my hip.  A few months later, while hiking at my favorite hilly Metropark, the right hip tore. Just like that. Both hips with labral tears. Unbelievable in someone so “healthy!”

So that is the genesis of the ignorance, tapas, long-suffering, and denial that landed me squarely on the operating table.

Anatomy and Repair of a Labral Tear

Image courtesy of Ortho Enterprises, LLC via www.hipfai.com

Image courtesy of Ortho Enterprises, LLC via www.hipfai.com

I had arthroscopic surgery on my left hip with labral tear repair and debridement on December 7, 2011.  Thankfully, one of the top surgeons in the world was located right in my home town. It was a four-hour surgery—much longer than the usual two to three hour surgery —because there was so much damage to the soft tissue. Keep in mind it only takes 45 minutes to do a hip replacement. That gives you a sense of the amount of remodeling the surgeon had to do. My entire labrum had de-laminated like a gasket pulling away from the rim of the acetabulum. In addition, the labral tear was so severe that it had torn clear into the cartilage lining the inside of the acetabulem.  Ligament teres was torn clean in half. I had both pincer and cam debridement of a mixed impingement (see images).  The pincer impingement had created bone spurs in the head of the femur, effectively creating a cam impingement.

When I came out of surgery, my surgeon said the operation was a success and that I would return to full range of motion, even better, when fully recovered.

Today, more than two years later, I am certainly much better than I was before surgery, but not yet one hundred percent. I had such a miraculous recovery within the first thirty days post-operatively, I went back to teaching.  My first day back I slipped on the ice and re-injured and popped an internal stitch before the joint was healed.  So I have to have a revision.

Smart Yoga
FAI frequently leads to injury of the hip joint, a fact not well-recognized in the yoga community, or for that matter, in the world of athletics.  Increasingly, major pro-atheletes are experiencing FAI and hip injuries that often go along with it. Musician and singer Lada Gaga tore her labrum.

In addition to yogis, FAI and labral tears are becoming increasingly prevalent in soccer players, hockey players and dancers.  In yoga, heavy emphasis is often placed on protecting the vulnerable knee joint; whereas the hip joint is viewed as being too stable to injure. My teachers taught me this; and I myself taught my students this as I, too, was ignorant.

Any repetitive injury combined with a specific pincer or cam hip architecture (see link above), can lead to the FAI syndrome and complementary injuries such as labral tears and bone spurs.

Listen to your SELF more than you listen to ANY of your teachers. That is the essence of yoga. As my philosophy teacher told me, we only need a map (teacher) to get us to the territory (self-practice). Once you’re there, you don’t need the map anymore.

 

Just because you’re hurt, doesn’t mean you’re broken.
–Morgan Freeman in the movie Dolphin Tale

 

Laurel Hodory, MS, E-RYT500,  is a teacher’s teacher and has been studying and teaching yoga since 1992. She has trained and certified hundreds of yoga teachers, teaches workshops internationally and has trained the OSU NCAA Women’s Rowing team and provided professional development to The Ohio State University Dance Department Faculty.  She inspires and empowers her students to wake up and live from their Truth. When she’s not on the mat, Laurel enjoys music, being outdoors, good food, and spending time with her family and friends.  For more information, go to www.laurelhodory.com.