It’s no secret that most forms of asana practice today (at least the popular ones) involve putting our joints in positions that are relatively extreme compared to those positions which everyday activities demand – and many practices involve taking the joints into positions considered far beyond the physiological “norm” of range of motion for a given joint.  In this respect, the physical practice appears not too far off from other sports that require similar extremes such as gymnastics.  In the latter, the elite is determined not just by dedication and training, but by an unrelenting form of athletic Darwinism – in which only the strong [read: genetically predispositioned to perform well for this sport] survive to showcase and compete on a global pedestal.  In yoga however, the dialog is much different.  Depending on the lineage, community, and individual teachers, there is much encouragement that “practice and all is coming” – that anyone, provided they have the zeal, dedication, focus, and determination, can achieve…..what exactly?  It appears (whether this is the intent or not) in many circles that achieving Samadhi, enlightenment or spiritual purity is intimately interwoven with the achievement of physical asana progression into more challenging and often more extreme postures.   Where does this leave the physically disabled in their quest for spiritual higher ground?  That is a topic for another day!  Pain in this context then is not only regarded as “weakness leaving the body” as the popular sports mantra states, but as a good and necessary part of the process of the purification of body, mind, and soul that occurs through the practice of yoga.  No wonder yoga devotees of various disciplines find it challenging to navigate how far to take their bodies, and exactly how to use the sensations they’re perceiving as a guide.

Well-known Ashtanga yoga teacher Kino McGregor tells “how she and her students distinguish from the spiritually necessary pain that she seems to be describing in her book, and the pain that indicates injury. She affirmed the difference between acceptable delayed-onset muscular soreness and pain that is to avoided: joint pain, or pain within practice that makes the yogi wince.”

One suggestion on how to navigate this tightrope is the concept of compression vs tension as put forth by Paul Grilley, international purveyor of the Yin Yoga style.  He states: “There are two possible limits to range of motion: tension or compression. Tension is a synonym for ‘stretching’, it is the resistance of fascia (ligaments) or muscles. Compression is bone contacting bone or pinching tissue between bones.”  Baxter Bell MD, of Yoga for Healthy Aging elaborates further: “Compression really does feel like things (muscles, skin, tendons, ligaments, fascia and bones) are getting smashed together. And sometimes it creates a kind of pinching sensation as well. This pinching sensation is one that I tend to back away from pretty quickly if it shows up in any yoga poses. And because compression could also put collapsing pressure on blood vessels and nerves, if you start to have an unusual pressure sensation in the joint, or start getting numbness and tingling downstream from the compressed area, that is another good indication to release out of the pose a bit.”  This concept works fairly well from a specificity perspective: it’s a pretty safe bet to back off if you feel these sensations they’re describing as “compression”. 

The problem however: neither of these perspectives is quite sensitive enough.  You cannot say with any degree of certainty that just because you’re feeling nothing at all within practice or perceiving what you believe to be a “tension” type sensation that you’re safe in the pose.

Let’s get more specific with this conversation by focusing on one joint in particular: the hip.  The hip is one of the most oft requested “focuses” of a yoga class if opened with asking students for what they want to work on.  Louise Hay tells us the hip may contain lumps of stubborn anger at our parents.  It is commonly discussed as a joint to be “opened” and “accessed” as if a doorway to the divine itself.  The past two years have seen an exponential rise in research and discussion about the hip in medical, yoga and public forums.  More and more tales of hip injuries are coming to public light: Lady Gaga’s labral tear, Broad’s NYTimes article citing numerous yoga related hip injuries, Diane Bruni's hip injury following a five-year-long regime of hip-opening, and most recently Kino McGregor's hip/hamstring injury.

Before we delve into how far to open or stretch the hips, let's pause to consider some of the myriad of factors to consider that may contribute to various forms of hip pain or injury, whether acutely obvious, or insidious onset repetitive strain in nature.

• Directional morphology of the ball and socket joint (femoral head and neck within the acetabulum) - including hip dysplasia or shallow hip socket; anteversion (forward facing) or retroversion (side (relative backward) facing) of the acetabulum, femoral neck or both; inclination (up or down facing) of the femoral neck and/or acetabulum; this can provide a greater limit to range of motion (hypo mobility or "compression") or a lesser limit (hypermobility or too flexible) in various directions depending on individual specifics (Clohisy 2009, Harris-Hayes 2011, Hunt 2012, Sahrmann 2011, Lewis 2015, Foster 2015, Garner 2015)
  
• Femoral Acetabular Impingment (FAI) - the femur bumps into the acetabulum sooner due to either or combined: cam (a thicker bump at the edge of the femoral head) or pincer (prominent rim of the acetabular socket) (Dolan 2011, Reiman 2014, Frank 2015)
• The ligamentum teres which extends from the center of the hip socket to the head of the femur is important for hip stability and position sense.  Overstretch, partial or full tears can lead to microinstability; hypertrophy from increased strain can make the hip socket more shallow leading to instability.  (Cerezal 2010)
• Intactness of the acetabular labrum - a fibrocartilage structure that extends beyond the bony socket, containing few nerves at the edge to convey position or pain information, deepening the socket by 21%, contributing to our position sense of the hip joint, and providing a suctioning seal for the joint to maintain synovial joint fluid distribution and pressure.  For such an important structure, it has a poor blood supply for healing on its own (Hunt 2007, Groh 2009, Alzaharani 2014, Dwyer 2014, Nepple 2014, Garner 2015)
  
• Extensibility of the hip capsule, a thickening of the fascia around the hip joint I often call the "seran wrap covering", also known as a joining of 3 ligaments that run from the pelvis to the femur.  The looser the capsule, the less it can offer to stability of the hip joint - this looseness or laxity in the capsule is often biased toward one direction more than the other depending on the person's movement patterns and activity demands
• Soft tissue relative stiffness, relative flexibility - passive resistance from fascia (including the capsule, ligaments, tendons) or from intrinsic passive stiffness of muscle tissue
• Gravity through the body and through the joint - influenced by positional alignment of the whole body (aka posture) and the hip components specifically (Lewis 2010, 2014, 2015).  How does that influence soft tissue loading and where force transfers through the articulating surfaces?
• Subtle joint "wobble wobble" - also called hyper mobility or increased accessory motion influenced by many of the above.  "Wobble wobble" in the spine and sacroiliac areas can affect the hip via both mechanical and neural pathways and vice versa (Martin 2006, Benjaminse 2009, Hoffman 2011, Sahrmann 2011)
• Muscle imbalance - Subtle movement patterns or subconscious habits, imbalanced recruitment of muscles, muscle weakness, muscles too long or too short to do their job effectively (Casartelli 2011, Sahrmann 2011, Buss 2013)
• Diminished joint position sense or proprioception due to joint variation, injury history, or local or general fatigue (Benjaminse 2009, Cerezal 2010, Alzaharani 2014, Okhravi 2015)
• Altered sensitivity to subtle sensory information as occurs in victims of trauma (Levine 2010, Parker 2015)
• Trunk/core neuromotor control, breathing patterns, foot mechanics, the brain and central nervous system, hormones, nutrition, gut health, collagen makeup, genetics, epigenetics, fatigue, the thin line between zeal for practice and a type-A competitive drive (with yourself or other practitioners), pressure to perform (as is often the case for high profile teachers), psychoemotional/energetic/spiritual factors....and the list goes on and on!!!
  

So, not only are the factors leading to hip injury complex, but several of them limit your ability to feel your way through it via stopping when you wince or feel compressive type sensations.

In Paul Grilley's itemized response to William Broad's article about women's flexibility in yoga as related to hip injury, his assertion that "pushing through compression is impossible" is misleading.  If you consider that compression sensation is bone on bone, I could understand why one might say that.  But, consider that when we are talking about extremes of joint range of motion, the places where the bones are coming into contact are not the places they're meant to contact, and may not be as able to resist the attempted "stretching" i.e. compressive force and it is possible to injure bone tissue.  And, before you get to the point of bone-on-bone contact, you've at the very least angered if not damaged the smooth slippery articular cartilage that overs the intended points of contact (or articulating surfaces). Even if the points of contact of the femur and acetabulum are not affected, the force will move until it finds a way out - motion occurs where motion is available....the proverbial "something's gotta give".  And when it comes to yanking around the hip, that something is often the SI joint, spine, pelvic floor or knees.  In the skeletally immature (likely under 20 years old, but I've heard older when it comes to the female hip), putting excessive extreme forces on the skeleton is tricky business. It can and does halt growth and change the way the bones develop.

Remember the hip labrum?  When you "compress" the hip, the labrum will be compressed or sheared first because it extends beyond the rim of the socket. You hope it will bounce back, but that is not always the case, especially if you use your femur like a mortar and pestle.  Free nerve endings (that transmit mechanical and chemical information about pain and inflammation) and mechanoreceptors (that detect stress, acceleration and tension) within the joint that help tell your brain what's going on in the joint (proprioception, kinesthetic sense) should theoretically send a warning signal.  Some of these warning signals are designed to work on a subconscious level as a reflex loop in the spinal cord that triggers an action (or relaxation) beneath our conscious awareness.

I propose that we often ignore the signals that arrive at conscious awareness, but there is a larger issue at play - are we even getting the signals?  

When you bring your knee toward your chest (and other variations of deep hip flexion), it might make sense that the femur and socket are coming into contact in the front, at the top of the socket.  So, it is often suggested in some lineages to take the top of the thighs back or deepen the groins to make room.  If this is accomplished, what is likely happening at the level of the joint is that the femoral head (ball) is traveling to the inferior (lower) portion of the socket and often also posterior (back).  The more often you take the joint in this direction, the less resistance the capsule provides, and it starts going there whether you want it to or not....not just while you're practicing yoga.  Alzaharani (2014) demonstrated that the pain and pressure sensors in that part of the labrum are less abundant.  This means, when the hip goes into that inferior/posterior glide, you may not get a signal at all that the labrum is being "compressed" until it's been damaged, and you're feeling the compression of bone on bone (or the other sequelae of hip labral injury).  This direction of glide to excess over-stretches the six deep lateral rotators of the hip (especially quadratus femoris) - limiting their ability to effectively perform their important hip stabilization task, and potentially altering the nerve signaling traveling through the "nerve to quadratus femoris" which provides some of the innervation to the labrum - further dampening the signals! P.s. the imaging sensitivity for posterior labral tears sucks, so a lot of these injuries are flying under the radar.   

Kino McGregor has graciously granted me permission to show you a few images of her in yoga poses that stress the posterior/inferior hip capsule and labrum.  Although her yoga asana practice has not been implicated as the true underlying cause of her injury, these images illustrate the concept of posterior/inferior glide quite effectively from an external view.

Another important structure for hip stability and proprioception, the ligamentum teres (or ligament of the head of the femur) is also stressed in similar positions.  Cerezal (2010) states that "the ligamentum teres may be to the hip what the anterior cruciate ligament (ACL) is to the knee: a strong intrinsic stabilizer that resists joint subluxation forces...Patients with a torn ligamentum teres develop subtle hip instability, which sometimes is referred to as micro instability....Repeated or constant traction on the attachment of the ligament centrally leads to hypertrophy of the transverse acetabular ligament, which in turn further decreases the size of the acetabular fossa"  The more shallow the fossa, the less stability you get from the "ball and socket" nature of the joint - it becomes more like a ball rolling around on a plate.  Folks with some of the directional morphology we discussed above have lengthened or hypertrophied ligamentum teres, with the same amount of feeling sensors (free nerve endings and mechanoreceptors) as in a normal hip.  This would be like a police force having to keep watch over a larger perimeter with the same manpower - it makes it easier for something to go undetected.

What most yoga practitioners think they're tuning into is the sensation of muscle stretch.  The trick is, the more extreme we get into ranges of motion, the less position sense information we get from the muscles.  Benjaminse (2009) states "rotations into the limit of joint motion result in progressively smaller length changes in the muscles and in progressively larger tension in the joint capsule. In a sense, the capsule load sensors increase their response as the muscle sensors are losing their ability to detect angular displacement."  That's IF the capsule hasn't already been overstretched to the point that it can no longer provide that information when you need it.

So, how do we know how far we should go?  I think the more important question is why do we want to go there?

Truly investigating the second question for yourself on your own path of life and practice is the key to unraveling the answer to the first.  Unfortunately no one can answer that for you.  Not even your guru, your teacher, your coach or your physical therapist.  You must get to know your motivations on a deep level, and as we are human they may change from minute to minute.

I think part of that unraveling involves evolving an equanimous sensitivity to not just the gross physical sensations of pain, compression, tension, and joint position, but to the rich sensory experience of the whole that may over time aid our interpretation of what's good, safe and forward progress, and what's potentially hazardous to our wellbeing.  This sensitivitity is more challenging when we are fatigued, overloaded, overwhelmed, highly charged, or any imbalanced state of the central or autonomic nervous system.  This is often difficult to navigate alone, and working one-on-one with a somatic therapist or trauma-saavy counselor  can help tremendously.

Specific to what we discussed in this article, it can be quite helpful to get some outside input on what exactly your joints, muscles, nerves and movement patterns are up to.  It takes a special person to help navigate these issues when your movement goals are outside the "norm" of sports medicine.  Rather than me making some blanket recommendations on exactly who that should be, why don't you reach out to me?  One of my zones of genius is helping people find the right "team", and I'm growing my network every day.


P.S. For those of you reading this who are currently in the weeds trying to figure this stuff out in the midst of an injury, I send love, healing light, and empathy.  I've certainly been there myself more times than I'd like to admit :)

Several news articles popped up in the last week (1, 2) after an article in a surgical journal (3) highlighted how peering down at our tech devices increases loads on our spine.  Many of you may be thinking that most extreme 60 degree, 60lb force looks like some teenagers you know!  But, it's not just teenagers.  If you go out in public, and take long enough to look up from your own smart phone, it's all around you!  People of all ages have their head down in tech devices.  Maybe you say, "that's not me, I keep my head up straight and just look down with my eyes..." Another study (4), published before smart phones and tablets were so ubiquitous, suggests that merely gazing down with posture controlled was enough to increase spinal loading.  

So, why all the fuss?  Because this is not just a one time loading (although, I'd be hesitant to let a 60lb kid sit on the back of my neck!).  This is a repetitive position or sustained posture that we find ourselves in over and over again.  And, the more prolonged or more frequently our body does the same thing, the easier it gets.  The muscles on the front get short and/or lazy; muscles, ligaments, and fascia on the back side become too lengthened to do their job effectively, and over a period of years, the shapes of the bones may begin to wedge and adapt to that position as well.  As we discussed in a previous article, the body follows the path of least resistance just like any other mechanical system...ask your high school physics teacher!  And so, without intervention, the short gets shorter, the stiff gets stiffer, the long gets longer, and the weak gets weaker.

Now, imagine a day in the life of Bob... Bob wakes up and reads the paper over breakfast (he's old fashioned like that.)  Then, boards the train to work, reading articles and emails on his iPad the whole way.  At work, he spends much of the day peering down at a laptop screen.  After work he heads to his CrossFit box where his favorite WOD involves as many sit-ups as he can accomplish in a timed effort.  One of Bob's friends recommended that he try yoga, so he catches a class after CrossFit.  He's been going for about 4 months now and really feels like he's getting the hang of it.  After a vigorous class (involving more crunch-like ab exercises), the teacher invites the students to enter into "the queen of all yoga postures" Salamba Sarvangasana or shoulder stand, "if it is in your practice."  Bob looks at what everyone's doing, remembers that he used to do that as a kid and effortlessly throws himself up into shoulder stand.  After yoga, he heads home, spends more time on his laptop, then reads a bit in bed before going to sleep.  The next morning, he wakes up with a splitting headache and a sore neck and can't imagine why!

Ok, so maybe one time of doing shoulder stand won't necessarily send Bob reeling.  But, it can happen!  It's not just that shoulder stand though, is it?  Bob has been practicing all of those other postures of prolonged forward head position (reading the paper, his iPad, laptop, reading in bed) for far longer than his shoulder stand.  And thus, he set himself up for the relative stiffness/flexibility imbalance that comes with it.

There are a few more problems I see with this picture.  Did you catch them?  

1. Many ab exercises further exacerbate a slouching (flexion) of the upper (thoracic) spine by contributing to a shortening of the abdominal muscles that create stiffness from the ribcage to the pelvis. (5)
   
2. The teacher glorified shoulder stand in front of an all-levels class by calling it "the queen of all yoga postures."  I'm well aware that this is oft stated in the yoga community. (If anyone can tell me the original source, I'd love to know!) However, how can the yoga practitioner cultivate equanimity when they're hearing they're less of a yogi if they don't do shoulder stand?
   
3. The teacher said "if it is in your practice."  This statement is one of my pet peeves.  It is meant with good intention.  In a typical all-levels class, a teacher cannot be expected to monitor every single student and give each of them something to work on appropriate for their current needs.  The teacher is intending for the students to self-assess their abilities and needs and choose what is appropriate.  Teachers should know better than to think that a human being, with an ego and a mildly competitive spirit, in their first year of yoga will decide appropriately what they're ready for.  In fact, I remember back to my first year of yoga practice...shoulder stand was the first inversion I practiced on a regular basis!  Some of you may be gasping in horror, while others may be asking yourself "what's wrong with that?"

So, what's the solution?

"If you practice shoulder stand properly you have nothing to worry about"  Wrong.

• I can hear some experienced practitioners saying, "well, if you do shoulder stand properly, you don't put any pressure on your spine at all."  Point taken.  And I will agree that a properly performed shoulder stand is certainly better than Bob (and beginner me) throwing himself into what looked like the pose on the outside. However, just because the spinous processes of your vertebrae don't touch the ground, doesn't mean you're exempt from the forces of gravity going through your spine at very different points than they're designed for.  Look at the picture of smart phone guy again: that 60lbs of force is not coming from direct pressure on his vertebrae.  
• "I always do shoulder stand with props, never without."  Good.  Especially if you are practicing longer holds.  But, even if you have your shoulders on several blankets, your head is still forward, even if you are working to maintain a neutral curve or normal lordosis in your neck.  Although I don't know of anyone who has studied it, I'd bet even if you turned the middle smart phone guy upside down with his head on the ground rather than his feet, and supported his shoulders on blankets, there would be more than 40 pounds of pressure at that point.  Plus, I'm willing to bet that Iyengar didn't spend the rest of his day when he wasn't practicing yoga hovering his head over a tech device.  I would also bet that if he ever got injured, it wasn't publicized.  *gasp!*

"As long as you include a counterpose, you have nothing to worry about"  Wrong.

• I understand the thought process here, that the counterpose somehow cancels out what you just did, but it's not that simple.  What then is the counterpose for 10+ hours a day we spend with our heads forward?  Things like fish pose, gazing up in urdvha hastasana, taking the head back in cobra or up dog, looking between the hands in forearm stand or handstand are not going to magically undo what we've done in daily activities and shoulder stand or plow.  
• One reason being, it's more than just our muscles, ligaments and fascia that get stretched in that forward head position.  Our nerve tissue gets stretched as well.  In many individuals, this nerve tissue is sensitive and not relieved by back bending.
• It's not a rainbow-like forward bending curve most of us are creating in the neck.  Most of the time, there's a shear happening at the CT junction, or the part of your spine where the neck becomes the upper back.  With this prolonged forward head position, the lower neck (cervical spine) begins to slide forward relative to the upper thoracic vertebrae creating a movement like a shifting tectonic plate.  In this instance, going into cervical extension (like the counterposes mentioned above) may actually feel worse as there is increased pressure on the discs, joints and nerve roots.

Here are my recommendations:

1. Spend less time on your tech devices.  We could all benefit from this, myself included!  Batch process your messages rather than checking them constantly all day.  Be with whomever is in the room with you live.  Go outside.
2. When you do have to use tech devices, try to keep a neutral spine with normal curves and have viewing at eye level.  Support your arms on a pillow if necessary to hold books or reading devices.  If you do a lot of work on a laptop, consider a docking station or separate screen so you can have both gaze and arms at appropriate position.  If you work from home, consider some alternatives such as lying on the floor part of the time.
3. Minimize forward head positioning at other times (at meals, watching TV, while working out)
4. Re-calibrate your relationship to "core work".  A 6-pack may look nice, but it can work against your ability to maintain healthy spine positioning.  Curling your spine into a C shape does nothing to improve central stability.  Tucking your tailbone or posteriorly tilting your pelvis has also been shown to shut down your primary stabilizing team.  Don't believe me?  Comment or contact me for the citation.
5. Learn what it feels like to engage your cervical core.  No, I'm not talking about jalandara bandha.  I'm talking about balanced stability around the neck and scapular stabilizers.  
6. If you're a yoga practitioner and not sure that you're doing shoulder stand "correctly," or that you're ready for it at all, work with an experienced teacher 1:1.   
7. If you're a yoga teacher, be mindful of your language as mentioned above.  Consider that your students are "householder yogis" and doing all these things cumulatively outside your class.  Teach your students what it means to have a healthy curve in the neck and to maintain it first in progressive heights of bridge (setu bandha sarvangasana) before ever attempting shoulder stand, whether with or without props.  Hold firm authority in your yoga classroom that if anyone is doing shoulder stand in an unsafe manner, you reserve the right to give them an alternative, or ask them to sit out the pose.

Stay tuned for more training programs where you can learn one on one with me how to implement these recommendations, and what to do instead!

1. Arndt 2014. Here's How Much Your Non-Stop Texting Damages Your Spine. Popular Mechanics. 
2. Wilson 2014. Your Smartphone is a Pain in the Neck. CNN Health.
3. Hansraj 2014. Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head.  Surgical Technology International.
4. Bonney 2002. Head posture and loading of the cervical spine. Applied Ergonomics. 
5. Sahrmann 2002. Diagnosis and Treatment of Movement Impairment Syndromes.

There’s a simple fact of physics which applies to the human body: motion occurs where motion is available.  Ignoring this fact gets people into trouble in all walks of life from couch potatoes to elite athletes.  Relative stiffness and flexibility are especially important in yoga where we are looking for a balance between the two.  This concept was very simply and effectively explained to me by Shirley Sahrmann, one of the greats in the world of Physical Therapy. She took two metal springs.  One was less stiff (a smaller spring to make it obvious) and the other was more stiff (a larger spring).  She linked the 2 springs together in series (end to end) and pulls on both ends.  Which spring deformed a greater distance?  Well it was the less stiff spring, of course! Because it took less force to deform or stretch the less stiff spring, that is the one that moved first and most.
  
Let’s apply this concept in the human body.  Imagine a person entering into a forward bend (uttanasana).  Imagine that the hips are very stiff, and the spine quite flexible.  It should be no surprise that in this instance, just like the springs, the spine will move and stretch more than the stiffer hips.  Now imagine another person who has a very stiff spine, and extremely flexible hips.  This person’s forward bend would look quite different!  

Although a well-rounded yoga practice includes contorting the body in all different directions, yogis are just as prone to imbalance in stiffness and flexibility as the rest of the population.  Practicing unaware of those imbalances will lead to the relatively less stiff areas becoming even more flexible, with little if any change to the stiffer areas.  The trick is figuring out where your individual body’s imbalances lie and staying mindful of them during your yoga practice.  This is something that often necessitates a trained, outside observer to help you sort through.  A physical therapist is a great choice for this.  I will be completely honest that even though I am a physical therapist, I have a difficult time sorting through some of my own imbalances.  Although I look at these things all day long with my patients and yoga clients, I cannot appropriately assess myself from an outside perspective.  So, from time to time, I work with a trusted colleague to help me tease out those imbalances. That way I can bring more internal body awareness (proprioception, kinesthesia) to them in my daily life and yoga practice.  

The example of the hips mentioned above is quite common in people with low back pain.  Most often, the hips are stiff and don’t want to move into flexion (forward bending motion) as easily as the spine wants to flex.  In this instance, a yogi with lower back pain can try a preparatory posture before yoga class and/or at home.  This movement begins with a flat back on hands and knees (table top position), taking his/her bottom toward the heels – but only so far that the spine doesn’t curl up (like cat pose). This helps to teach the hips how to flex with the spine in neutral.  We often use this as a therapeutic exercise.  Be aware, as with any exercise, it is not for everybody.  There are some folks whose hips are too flexible toward the back of the joint for which this exercise would be contraindicated.  

Another common finding shows different areas of the spine to be relatively stiffer or more flexible.  In yoga this is particularly important due to the amount of back bending (spinal extension) we do.  In the clinic I often see people with very flexible joints at the base of the spine (L4-5, L5-S1) with quite a bit of stiffness further up in the spine.  Visualize a yogi in bhujangasana (cobra), ustrasana (camel), or urdvha dhanurasana (full wheel pose).  If, for instance, the mid thoracic spine (just below the shoulder blades) is much stiffer than the base of the spine, the majority of the back bending motion will happen as a hinge at the base. While for some people initially this can relieve pain (the McKenzie approach uses movements that look very similar to yogic back bends), over time, this leads to exploitation of those more flexible areas, and possibly increased pain down the road.

My number one recommendation for investigating relative flexibility in yourself is to get another set of eyes on you.  At a minimum, make a private yoga lesson appointment with an experienced teacher.  If you are injured or in pain, see a physical therapist.  Some medical professionals are friendlier toward the practice of yoga than others.  There’s a growing community of us who merge yoga and medicine.  You can search for one of these combo PT yogis in your area at www.fizzyyoga.info – and if you don’t find one in the directory, likely one will be added soon!  To work with me in person or remotely, send me a message on my contact form.

I hear this a lot from both medical providers and yoga practitioners.  I also hear people who shy away from yoga due to not being flexible enough (more on that in a later post!).  My favorite thing to tell people on either end of the spectrum is that yoga is all about balance.  If you are super flexible (or hypermobile in your joints) you can work on strength and control through yoga, if you are on the stiff side, you can work toward a healthy degree of flexibility through yoga.  

Why would a healthcare provider prohibit yoga?  Often, the person who can put their palms flat on the floor with no resistance is more than flexible in their muscles and tendons.  They have what we call hypermobility, or more than “normal” motion of the joints.  Conversely, not all hypermobile folks are outwardly flexible.

“Is that me?” You likely fall in the hypermobile category if you answer yes to any of the following questions:

• Have you ever been called “double jointed”? e.g. your knees or elbows hyperextend, you can touch your thumb to your forearm, your pinky finger bends backward more than 90 degrees
  
• Can you easily touch your toes in a forward bend or further? (palms on the floor, or past the feet)
  
• Do you get certain poses “for free” (with minimal effort) such as full wheel or camel or full shoulder binds?
  
• Do you love to have your joints popped (either by a professional or yourself) but find the relief temporary?
  
• Do you find it difficult or painful to remain in any one position for a prolonged period of time?
  
• Do you feel stiff and usually feel better if you move around or exercise?
  
• Do you feel stiff and crave stretching, but sometimes feel worse afterward?  
  
• Have you injured the same body part more than once, and each time, the precipitating incident more and more trivial?
  

Some of the uber flexible have a genetic connective tissue disorder called Ehlers-Danlos Syndrome in which the collagen tissue (which makes up much of the soft tissues in the body) is more elastic, or less able to resist tensile loads.  Whatever the cause of the hypermobility, there isn’t an easy fix to restore the joints to a more normal range of motion.  The best way to prevent injury and pain is to avoid taking the joints into their extremes of range of motion and strengthen muscles around the joints. 

If you are one of those hypermobile folks, what do you do?  In most cases, you don’t have to give up your yoga practice, but you will be better served by approaching it differently.  These are some basic suggestions to get you started, but as usual, if you are injured or have difficulty with these suggestions, seek out some private instruction with an experienced teacher and/or a PT who loves yoga! (like me!) 

Use caution with heated classes.  Some of our constitutions thrive on heat.  Heat feels great and allows you to stretch more.  However, if you are already hypermobile, adding heat to the mix may allow you to stretch past your healthy range without noticing it.  So, I’m not saying avoid heated classes altogether, but approach them mindfully.

Don’t take every pose to the most “advanced” variation.  The hypermobile person will often be instantly “good” at yoga.  They will be able to achieve the extreme shapes with relative ease.  Do not confuse this for being an “advanced” yogi.  What you don’t see in those experienced yogis is the incredible amount of work their muscles are doing in the poses.  Your pose may look similar on the outside, but if you’re not doing the work inside the pose, you could be abusing your body rather than nourishing it.  Most yoga teachers will offer “bus stops” or several variations of each pose.  Experiment with taking a different variation than you usually do and work on the following suggestions…

“Hug in.”  or “Hug muscle to bone.”  This is yoga speak for using your muscles in poses.  This achieves several outcomes.  1. It gets you focused on your body and moving with intention rather than achieving some outward ideal of the pose.  2. Activating the muscles around your joints in a balanced way helps create stability.  3. Over a long period of time, consistently activating those muscles will create “hypertrophy” – the muscles actually add more fibers in parallel.  This creates passive stiffness and helps protect your joints even when you’re not actively engaging them.

Move slowly.  It may be tempting to walk into those fast-paced level 3 vinyasa classes because you can achieve the shape of the poses, but being hypermobile often means your sensation of your body position and joint position (kinesthesia and proprioception) is more difficult to connect to, especially when moving at a faster pace.  The easiest sensation to connect to is that of muscle stretch – at this point, you may have already taken the pose too far.  Also, many of us have adopted resting positions of our joints which are already on the extreme side.  In that case, you can’t expect your body to magically find the optimal position on its own, certainly not when moving fast.  Instead, slow down and learn to connect to the sensation of the boundaries of your muscles and the subtle movement within your joints.  It’s quite fascinating and will transform your practice!

Reacquaint yourself with gravity.  If I were to try to sum up a multitude of movement impairments in one concept it would be an impaired relationship between your body and gravity.  When you are hypermobile, gravity’s opposite upward force doesn’t transfer quite the same from the ground into your body as it does in someone with a stiffer system.  You have to practice and train it.  For example: Feel even weight between both feet, inside-outside toe balls and inside-outside heels.  Use the muscles of the feet to connect to the earth and lift and support your legs.  When your hands are in connection with the earth, use the ring of the palm and fingertips to anchor down and support your arms.  Even starting here can make a world of difference for some!  Now, whatever is in contact with the earth, try some swaying front to back, side to side (like a metronome) or in small circles.  What I see happen in injured folks with these shifts is often the body bends like a blade of grass in the breeze, rather than a sturdy steel pole…as if the top half of the body is disconnected from the bottom half.  Making these connections is vital for your true core** strength.

Ask yourself some deeper questions.  Why do you do yoga?  Is it to push yourself to the extreme?  You may want to reevaluate.  A lot of hypermobile folks I have worked with are unwilling to back off their yoga or other activities the slightest bit in the name of mindfulness.  This is a dangerous mindset that in and of itself can be injury promoting.  Understandably, slowing down or backing off can be frustrating, but be patient and compassionate with yourself.  On another front, sometimes excessive “openness” in the body correlates with excessive openness in other layers of our person (energetic, psycho-emotional, etc).  You may be taking on more than your fair share of negative energy, emotion or stress from others around you.  Just investigate and cultivate an awareness of yourself.  It may take some time to really get to the bottom of it, but that’s what life and yoga are all about!

Here’s to finding balance in life and yoga!


**yes, I think core strength is vital for those with hypermobility just like for any of us…however, I think our traditional model as most of us understand it in the fitness and even rehab community is flawed.  More on that subject later!