BraceLab Clinical Clues

February 2022 No. 25

Adding Resistance to Yoga Routine

by Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

After performing yoga thirty minutes each day for five days a week to manage stress, L.M., 57, developed right hip pain during and after yoga practice. With a history of anxiety and migraine headaches, she adamantly refused to resume anxiety medication or attempt different exercises. She was steadfast in her desire to continue her daily yoga.

Examination revealed excessive right internal and external hip rotation, accompanied by right hip abductor and extensor weakness. The challenge was understanding what part of her yoga routine caused these hip problems. Resolving her symptoms was complicated by her refusal to attempt any exercise other than yoga, and especially any specific strengthening workout.

The first step to finding a solution was evaluation of her yoga routine by observing her full program. L.M.’s routine consisted of supine and sitting breathing/relaxation, sitting flexibility, and standing balance/strength.

Observing L.M.’s yoga postures created two concerns. First, during her sitting flexibility posture, she consistently pushed her joints beyond their normal end range position. This was remedied with education about the undesirability of joint hypermobility.

Secondly, during the standing balance/strength exercises, L.M. experienced pain during warrior one, two, and three positions. The known decreased activation of the gluteus medius and maximus in yoga patients (1) correlated with L.M.’s findings of abductor and extensor weakness. To avoid specific strengthening exercises which the patient would refuse, resistance was introduced into her yoga postures:

Warrior One:

  • Usual yoga instructions: With the front leg knee directly over the ankle, straighten the back leg by pressing the heel towards the floor. Keep the arms over the head in an H position with the palms facing each other. (2) See Figure 1
  • Modification for L.M.: While maintaining the warrior one position with the hip and knee flexed, complete 15 repetitions of hip abduction against a resistance band anchored on an immovable object, or the wall/door, and looped around the right knee. The knee will transition from genu valgus to genu varum against the resistance. See Figure 2-3.

Figure 1: Traditional Warrior One pose

Figure 2: Starting position for Warrior One modification

Figure 3: Ending position for Warrior One modification

Warrior Two:

  • Usual yoga instructions: Keep the front leg toes to the right direction and the front heel aligned with the back foot arch. Bend the knee directly over the ankle. Sink the hips down towards the floor while keeping the head up to lengthen the spine. See Figure 4.
  • Modification for L.M.: While maintaining the warrior two position with the hip and knee flexed, complete 15 repetitions of hip abduction against a resistance band anchored on an immovable object, or the wall/door, and looped around the right knee. The knee will transition from genu valgus to genu varum against the resistance. See Figures 5 & 6.

Figure 4: Traditional Warrior Two pose

Figure 5: Starting position for Warrior Two modification

Figure 6: Ending position for Warrior Two modification

Warrior Three:

  • Usual yoga instructions: Shift all of the weight onto the supporting leg and keep it straight. Raise the back leg up and keep the hips, trunk, arms, and head in one straight line for the final position. See Figure 7.

Figure 7: Traditional Warrior Three pose

  • Modification for L.M.: Shift all body weight onto the supporting right leg and keep it straight. Raise the back leg up, keep the hips, trunk, and head in one straight line while holding a dumbbell in both hands. Lightly tap the dumbbell on the ground before returning to the starting position. Repeat this movement for 15 repetitions. See Figure 8 & 9.

Figure 8: Starting position for Warrior Three modification

Figure 9: Ending position for Warrior Three modification

As yoga continues to grow in popularity, it is valuable for all clinicians to expand their ability to evaluate and modify aspects of a yoga routine to relive specific symptoms.

 

1. Adler KL, Kenney R, Messing S, Giordano BD. Activity of periarticular hip musculature during yoga in patients with hip pain: a descriptive study of a case series. J Yoga Phys Ther 2016; 6(4):259. doi: 10.4172/21577595.1000259

2. Liu A-M, Chu I-H, Lin H-T, Liang J-M, Hsu H-T, Wu W-L. Training benefits and injury risks of standing yoga applied in musculoskeletal problems: lower limb biomechanical analysis. Int. J. Environ. Res. Public Health 2021; 18(16), 8402. https://doi.org/10.3390/ijerph18168402

 

Download Clinical Clues No.25, Adding Resistance to Yoga Routine; February 2022

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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