Hip Pain in Yoga: How to Modify Poses for Students with Femoral Acetabular Impingement (FAI)

Hip pain related to yoga is a really common injury presentation I see in clinic.

This week in clinic I had a patient present with hip pain, that was worsened through yin yoga poses and she was finding it hard to still practice.

It’s important as a teacher to understand what could be happening so you can advise the student when they are suffering from pain or injury. Ultimately, you want every student to be able to continue a yoga practice, but you must be confident in conducting safe modifications to allow them to do so.

The patient presented with pain in deep hip rotation poses, such as pigeon and bound angle. The pain was local to the front of her hip joint and was sharp upon movement.

After assessment I diagnosed the patient with Femoral Acetabular Impingement (FAI).

FAI is when combined hip flexion, internal rotation, and or adduction can cause impingement of the head of the femur against the labrum (the thigh bone against the hip socket).

Put simply, hip impingement occurs when the femoral head (head of the thigh bone) and acetabulum (hip socket) don’t fit together properly, and as a result, cause pain. FAI most commonly occurs with combined hip flexion and internal rotation of the femur. This can be a result from genetics or development.

As a teacher, it’s essential to know which yoga poses may trigger or exacerbate hip impingement.

How can YOU do to modify this for the student?

Poses that may create pain and therefore to avoid and modify

• Chair with a twist- This pose may increase hip flexion and internal rotation, both of which can worsen hip impingement. Modify this by using props or guiding the student to avoid deep twisting in the lower body.

• Seated spinal twist - deep internal hip rotation in a seated twist can be painful for someone with FAI. Instead, encourage a more gentle twist and keep the knees aligned or slightly wider to reduce the strain on the hip

• Revolved high lunge -this pose also requires deep hip flexion and internal rotation of the front leg, which can increase pain for someone with hip impingement. Modify this by adjusting the student’s stance or offering alternative poses such as low lunge with a gentler twist

• Knees to chest- This pose often involves deep hip flexion and compression, which could increase pain. Use props like a bolster or blanket to prevent deep flexion and create a more neutral position

  Practical Modifications for Hip Pain in Yoga

• Use Props for Deep Flexion
  For poses like Pigeon or Bound Angle, consider using props such as a bolster between the thigh and belly to reduce hip flexion and rotation. This can help prevent deep impingement and create a more supportive position for the hips.

• Open Twists
  When working with a student who has FAI, try using open twists rather than deep revolved poses. Open twists—like those commonly practiced for pregnant students—can provide the benefits of a twist without placing undue stress on the hips.

• Adjust the Student’s Stance
  Sometimes simply adjusting the student’s stance can help. In poses like Warrior 2 or High Lunge, try widening the stance or bringing the feet farther apart to reduce the amount of hip rotation and flexion.

• Avoid Overstretching
  Encourage the student to avoid pushing too deeply into poses. Ensure that the student feels supported and avoid deep internal hip rotation or flexion, especially during longer-held poses.

Proper modifications are key to helping your student continue practicing yoga safely and effectively. Without modifications, there’s a risk of further damage to the labrum in the hip joint, which could worsen the injury and, in the worst case, require surgery. Remember we always want our students to be able to still practice yoga, so they can maintain strength and flexibility elsewhere and can still mentally benefit from yoga and from the the positive impacts yoga has on their nervous system.

As a yoga teacher, it's your responsibility to ensure your students stay safe and supported on the mat, while still receiving the full benefits of yoga. Understanding the anatomy of hip pain and being confident in yoga modifications can help keep more students on the mat, moving safely and effectively.

I hope this helps! .. Any questions? sophie@homebodyanatomy.com