Last week I covered the top half of this pose in Cow's Face Arms. This week I’ll go over the rest of the pose, specifically what is happening in the hips.Muscles Stretched: Gluteus maximus, medius and minimus, tensor fascia lata, piriformis, possibly other small rotators of the hip including obturators and gemelli.
Points of Body Awareness:
*Is your spine in a neutral position? Is there an inward curve in the small of your back? Is the pelvis tipping slightly forward? If not, use props to elevate the hips
*Actively bend the ankles (dorsiflex) while you hold the posture. This will help to protect the knees and provide a sense of stability within the pose.
*There should not be any discomfort in the knees. If so, modify or find an alternative pose.
*Are you able to feel grounded? Can you let go, especially on the side of the top leg? Can you let the sit-bone on that side descend and find symmetry in the side waists?
*Hold this posture for at least 6 breath cycles.
To Modify: If you are unable to achieve a neutral spine position or if the posture feels too intense, sit on a block, folded blankets or a bolster.
There is a supine version of the stretch where you lie on your back, cross the thighs, bring the knees toward the chest and grasp the legs just above the ankles. Keeping the knees together, spread the ankles apart until you feel a stretch in the outer hip area.
To Challenge: Fold forward over the legs to increase the stretch in the hips. This can be done with the arms still in Gomukhasana posture which will increase the stretch in the shoulders or the arms can be released and relaxed by your sides.
I like to do a version of Viloma Pranayama or Interrupted Breath in this posture. Inhale completely. As you begin to fold forward, exhale 1/3 of the breath. Pause for a few seconds. Then continue to fold forward while exhaling 2/3 of the breath. Pause. Then exhale completely as you fold all the way forward over the legs. Inhale completely as you rise back up.
PT Notes: In my experience, patients tend to really enjoy this pose (mostly young to middle-aged outpatients in a sports medicine clinic). I have often used Gomukhasana for patients with low back pain and hip problems including DJD and impingement. This posture is possibly safer for patients with HNP than more traditional supine piriformis stretches because it is easier to maintain a neutral lumbar lordosis, provided the appropriate modifications are used. It can also be less irritating to those with hip problems as it maintains external rotation during flexion/adduction, avoiding compression of the iliopsoas, the anterior labrum or joint surfaces.
This pose may not be appropriate for patients with knee injuries or s/p total hip replacement.
