Introduction
This essay will explore some aspects of yoga and hip work. The hips are an area which to most of us hold a lot of tension. This can have many reasons, but in this essay we will look at one specific problem, the piriformis syndrome. What are the main causes of performs syndrome and what asanas can we use to relieve the pain? Apart from that, I will also explore the statement that ’emotions are stuck in the hips’, which is commonly heard through out yoga classes – are there any relevance to this and how can this be addressed in our yoga classes?
The piriformis muscle
The piriformis muscle is located in the hip and serve as stabilizer of the scare iliac joint, externally rotates the femur and abducts femur when hip is flexed, as in tree pose. The piriformis is one of the deeper muscles of the hip and is covered by the gluteus muscles. The muscle is one of six external rotators of the femur bone and originates at the front of both the sacrum and ilium and inserts on the greater trochanter.
Piriformis syndrome
If your are suffering from pain in the hip and buttock accompanied by a radiating pain that runs down one of your legs, you might be suffering from piriformis syndrome. The symptoms usually increase after prolonged sitting, walking or running and can give reduced range of motion of the hip joint.
The sciatic nerve runs below the piriformis muscle on most of us, but on some it runt through the piriformis muscle, this increases the risk of piriformis syndrome. If the piriformis muscle gets tight or inflamed it can pinch the nerve, which causes the pain. The difference between piriformis syndrome and sciatica is depending on where the sciatic nerve is pinched, in both cases the sciatic nerve is irritated. Sciatica is caused by problems in the lower spine, as a herniated disc or other lumbar spine related issues. It is important to differentiate between these two conditions, since it should be treated in different ways.
So what causes the piriformis muscle to tense up and get inflamed? It could be over use of the muscle caused by long walks, running or to intense training. Other reasons could be a hard pressure on the muscle while sitting on a hard surface, or sitting on uneven surface, e.g. having something in your back pocket. Yet other causes could be larger traumas to the hip in a car crash or an unbalanced hip, causing strain on the muscles of the hip.
Yoga asana as treatment
Yoga have proven to give good results as treatment of piriformis syndrome if practiced wisly and with caution. Yoga could also make things worse, of course, if practiced in an unhelpful, to aggressive way. What we need to do is to mobilize the hip, spine and open up the muscles of the hips, lengthening and release. It can also be helpful with restorative poses to relax the piriformis muscle. In forward folds the spine should elongate and length should be superior to depth, in order to protect the lumbar spine and sacroiliac joint.
Ardha matsyendrasana – This seated twist gives the piriformis a mild stretch in its half form. The further you get to the full version of the pose the deeper the stretch of the piriformis muscle is, but be aware, stretching to aggressively can cause sciatic pain and increase the problem. It is recommended to have you elbow softly around the bent knee instead of hooking your elbow on the outside of the knee not to cause more tension in the hip.
Supine spinal twist – Another easily accessible stretch of the piriformis is a supine spinal twist, either with bent knee or with the top leg stretched out.
Gomukhasana – This form helps to stretch out the hip rotators. It can be performed with the bottom leg folded in or stretched out. The knees are aiming towards stacking onto one another. Keep the hip bones rooted and the spine long. A folded blanket can be used underneath the hips, if sitting up is too hard. To intensify the stretch, forward fold with a straight spine.
Agnistambhasana – This is my favorite pose to stretch the
piriformis, but takes a quite open hip to perform and knee problems is a contra indicator. The lower legs are stacked onto each other, knee aiming for opposite ankle, feet are flexed to protect the knees. Both seating bones should be firmly rooted into the ground. If knees are not touching ankle, one can just stay with the spring upright, if there is not much stretch in the hip, one can start to forward fold with an elongated spine.
Raja kapotasana – Another intense hip opener that stretches the piriformis in similar way to angistambhasana. here there is also nee to be aware of the knee joint and go carefully not to over stretch. One knee is bent, coming out to one side, toes pointing down towards the groin. To intensify the knee can be bent closer to a 90 degree angle. The other leg is stretched out behind. To start with one can be on hands and with the spine erect and then move into a forward fold, trying to keep the hips aligned.
Supported setu bandha – This is a pose not to stretch the piriformis but to relax it. Put a block underneath the hip in a hight that does not cause pain or compression in the lower back. Keep feet firmly on the ground and don’t let the knees fall out too much to the site. Then try to relax the hips, buttocks and groins as much as possible.
Other helpful asanas and movements – All sorts of warming up exercises as sun salutations, mobilizing movements in all fours and rotation of the hips can be
helpful to relieve the spasm in the piriformis. Caution in lifting up the leg backward in e.g. salabasana. In my experience lifting the leg from the inside of the thigh and inward rotating the leg has been a helpful approach not to strain the piriformis.
Another observation of my own is that is is very helpful to combine piriformis stretches with opening of the hip flexor, as supta virasana or equal.
Emotions and hip tension
It is commonly heard in yoga circles that emotions and hips have some sort of connection, that by opening up the hips we can realize emotions that are somehow stuck here. To someone who have been practicing yoga it is not illogical in any way that the body and the mind is connected, but are there any research around this and how can we incorporate this notion into our yoga classes and make it helpful to our students?
I do not find a lot of secular research on the topic, yet the idea of body and mind connection is relatively new to western medicine. One interesting study was made in 2013 where participants from both Europe and Asia was asked to mark in an image of the body where they perceived different emotions to be located. A high percentage of the participants marked the same areas, as seen on the figure to the right. This indicates that there is a correspondence and a sort of emotional echo in the body. We all know this, don’t we?
There are not much research to be found around hips and emotions but Psycology today mentions one study in Germany where there was a connection found between the jaw muscle and the hip. When participants released the tension in their jaw, the range of motion in the hip increased remarkably.
The hip region is a hub for many things in our body, as the digestive system, genitals, big nerves, base of the spine and many muscles. It is not surprising that this area can feel vulnerable to open up. In the yoga world there seem to be a joint understanding that opening up the body can cause emotional release, but how this should be encouraged, performed and done there are different views on. Some teachers as Anna Forrester, founder of Forrest yoga, argues in Yoga Journal that she thinks that her role is to push her students to go into their emotional pain in order to release it. In a certain area of the body feel tender she encourage her students to focus on that area, with asana and pranayama. Yet other teachers advocate a more subtle approach, that pushing might cause more damage than good and that the practice should be focused on self-acceptance rather than wanting things to be different than they actually are, and then the unfolding will follow naturally.
Conclusion
How can we incorporate this perspective in our yoga classes? In the start of this essay we explored the piriformis syndrome and potentially useful asanas. Just clinically performing asanas without an holistic approach might release symptoms of pain in the body, but to create change and helpful habits in the long run, I believe we need to take our whole being onto the mat. In my own life I can definitely say I feel a connection of emotional pain and hip pain. But of course we can approach our hip pain from all sorts of levels at the same time, stretching, breathing, meditating and reflecting, all at once. The way we live, move and feel are all connected in an intricate web and one thing will definitely affect another.
In a yoga class we need to take this into consideration, without making a drama out of it. If teaching a hip opening class, it might be helpful to mention that hip work can release emotions, but nor necessarily, mentioning it can also give expectations that are not helpful. We could also just encourage our students to stay kindly and mindfully present to whatever appears, hip work or shoulder work equally. In my opinion we need to take a balanced approach to pushing our students or not. Depending on the group and how well you know them you need to take different actions. Encouraging people to stay with an intense asana for a long time might be a good idea, but in a general class I would always give students the option to back out. When approaching what is painful, terrifying of sad we need a certain amount of stability and integration and it is up to people to figure out themselves whether to push on or back out.
