You may have this condition, and not even know it. In cadaver studies, 93-96% of (careful) hip dissections show hip labral tears (full disclosure: the average cadaver age was 78, but read on).
The labrum is a fibrous lip of cartilage that deepens your hip sockets the way a maternity waistband hugs a pregnant belly (and makes pants less likely to fall down). The labrum has been shown to stabilize the hip in the socket in a similar fashion to the aforementioned pants.
Labral tears fall on a Venn Diagram of hip aches and pains that frequently overlap with “Femoroacetabular Impingement”, also known as FAI (see my own drawing below). FAI usually affects younger to middle age population (as opposed to clear-cut osteoarthritis that is most often diagnosed in older adults) and some authors have associated a physical (hatha) yoga practice with FAI.
Correlation doesn’t equal causation, and I’ve been sitting on this blog post concept for a long time — I think some clarity on the topic of hip injuries and yoga is overdue.
What is Femoroacetabular Impingement?
FAI is notable because it is con
sidered a cause of premature osteoarthritis, i.e. is on the continuum of degenerative joint disease. Your femur is your thigh bone, the largest and strongest bone in your body. The acetabulum is the socket in which the “ball” or head at the top of the femur rests. Together they form the hip joint, or very specifically, the femeroacetabular joint.
The pinching or impingement of FAI is the thigh bone pressing against the socket, the acetabulum. Other bony prominences of the pelvis can also cause hip impingement. This may be developmental or congenital, or stem from repetitive extreme ranges of motion. Compression of soft tissue between bone is also possible, and the labrum may be trapped between the thigh bone and acetabulum or the thigh bone and another portion of the pelvis.
The person in pain can’t decipher which one is happening without diagnostic imaging, like an xray or an MRI. Anterior or groin pain is a key symptom of FAI, and almost certainly involves abnormal hip joint mechanics. Pain may show up posteriorly or come on only a certain range (usually full flexion – for example, knee to chest – with internal rotation taking the heel out to the side and knee to opposite shoulder). Instead of pain, there may simply be limited range of motion, typically from the femur having abnormal contact with the socket.
(FYI, many people have a non-symptomatic labral tear).
A diagnosis of Femoroacetabular Impingement is not particularly helpful in isolation. It doesn’t doom you to surgery. I’d recommend vetting out what might have caused it, and whether you have any of the following conditions that are close relatives of FAI:
Western science’s understanding of FAI and labral tears is evolving, but we know that both are much more widespread than previously thought. They may even account for some of cases of back pain due, SI joint pain, or even pelvic pain, the pain referring from the hip.
Labral tears are very likely under-diagnosed, and are estimated to be the cause of hip or groin pain in athletes up to 55% of the time.
What causes FAI?
This is the juicy part I want to emphasize: anyone for almost any reason can get FAI. FAI and labral tears are frequently associated with an active lifestyle, and athletic pursuits, but also have genetic (or epigenetic) contributions.
Labral tears are most frequently at the front of the hip and often are associated with sudden twisting or pivoting motions. Can hatha yoga cause them? Possibly: a rapid transition from ardha chandrasana (Half Moon Pose) to revolved Half Moon Pose could be a cause, but would be much more likely if the hip joint was stuck or unstable initially.
However, this is crucial to point out when vetting cause vs. correlation: more than 3/4 of hip labral tears have no clear cause. The presumptive cause in these cases is repetitive activity. There are repetitive styles of hatha yoga, and teachers with formulaic or repetitive class plans, but hatha yoga itself is vast and quite far from repetitive.
For context, a random smattering of recent patients that I’ve treated with hip labral tears include:
Sports commonly associated with hip labral tears include: hockey, soccer, cycling and ballet. Ballet is often lumped together with yoga asana (they are not the same) and other styles of dance (also not the same) in popular media articles on this subject, which I think is an unfair comparison, though I understand the linkage.
But just being alive and moving may cause these conditions.
Treatment is usually multi-pronged and may range from “conservative” (noninvasive) to major surgery.
On the conservative side, treatment may include:
Did Yoga Cause my FAI, hip pain or Labral Tear?
It is certainly possible that a yoga practice contributes to hip pain, FAI, osteoarthritis or labral tears. However, you – the yoga practitioner – may have developed these issues anyway – either from pre-disposition (more on this in a future post) or from a distinct physical activity that yoga replaced in your life.
Yoga may also save you from FAI (and its ilk) by 1) increasing your bodily awareness and alerting you to what doesn’t feel ok and 2) from widening your general spectrum of movements and even 3) from its therapeutic qualities (a vague statement, I’m not stating that all yoga is therapeutic).
I don’t have a magic wand to prevent these hip pathologies, however, a few gems:
As a rule, don’t get into a rut with your yoga practice. Let’s say forward folds are easy for you: do the opposite (a concept from Patanjali’s Sutras known as pratipaksha bhavanam). Use your practice to go into the places that are limited, not to show off your extreme range. Say no to frequent splits (hanumanasana) and passive end-range wildness like foot behind the head pose (eka – or dua – pada sirsasana).
Juice up your transitions. The spaces between the poses and the time getting into the poses are *just* as important as the pose itself.
Pump up the grace all over the place!
Want to try moving from garudasana to hasta padangustasana to ardha chandrasana? I may not teach it, I may not even recommend it for most, but I am not going to stop you. The solid weight evidence isn’t there to point fingers at this as a cause any more than cycling or sitting — if practiced cautiously. To practitioners and teachers alike: please proceed slowly with a level of care and precision in the transitions at least as much as you would give to the poses.
Have you experienced hip pain? Or a diagnosis of femoroacetabular impingement or hip labral tears? Are you a yoga teacher who has stopped teaching or practicing long sequences on one foot / one side? I’d love to hear from you in the comments below.
Originally published- 03/19/2015