Maybe. And maybe not. It depends on a lot of different things: the shape of your hip joint, the orientation of the joint socket; the torsional angle of your thigh bone; the laxity of your ligaments; the postural tension in your low back and the flexibility of your connective tissue and muscles (myofascial) as well as a potential combination of these!
Oftentimes the problem isn’t so much putting our leg behind our head that causes problems but what drives students to push themselves beyond healthy limits. This self-coercion is often fuelled by the myth that if you are a very good yogi, i.e. one who practises daily with devotion and a pure heart and mind, then you should or eventually will be able to not only do leg-behind-head postures (LBH ) but any and all other postures. This is simply not true. This myth has been purported by those who have the genetics to be able to do almost any posture and is continued by those who believe it and don’t yet know better. The purpose of this blog is to debunk that myth in the context of LBH postures with education, which hopefully will lead to an understanding that inspires greater acceptance, respect, care and love for the hips we have, LBH suitable or not!
HIERARCHY OF LIVING TISSUES
Amongst the living tissues of our locomotion system there is a hierarchy that determines whether we can or cannot do certain postures and with how much ease or challenge. Bones are at the top of this hierarchy! Females are skeletally mature at ~18 years and males at ~21 years. Once ‘set in bone’ the shape and orientation of our bones and joints will not change. And here-in lies some important predictors of whether or not we ever will be able to place our leg behind our head, and with how much ease and/or risk of injury.
Most of us are familiar with the structure of the hip joint as a simple ball-shaped head and a cup-shaped socket. This construction allows for movement in all directions, i.e. circumduction. The inside of the acetabulum is lined with cartilage, called the labrum. The labrum increases the articular surface or the joint, which greatly increases its volume. It helps to create a seal maintaining the pressure of the synovial fluid within the joint capsule. This protective layer of cartilage also resists vertical and lateral translation of the femoral head. It is stressed by excessive translation, compressive loads and extreme ranges of motion.
BONY VARIATIONS: Acetabular Version
The deep socket (acetabulum) of the hip joint provides structural stability for this multi-axial, mobile joint. However, there is a lot of variation between individuals in this as in many of our other joints. Let’s start with the extreme of a hip joint where the acetabulum is too shallow to adequately cover the femoral head and thereby stabilise the joint (hip/acetabula dysplasia). Hip dysplasia occurs to varying degrees, the most severe being when the joint experiences repeated dislocations. Unfortunately, the position of LBH postures with the leg in extreme flexion, abduction and external rotation, stresses the more vulnerable anterior portion of the labrum. This coupled with the inherent instability of hip dysplasia can eventually lead to tears in the labrum. The excessive, repeated translation that already happens in hip dysplasia predisposes the joint to premature osteoarthritis due to the increase in wear, tear and the body’s attempt to repair it. Even mild forms of hip dysplasia will in the short-term make leg-behind-head (LBH) postures more easily accessible but are counter-indicated and unsustainable in the long-term.
The acetabulum of the hip socket/acetabulum normally faces out to the side and somewhat forward. However, this orientation can vary, and is another important factor that affects our natural ability to perform LBH postures. If the acetabulum faces more towards the front of the pelvis (acetabular anteversion), a larger movement is required to get your leg behind your head. Conversely, if the hip socket is more to the back of the pelvis (acetabular retroversion) one does not need as much lengthening of other tissues to get their leg in position. Ante- or retroversion of the acetabulum can only be accurately distinguished with imaging.
BONY VARIATIONS: Femoral Version
On a bony level, another influencing factor is called femoral version or torsion. This is the angle between the neck and the shaft or distal condyle of the femur. In this case the femur also can be anteverted or retroverted. As with retroversion of the acetabulum, retroversion of the femur makes for greater external rotation at the hip joint. These are those yogis with ‘naturally open hips’, whose feet fall into extreme outward rotation when they lie face-up and who walk with their feet in a turned out position. As normal toe-out is between 5 and 12 degrees you will not walk with straight feet unless you have femoral anteversion. In this case the hip joint is internally rotated and in extreme cases the toes will turn in. An anteversion angle of greater than 15 degrees stresses the anterior labrum and ligaments of the hip joint. These people have a limited amount of external rotation in their hip joints, which is one of the main movements needed to access LBH postures.
It is possible to measure the degree of femoral version by lying prone with the knee bent to 90 degrees. Anchor the greater trochanter (the bony protrusion on the side of the hip) and then turn the foot outwards (which is internal rotation of the femur at the hip joint) to measure anteversion. You can measure this angle relative to the vertical position with an goniometer app on your smart phone. The opposite direction measures femoral retroversion.
BONY VARIATIONS: Femoral Neck Length
Additionally in our bony anatomy, a longer and more concave femoral neck allows a greater range of motion and more freedom of motion at the hip joint, whereas a shorter and less concave neck will limit the ability to externally rotate the leg into LBH postures.
The next structure that limits our flexibility is our ligaments. Ligaments connect one bone to another at the joint and come into play at the end range of joint motion. Ideally, ligaments are strong with minimal elastic properties as they are our passive stabilisation system. There are three ligaments surrounding the hip joint and one deep within the joint. The iliofemoral ligament resists lateral rotation of the hip and the deep ligamentum teres secures the center of the femoral head to the labrum of the acetabulum and is also tensioned with external rotation. Conditions that compromise stability at the hip joint, for example, hip dysplasia will put extra stress on these ligaments and can lead to ligament and/or labral tears.
A concern within the yoga population are those with hereditary disorders of connective tissue (HDCT). These individuals are hypermobile which makes yoga attractive because they are very good at it! Even mild forms of HDCTs like Joint Hypermobility Syndrome (JHS) (see my blog about this), where there is generalised ligamentous laxity, means that proprioception is impaired and the risk of injury is increased. In these yogis strength and resistance work is more what is needed rather than extreme ranges of motion that further destabilise their joints.
With its extreme hip flexion, external rotation and abduction it is necessary to have sufficient length in the hip extensor, deep lateral rotator and adductor myofascia of the hip joint. Beyond hip anatomy, the myofascial of the low back also plays an important role in LBH postures. Those with a hyper-lordosis and shortened low-back paraspinal muscles are in a passive lumbar extension posture. This myofascial tension makes it more challenging to adopt the flexed lumbar position necessary for LBH postures. Hyperactivity of the superficial spinal muscles is often compensation for a lack of strength and stability in the deeper stabilising muscles of the low back. Forcing LBH postures without addressing the lengthening and stabilisation needed in the low back can lead to excessive load on the intervertebral discs and increase the risk of disc injury.
Physical proportions are another contributing factor, e.g. those with a wide trunk and/or short arms as well as the proportions of a long trunk and short legs are further challenged. And then there are other influences like Ayurvedic dosha types where a vata constitution makes joints more susceptible to injury when performing extreme ranges of motion while those with more kapha have greater resilience in their joints.
UPRIGHT LBH POSTURES
The most challenging and physically demanding of the LBH postures are those where the spine is held upright. LBH with its extreme range of motion demands total relaxation at the hip joint. The weight of the leg behind the neck or atop of the shoulders is increased with every degree of extra tension / lack of flexibility in the hip joint. To support this weight and remain upright requires great strength and resilience in the trunk and neck. In this position the intervertebral discs are loaded in flexion, which is their most vulnerable position. Without adequate deep paraspinal muscle strength providing stability the discs are unprotected and vulnerable to disruption.
Many practitioners practice LBH postures for decades and never have a problem. Never the less, the bottom line is that not everyone is born to put their leg behind their head. The ability to put your leg behind your head requires more than only practice, purity and devotion. It also requires stable hips that are not adversely shaped to prevent you getting there. The tension in myofascia is able to be overcome, but the shape of your bones will not change. What is then important is that you do not force your body beyond its natural limitations and destabilise your joints. I have seen many students continually crank themselves into LBH postures, presumably aiming for the perfect yoga body. As important, is to not allow teachers to apply forceful LBH adjustments to have you meet their yoga ideology.
Many attribute psychological, energetic and/or spiritual benefits to LBH postures. This may be the case. However, if the cost is that you damage your body to achieve this, you cannot call it yoga. Then it is self-coercion, ambition and self-abuse, making yoga yet another consumer object on our already long list of obstacles toward the goal of yoga: to experience ourselves as a part of the divine consciousness of life that resides within this, our sacred body.