Preventing Yoga Injuries vs Preventing Yoga, Part III: Joint Mobility, Stability and Proprioception

By Ray Long

A central concept in all healing arts is that of correcting imbalances within the body. The principle of re-establishing balance can be found across all cultures from Navajo sand paintings, Ayurveda, Traditional Chinese Medicine to modern allopathy. And anything with true healing power also has the capacity to cause injury when practiced without balance. For example, joint mobility is beneficial for a number of reasons–provided it is balanced with joint stability. In this blog post I discuss the concept of joint proprioception and its relationship to joint stability and yoga, concluding with a tip for “re-setting” muscular proprioception following hip openers.

Proprioception refers to the sense of the relative position of neighboring body parts, such as the femoral head within the hip socket (acetabulum) as well as the muscular force utilized in movement of those parts. This is in contradistinction to exteroception, which is the perception of the outside world (like the feeling of the feet on the ground) and interoception, which is the perception of the inside of the body (pain, hunger etc). I look at proprioception as a type of “GPS” for the joints.

Joint position is detected by specialized nerve endings known as “proprioceptors” that are located within the muscles, ligaments and joint capsule and the periosteum (on the surface of the bones). These receptors communicate information about the joints to the brain via the sensory columns of the spinal cord. Conscious sense of joint position is transmitted to the cerebrum of the brain; unconscious proprioception is communicated to the cerebellum. Figure 1 illustrates this pathway in a cross section of the spinal cord.
spinal_tracts
Scientific studies have demonstrated that joint position sense is decreased in persons with osteoarthritis, with the consideration that reduced proprioception may play a role in the development of the disease. Indeed, exercises that improve proprioception have been demonstrated to be effective in the conservative management of osteoarthritis.

Proprioception is also reduced in persons with joint hypermobility; exercises that improve joint position sense are also effective in reducing symptoms in this population. I suspect that proprioception may be also be a factor in those having joint pain associated with subtle instability (who do not have an identifiable cause for their pain such as arthritis, hypermobility or a structural lesion). Similarly, the diminished performance seen in certain athletes following stretching routines may be related to reduced joint position sense.

I bring this up in relation to yoga because certain individuals experience soreness in their hips following hip opening poses. Understanding that this pain may be related to decreased proprioception, I have been using a simple technique to re-establish joint position sense following these poses. For example, I worked with several practitioners during the Blue Spirit Intensive who had this type of hip soreness. Following a sequence that led to Full Lotus, we applied the technique, which “resets” the joint position sense in the hips. After the “reset”, these folks noticed that the hip pain they typically felt was gone, with this benefit remaining throughout the day.

This leads me to believe that some of the hip pain experienced by practitioners may be related to a reduction in muscular proprioception after stretching, which persists as a subtle form of instability during other activities following practice. Furthermore, the soreness appears to be relieved by a technique to increase proprioception that involves co-activating the muscles surrounding the hip joint at a midpoint of the joint’s range of motion.

Here’s the technique…

Following a hip opening sequence, and before Savasana, I utilize an intermediate version of Warrior II, where the forward knee and hip are not flexing deeply (figure 2). Then I “co-activate” the hip muscles in the forward leg (co-activation involves simultaneously contracting muscles that have opposite actions). The cue for this is to imagine pressing the inside of knee into an immoveable object while at the same time pressing the outside of the knee into a similar object (the knee remains centered and does not move). This engages both the hip adductors and abductors, as well as the internal and external rotators in a position where the joint is in the mid-range of motion. Done properly, this cue should give a feeling of stability in the hip joint.

Since it is a neurological process, this technique does not require strong muscular contraction; I only utilize just enough strength to feel the muscles engage and the hip stabilize. Furthermore, the cue only requires a short duration. I have been using 20 seconds, repeated twice on each side. The effect is a bit like “resetting” a GPS that has gone out of its normal range. Figures 3-5 illustrate the muscle groups involved with the arrows demonstrating the direction of force. Visualization of the muscles helps in this process.

Figure 2: Warrior II intermediate version. I use this for training proprioception.

Figure 2: Warrior II intermediate version. I use this for training proprioception.

Figure 3: Co-activating the hip adductors, abductors and rotators in Warrior  II.

Figure 3: Co-activating the hip adductors, abductors and rotators in Warrior II.

Figure 4: Co-activating the hip adductors, abductors and rotators in Warrior  II.

Figure 4: Co-activating the hip adductors, abductors and rotators in Warrior II.

Figure 5: Activating the deep external rotators of the hip in Warrior II.

Figure 5: Activating the deep external rotators of the hip in Warrior II.

Thanks for stopping by. We hope that you enjoy this tip on training proprioception of the hip joint. Note that if you have persistent hip pain or other symptoms, be sure to consult a health care provider who is appropriately trained and qualified to manage such conditions.

If you would like to learn more about anatomy, biomechanics and yoga, feel free to browse through The Key Muscles and Key Poses of Yoga. Also, check out the Yoga Mat Companion series, which contains many examples of co-activation (including the one in this post). Many thanks for your support by sharing us on Facebook, Twitter and Google Plus as well.

Namaste’

Ray and Chris
Long

Author; Ray Long

View Profile

Visit Ray’s Website http://www.dailybandha.com http://www.bandhayoga.com

References:

Wolf JM, Cameron KL, Owens BD. “Impact of joint laxity and hypermobility on the musculoskeletal system.” J Am Acad Orthop Surg. 2011 Aug;19(8):463-71.
Smith TO, Jerman E, Easton V, Bacon H, Armon K, Poland F, Macgregor AJ. “Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis.” Rheumatol Int. 2013 Nov;33(11):2709-16.
Smith TO, King JJ, Hing CB. “The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis.” Rheumatol Int. 2012 Nov;32(11):3339-51.
Sahin N, Baskent A, Cakmak A, Salli A, Ugurlu H, Berker E. “Evaluation of knee proprioception and effects of proprioception exercise in patients with benign joint hypermobility syndrome.” Rheumatol Int. 2008 Aug;28(10):995-1000.
Lund H, Juul-Kristensen B, Hansen K, Christensen R, Christensen H, Danneskiold-Samsoe B, Bliddal H. “Movement detection impaired in patients with knee osteoarthritis compared to healthy controls: a cross-sectional case-control study.” J Musculoskelet Neuronal Interact. 2008 Oct-Dec;8(4):391-400.
Sharma L. “Proprioceptive impairment in knee osteoarthritis.” Rheum Dis Clin North Am. 1999 May;25(2):299-314, vi.
Liikavainio T, Lyytinen T, Tyrväinen E, Sipilä S, Arokoski JP. “Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.” Arch Phys Med Rehabil. 2008 Nov;89(11):2185-94.
Lauersen JB, Bertelsen DM, Andersen LB. “The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials.” Br J Sports Med. 2013 Oct 7.
Caplan N, Rogers R, Parr MK, Hayes PR. “The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics.” J Strength Cond Res. 2009 Jul;23(4):1175-80.
Higgs F, Winter SL. “The effect of a four-week proprioceptive neuromuscular facilitation stretching program on isokinetic torque production.” J Strength Cond Res. 2009 Aug;23(5):1442-7.
Handrakis JP, Southard VN, Abreu JM, Aloisa M, Doyen MR, Echevarria LM, Hwang H, Samuels C, Venegas SA, Douris PC. “Static stretching does not impair performance in active middle-aged adults.” J Strength Cond Res. 2010 Mar;24(3):825-30.
Wu Q, Henry JL. “Functional changes in muscle afferent neurones in an osteoarthritis model: implications for impaired proprioceptive performance.” PLoS One. 2012;7(5): Epub 2012 May 14.
Shu B, Safran MR. “Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability.” Clin Sports Med. 2011 Apr;30(2):349-67.
Smith MV, Sekiya JK. “Hip instability.” Sports Med Arthrosc. 2010 Jun;18(2):108-12.
Holla JF, van der Leeden M, Peter WF, Roorda LD, van der Esch M, Lems WF, Gerritsen M, Voorneman RE, Steultjens MP, Dekker J. “Proprioception, laxity, muscle strength and activity limitations in early symptomatic knee osteoarthritis: results from the CHECK cohort.” J Rehabil Med. 2012 Oct;44(10):862-8.

Here is a selection of some of the other articles posted here by Ray Long:
  • Sitting Up Straight and Expanding the Chest Forward in Sukhasana March 5, 2013 By Ray Long This technique is portable to other poses. In Tadasana, for example, simply fix the palms against the sides of the hips and attempt to drag them backwards. Note how the chest expands forward and the back straightens. See this concept in action for Sukhasana in the video above. Here’s the Anatomy . . . The ...
  • Lengthening the Torso in Forward Bends January 26, 2013 By Ray Long In “Preventative Strategies for Lower Back Strains Part I,” we discussed femoral-pelvic and lumbar-pelvic rhythm, muscles that influence these rhythms, and the effects of these muscles on the lumbar spine. Here, our discussion progresses as we cover the trunk, the thoraco-lumbar fascia (TLF), Uddiyana Bandha and how accurate knowledge of this can be ...
  • Preventing Yoga Injuries vs Preventing Yoga, Part II: Joint Hypermobility January 19, 2014 By Ray Long In this post we discuss labral tears and the condition of joint hypermobility. I also present the case of a specific injury from yoga practice, its biomechanical basis and the steps that can be taken to aid in its prevention. First, however, let’s look at the concept of association vs causality. Simply put, ...
  • Degenerative Disc Disease, The Sushumna Nadi and Yoga January 25, 2013 By Ray Long “A sword by itself rules nothing. It only comes alive in skilled hands.” Sir Te to Governor Yu in the martial arts classic, Crouching Tiger, Hidden Dragon. With this in mind, let’s look at a condition that affects the spinal column and, thus, has the potential to affect the Sushumna Nadi. Degenerative disc disease ...
  • Balancing Freedom and Restraint in Yoga March 23, 2013 By Ray Long  The work of legendary furniture designers Charles and Ray Eames has been described as a balance of freedom and restraint.Mr. Eames was once asked: “Have you ever been forced to accept compromises?” He responded: “I don’t remember ever being forced to accept compromises, but I have willingly accepted constraints.”1  Practicing yoga also involves ...
  • Using the TFL to Refine Utthita Parsvakonasana March 23, 2013 By Ray Long Author; Ray Long View Profile Visit Ray’s Website http://www.dailybandha.com   http://www.bandhayoga.com Share this:FacebookTwitterGoogle
  • Antagonist/Synergist Combinations in Yoga March 14, 2013 By Ray Long Author; Ray Long View Profile Visit Ray’s Website http://www.dailybandha.com   http://www.bandhayoga.com Share this:FacebookTwitterGoogle

You may also like...

Leave a Reply

Error: Please enter a valid email address

Error: Invalid email

Error: Please enter your first name

Error: Please enter your last name

Error: Please enter a username

Error: Please enter a password

Error: Please confirm your password

Error: Password and password confirmation do not match