Yoga Therapy for Knees

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WHY ARE WE PRONE TO KNEE

PROBLEMS?

Our bodies are predisposed to injuriesof the extensor mechanism because thehip joints are wider than the knees in aneutral standing position. The naturalY-shaped configuration to the leg

bones promotes uneven contraction ofthe quadriceps, and problems such ashyperextension of the knees make thesenatural imbalances even worse. As a

result, when we contract the quadricepsto straighten the leg, the unevenness of

the contraction tends to pull the kneecapto the outside, thanks to the greater pullof the outermost quadriceps (the vastus

lateralis).The innermost quadriceps (the vastus

medialis) is most responsible for counter-acting this pull. This muscle tends to be

weak and underused, while the outerthigh muscle tends to be stronger fromoveruse. So if you want to keep the kneehealthy (i.e., tracking properly in its

femoral groove), you need to learn tostrengthen the vastus medialis. In fact,

physical therapists consider exercises tostrengthen this neglected muscle key inthe rehabilitation of knee injuries.

THE CHALLENGE OF WORKING WITH

THE INNER QUAD

Yoga students are often told to liftthe kneecaps in straight-legged poses toengage their quadriceps and, ostensibly,

protect their knees from hyperextension.But lifting the kneecaps in a healthy and

balanced way requires focused attention,especially if you already have problems in

your knees.

This is easy enough to check. Sit orstand with your legs straight and yourfeet parallel to each other, then engage

your thigh muscles so that your kneecaps

lift or pull toward your hips. Do yourkneecaps move up in a straight line, or dothey move in an angle toward the outsideof your knees? If the latter is the case,

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Heres a simple anatomy lesson: Thekneecap is designed to slide along agroove in the femur, and it has to movesmoothly within that groove to do its job

well. If it goes off track (and it often

does) it grinds away at the cartilageunderneath and destabilizes the knee.The ensuing wear and tear is a key rea-son for knee replacement surgery, which

a lot of people believe is necessarybecause they think the cartilage isgone. But the truth is that cartilage cangrow back, albeit slowly. The main prob-lem is that if we dont correct the imbal-

anced pull of muscles on the kneecap, we

will continue to grind our cartilage downfaster than our body can replenish it.

So why does the kneecap go off track?

The cause lies mainly in the quadriceps, agroup of four muscles that merge just

above the knee into a singlequadriceps tendon. Thistendon surrounds andattaches to the kneecap,

continuing down belowthe kneecap as the patellarligament, where it attachesto the tibia (shin bone). Thekneecap serves an important

mechanical function. Thequadriceps tendon passes overthe kneecap like a rope over apulley, and the kneecaplike a pul-

leyincreases the strength of thequadriceps to straighten the leg 30 per-

cent. Together, the quadriceps and thekneecap form the extensor mechanismfor straightening the leg. Misalignments

come when the rope of the quadricepsexerts a sideways pull on the kneecappulley, creating friction in the mecha-nism.

Hatha yoga has a lot to offer to correctthis misalignment; the standing poses areespecially effective. But be forewarned:Misalignments of the knee in variousasanas can amplify the imbalances that

lead to injury and can aggravate existingproblems instead of correcting them.The good news is that good alignmentand proper tracking are easy to achieve

once you know what to pay attention to.

{ asana solutions }

Yoga Therapy for Your KneesWith a simple anatomy lesson, isometric exercises, and attention to alignment in standing p oses,

you can undo chronic pain in your knees.

By doug keller

Photo

credit.

If you have chronic pain in your knees, if they snap, crackle, and pop when you bend or extend them, or if they

tend to hyperextend, you may have improper tracking or dislocation of the kneecap. This misalignment causes

the most common kind of chronic knee pain and damage to the knee joint, which develop slowly over time.

WHEN THE KNEECAP slides straight up and

down the femoral groove the joint remains

healthy. If it slides up and to the outside it will

grind away the cartilage and damage the joint.

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FemoralGroove

Tibia

Fibula

Femur

Kneecap(Patella)

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then you need to strengthen the vastusmedialis, the inner quad, and learn howto use it properly.

This has its challenges. First, it can bedifficult to find and isolate this muscle,

because you can feel the vastus medialisfirming most only in the last 10 t o 20degrees of knee extension. So it takesfocused attention to even feel and under-

stand what the muscle does.

Second, structural misalignments thatcannot be changed (like being knock-kneed or bowlegged) tend to limit the

vastus medialiss proper functioning

and can even weaken it in relation to theother quadriceps muscles, making it evenharder to work with.

Finally, although engaging the vastusmedialis properly can prevent hyperex-

tension of the knee, doing so is essentially

useless if the knee is already hyperextend-ed. Consequently, its important to con-sciously avoid hyperextension in the firstplace, rather than relying on the strength-

ening exercises to prevent it. This is criti-cal, because the habit of hyperextension

will otherwise pull you right back intoyour imbalanced patterns of knee exten-sion even after you do the work of

strengthening the vastus medialis.Heres what you can do to keep your

kneecaps tracking properly:1. Find your vastus medialis, the inner

quadriceps muscle.2. Strengthen it with small extension

exercises.3. Continue to strengthen the vastus

medialis in bent-knee warrior poses.4. Incorporate that work into straight-

legged asanas.

STRENGTHENING YOUR INNER QUAD

Isometric extensions will help you

identify the inner quad and its action asyou strengthen it. To do this, sit in dan-dasana (staff pose), with your legsextended forward. Support your upperback against a wall if thats more comfort-

able. Roll up a small blanket or stickymat and place it under your knees to pre-

vent hyperextension while your quadri-ceps are contracted. Next, rotate your

legs out 10 to 15 degrees (if the soles ofyour feet were on a clock face, your toeswould be pointing to one oclock). Tofind the vastus medialis, place your fin-gers about one inch above the inner (or

medial) corner of your kneecap, and thenwalk your fingers about one and a half

inches toward the inner thigh. Straightenyour leg slowly to feel the quadricepsengage. Youre looking in particular for

the firming of the teardrop-shaped mus-cle just under your fingers. This is the

vastus medialis, the inner quadriceps.You will feel it fully engage as your leg

straightens completely. Hold the contrac-tion for 8 to 10 seconds, then release.Repeat this for two more rounds, makingsure you dont extend the leg so hard that

you feel locking or pinching in the knee.

Repeat this exeNext, do the

rotating the legaligned so that ystraight up towa

your leg fully an

the inner part oyoure touchingstrongly as you

of the quadricepkneecap moves

center of the knare engaged in athan pulling to t

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If you want to keep the knee healthy you need to strengthen the vastus medialis (the inner quadtherapists consider exercises that strengthen this neglected muscle key in the rehabilitation of k

VASTUS LATERALIS,

the outer quadricep, pulls

the kneecap up and outward.

When the muscle is overde-

veloped it pulls the kneecap

out of the femoral groove.

VASTUS MEDIALIS,

the inner quadricep, pulls

the kneecap up and inward.

It counters the pull of the

vastus lateralis.

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Doug Kellersyoga journey includes 14 years ofpracticing in Siddha Yoga ashrams, intensive train-ing in the Iyengar and Anusara methods, and near-ly a decade of teaching in the United States andabroad. Asana instruction, essays, and otherenlightening information is available on his website:

DoYoga.com.


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other leg. You can do these exercises sev-eral times a dayjust be careful not to

fatigue the muscle by doing too manysets at a time.

THE WARRIOR POSES

Among the traditional asanas, the

warrior poses (virabhadrasana I and II),in which the front leg is bent and theback leg is straight, are particularly effec-tive for strengthening the vastus medi-

alis, if done with proper alignment andaction. Because although its easiest to

isolate this muscles action when the legis fully extended, it is also engaged andstrengthened when the knee is bent at a

90 degree angle and the leg is bearingweightas long as the knee is positionedvertically over the heel, and the inner heelremains grounded. This is the case in a

well-aligned warrior pose.To come into the pose, step your feet

wide apart, while extending your armsout to either side. Your feet should beroughly beneath your wrists. Turn your

left foot in about 30 degrees and yourright leg out 90 degrees. Keep your t orsoupright as you bend your right knee.Make sure your knee does not go beyond

your ankle and toes: Keep the shin verti-cal while striving to bring the thigh paral-

lel to the floor, so the leg is bent at a rightangle. If the knee goes beyond your ankle

and your weight shifts into your toes,

widen the distance between your feet.Turn your head to look out over

your right fingertips.Even when your stance is the proper

width and your knee b ends to a right

angle, a commonand harmfulmis-alignment is to let the thigh turn inwardso that the knee points more toward thebig toe. This happens especially when

the arch of the foot collapses, whichplaces stress on the inner knee and pre-

vents you from strengthening t he

quadriceps in a balanced way. A lesscommon misalignment is to shift the

weight to the outer edge of the foot, sothat the knee turns more toward the lit-tle toe. In this case the muscles alongthe outer thigh tighten, and the outer

(lateral) side of the knee is stressed. Inthis case too, the vastus medialis doesntfunction properly.

Proper alignment in the warrior poseallows the vastus medialis to work in har-

mony with the other quadriceps to alignand strengthen the extensor mechanismof the knee. Misalignments, on the otherhand, disable the vastus medialis and

increase the muscular imbalances thatcause wear in the knee. You can protect

your knees and strengthen the vastus

medialis by following three basic rules forthe warrior poses.

First, make sure your knee is bent

properly to a right angle, so the weight iscentered in your heel. If your toes aregripping, its a sign that your knee is

going too far beyond your heel.Second, dont let the inner arch of

your foot collapse, for this is a sign thatyour knee is turning inward too much.We sometimes compensate for this col-lapse by shifting weight to the outer edge

of the foot, causing the inner heel to lift.But this stresses the outer knee anddefeats the purpose of the pose. The chal-lenge of aligning the knee is to keep yourinner heel and big toe mound grounded

while keeping the inner arch of the footlifted. These two actionsgroundingand liftingwill keep the knee fromturning inward or outward too much. Lift

your toes to help engage and lift the innerarch; as you bend your knee, draw t heenergy from the inner arch up through

the calf to your inner knee, so that yourknee remains directly over your heel and

does not turn inward.Third, make sure that the heel,

kneecap, and hip joint of your bent leg

are in the same plane by allowing a slightturn of the hips. (If you were doing the

pose next to a wall, your outer rightankle, knee and right hip would all b etouching it.) To achieve this, when youbend your knee, let your outer hipdescend toward the floor (as if you had

something heavy in your hip pocket) asyou lift energy from your inner arch upthrough your inner knee. This will make

your leg spiral out as you bend it, until

your heel, kneecap, and right hip joint areall aligned.

The purpose of these three actions inthe bent leg is to ensure that all fourquadriceps muscles are working harmo-

niously to stabilize the knee. As a result,the vastus medialis gets a much-needed

workout that brings it into balance withthe other quadriceps. To confirm this,

gently pinch your thigh above the innerknee to check that the muscle therethe

vastus medialisis as firm as the thighmuscles at the outer knee.

TRIKONASANA

Proper alignment of the knee in thewarrior poses automaticallygives the vastus medialis ahealthy workout. Now you can

apply these same actions to the

straight-legged poses liketrikonasana, in which workingthe vastus medialis consciously

is more challenging.Step your feet wide apart,

turning your left foot in 45degrees and your right leg out90 degrees, toward the edge

of your mat. Bendyour right kneeslightly and align

your heel, knee,

and hip as in war-rior pose. Then

straighten the leg mindfully, engaging thevastus medialis, especially in the last 20

degrees of extension. If you engage thismuscle properly and your leg is alignedas you straighten it, youll see yourkneecap draw straight up your leg, and

youll find it nearly impossible to lockyour knee. But if you let go of the vastusmedialis even for an instant, the knee caneasily hyperextend and lock into thatposition.

Fold at the hip crease to taketrikonasana to the right. Keep the vastus

medialis firm and lift along your innerthigh, maintaining the straightness of

your leg without locking the knee. If youfeel pressure in the knee joint, youveprobably relaxed the vastus medialis andhyperextended your knee. Come out ofthe pose and try again. As a bonus for

good alignment, youll feel a strongerstretch along the inner edge of yourthigh, from your inner knee back toward

your sit bone. Be careful not to over-

stretch: use the support of a block foryour hand if you need it.

CONCLUSION

The standing poses of hatha yoga pro-vide powerful and effective means for

strengthening and stabilizing our knees,

helping us to overcome structural imbal-ances that might otherwise lead to chron-ic wear and tear (and ensuing pain) in

your knees. A little extra mindfulness inaligning and working our legs in theseposes will enhance the natural therapeu-tic benefits these poses have to offer.+

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TRIANGLE POSE

If the vastus medialis is

engaged properly youll feel astretch along the inner thigh and

the kneecap will slide along the

femoral groove, which pre-

vents hyperextension.

TO PROTECT THE KNEE

make sure its above the secondtoe and that both the toe and the

knee are on the same plane as the

sit bone.

IF THE VASTUS MEDIALIS is not properly engaged

the knee falls inward. The vastus lateralis then pulls thekneecap outward, stressing the inner knee. When the

weight shifts to the outer heel the knee splays out over

the little toes and stresses the outer knee.

WARRIOR II Ground the inner heel and toe mound

while lifting the arch up all the way through the inner

knee as your outer hip drops down.

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Yoga Therapy for Knees