Hip Joint Pain

Create space in the hip joint, a possible solution to hip joint pain

One simple solution is to focus on creating space in the hip joint.

If your knees are straight you can start by pressing your feet away from your pelvis. Imagine pulling on a tight pair of hip boots. Push your foot outwards away from the hip joint. Or imagine pulling on super tight jeans. But not too tight.

Once you get the action (and if you pay attention and do the action slowly you'll notice tension in the butt or inner thigh or outer thigh) you may also notice that it seems as if the head of your femur is moving slightly away from your hip joint, then try it with the knee bent.

In this instance try moving or pushing the knee away from the hip joint.

Generally when first teaching this action I'll have students lengthen the leg and then lengthen the spine and then relax, just to help get the feel for the action.

I go over the why of this action and what causes it in my hip joint anatomy article.
Basically you are learning to use your obturator internus and gemellus and perhaps in a forward bending situation, the obturator externus.

It can be overdone, and I've overdone it to the point of including the movement in every pose during a routine and then what happens is an unpleasant feeling in the hip, exactly as if I'd overdone it.

So I'd suggest practicing to the point where the original hip pain is no longer there.

Note that in a pose like this seated hamstring stretch, where the arms can be used to pull the leg into the hip socket, I'd suggest reducing arm tension, modify it so that you use the arms to help lift the leg without pulling the leg into the hip socket.

Create space in the hip joint while inhaling, then gradually add tension to the arms so that you pull the leg into the hip socket.

This then strengthens the muscles that create space in the hip joint.

With enough practice of this technique over time you may find that you can use your arms to pull the leg into the hip socket and the muscles that create space are strong enough to resist the compression.

Hip joint pain in marichyasana and ardha matsendrasana, pulling slack tissue out of the way

In poses like marichyasana or ardha Matsyendrasana you may have some slack muscle or connective tissue and when you go into an extreme position that connective tissue gets caught between thigh and pelvis (at least that's what it felt like to me.) And so a possible solution is using muscle tension to pull the slack tissue out of the way.

In a posture like matysendrasana or marichyasana c you can try activating the quadriceps.

The idea in so doing is to help pull some of your connective tissue out of the hip joint.

Or try pressing the knee inwards and then resist so that you activate the inner and outer thigh simultaneously to stabilize the hip, and as mentioned, help draw any loose tissue out of the way.

You may also find that it helps to adjust the position of the pelvis. If your left leg is on top try moving the right side of the pelvis back a little (turn the pelvis to the right) so that you create space.

You could also work at creating space (and length) in the torso. To do so draw the lower belly in. Then draw the backs of the kidneys up, away from the pelvis. Try emphasizing one side then the other.

Lifting the backs of the kidneys (or if you like, the bottom/12th ribs) activates some fibers of the respiratory diaphragm and pulls up on the uppermost fibers of the psoas muscle (at least that's my understanding of what happens.)

The feeling is different than that of pulling up on the back ribs (which uses the Levator Costarum muscles.) When pulling up on the backs of the kidneys it feels like the support is coming from deep within the body.

Activating the levator costalis, the feeling is more external and can involve all of the ribs (where pulling up on the kidneys only seems to involve the lowest pair of ribs.)

Hip pain in Pyramid pose and revolved triangle, a sequence of activations for stabilizing the hip

If you get pain in the hip joint of your front leg in standing poses like pyramid pose/parsvottanasana or revolved (twisted) triangle, where you are bending forwards with the legs straight, a sequence of actions that can be used to stabilize the hip are as follows:

• First press the front of the foot down so that the foot feels strong. Prevent the heel from liftin as you do this.
• Create space in the hip joint of the front leg by creating a rearwards (and upwards) push on hip bone back, away from the femur. Alternatively, try pushing the knee away from the hip bone. In either case, look for a sensation of space in the hip joint as you do this.
• Try slightly internally or externally rotating the thigh relative to the pelvis (turn your knee slightly inwards or outwards) to vary the sensation in your hip.
• Try pulling outwards on the sitting bone of the forward leg while keeping the thigh and pelvis stationary.Alternatively, try pushing inwards on the sitting bone.

Hip pain, activating pectineus or obturator externus

Another action that you can try is pushing back on your pubic bone. If you do this while standing to begin with, you can first of all try creating a rearwards push on your pubic bone without allowing your hips (or legs) to move. You should notice your butt muscles activating. You might also notice that you can feel your sitting bones as you do this. (Try activating and relaxing a few times to get a feel for it!)

From there, try the same action but focusing on one side of the pubic bone at a time. Try pulling back on the left side of your pubic bone. Notice your left butt activating and notice a pull on your left sitting bone. Repeat for your right side.

Once you get a feel for this, try slightly moving your pubic bone left or right to adjust the activation sensation. Then try the same thing while in pyramid pose or revolving triangle.

This may activate the pectineus muscle or the obturator internus or both.

Activating the sides of your waist

To further improve the possibility of alleviating hip pain, once you have a feel for pushing back on your pubic bone, work at lengthening both sides of your waist. Try pulling the sides of your ribs away from your hip bones. From there, create a downward pull on the sides of your ribs to help add more tension to the sides of your waist. Alternatively, after pulling the sides of your ribs upwards, simply pull inwards on the sides of your waist.

As well as feeling the sides of your waist activate, you should be able to feel the hip crest of each hip bone.

To adjust so that both sides of your waist feel even you can try sliding your ribcage slightly forwards or rearwards relative to your pelvis. You can also try sliding it slightly left or right relative to your pelvis. You can also try slightly twisting.

Alleviating hip pain by lifting the fronts or backs of the ribs

Another alternative for varying the pull on your hip crest is to try and accentuate the lift of your front ribs away from the front of your hip bones. Alternatively, try lifting the backs of the ribs away from the back of your hip bones. In either case, once you have a feel for lifting the fronts or backs of your ribs, make slight adjustments so that the sensation is even on both sides of the waist. Alternatively, use the same adjustments to see if if helps you to better alleviate hip pain and make your hips feel more comfortable.

One reason lifting the fronts or backs of the ribs may help with alleviating hip pain is that by doing so we anchor the front of the hip bone (by lifting the fronts of ribs) or the back of the hip bone (by lifting the backs of the ribs). In one case, we anchor one end of the obliques, in the other, we anchor one end of the spinal erectors. With one end anchored these muscles can then generate a pull on the front or rear of the hip bone.

Activating iliocostalis by exerting it against the obliques to stabilize the ribcage and hip bones

For greater stability, you can exert a downward pull on the backs of your ribs to lift the fronts of your ribs. You'll be using the spinal erectors, in particular the iliocostalis and longissimus.

From there, you can create a downward pull on the fronts of your ribs without allowing your front ribs to move. You should find that this activates your abs. (If you feel this at the side of your waist, it's a good indication that you're activating your obliques!) At the same time, the sensation of activation at the back of your body will increase your obliques are activating against your iliocostalis.

This dual activation of opposing muscles helps to better stabilize your hip bones which means that the muscles of your hip have a stable end point from which to act across the hip joint.

Combining this with the previous action of pushing back on your pubic bone, you can generating the pull on the pubic bone first, then from there create the pull on your ribs. Or try creating the pull on your ribs first and from there then create a rearward push on your pubic bone. Adjust by rotating your knee left or right. Alternatively adjust by shifting your ribcage relative to your pelvis.

Activating longissimus and pubococcygeus to help stabilize the sacrum

When creating a downward pull on the backs of your ribs, if you can generate a pull closer to the spine, you may be able to activate the longissimus muscle. The fibers of this muscle attach in part from the long dorsal sacroiliac ligament which attaches from the back of the hip bone near the PSIS to the sacrum and from there runs up the back of the body to attach to backs of the ribs.

Note that to aid in their activation, you may find it helps to activate pubococcygeus (the article is about learning pubococcygeus activation to reducing flatulence.) And so what you could try doing is pulling your tailbone towards your pubic bone to activate pubococcygeus. (Do so without allowing your pelvis to move.) From there push back on your pubic bone relative to your femur. (Again, create a push without allowing your pubic bone to move). From there, generate a downward pull on the backs of your ribs, generating the sensation closer to the spine to target the longissimus, but also try radiating the sensation slightly outwards, away from the spine, to also activate iliocostalis.

Further to the above, because longissimus attaches to the long dorso sacroiliac ligament, you may find it helpful to add tension to this ligament as a way of anchoring the thoracic longissimus and stabilizing the SI joint. Note that this can require adjusting of hip bone positioning and tension in the hip joint as well as adjusting the position of the ribcage relative to the pelvis (sliding the ribcage forwards or rearwards relative to the pelvis) and also adjusting tension while exerting the iliocostalis and longissimus against the obliques.

Activating the adductors to help alleviate hip pain

More than likely you may find that one of the above activation suggestions helps initially, but you still experience hip pain the next day, and the same activation no longer works.

If the rib and side of the waist activation helped, we can reason that it helps to stabilize the crest of the hip bone thus anchoring the hip muscles from above.

An alternative is to anchor those muscles from below by stabilizing the ischiopuboramus. On each hip bone, this is the bottom edge of bone that joins the pubic bone to the sitting bone. It may help to think of them as like the rockers of a rocking chair or rocking horse.

The main muscles that attach here are the adductors or inner thigh muscles. The bulk of these muscles attach to the back edge of the femur.

After first pushing back on one side of the pubic bone, try creating an inward (and upward) pull on the back of the femur to activate the adductors on the same side leg. Prevent your femur from moving. In particular prevent it from rotating. That said, once you can get some sort of activation response you can try adjusting the rotation of your femur slightly to get a better feeling response. Alternatively try turning your pubic bone (and thus your pelvis) slightly left or right relative to your femur.

Note that a further tip for activating the adductors is to create an inwards pull on the femur relative to the hip bone. Or try creating a downward pull on the ischiopuboramus (remember, the rocking chair rocker) relative to the same side femur.

More on dealing with Hip Joint Pain

For more on hip joint pain, in particular at the front of the hip joint, read Anterior Hip Pain

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