Protecting your knees during yoga
Lotus Pose (Padmasana) is a supreme position for meditation,
and Lotus variations of other asanas can be profound. However, forcing
the legs into Lotus is one of the most dangerous things you can do in
yoga. Each year, many yogis seriously injure their knees this way. Often
the culprit is not the student but an overenthusiastic teacher
physically pushing a student into the pose.
Figure 1/Safe Knee Placement
Figure 2/Unsafe Knee Placement
Fortunately, there are techniques that make Padmasana much safer to
learn. Even if you don't teach full Lotus, you can use the same
techniques to protect students in related postures, such as Ardha Baddha
Padmottanasana (Half-Bound Half-Lotus Forward Bend)
Baddha Konasana (Bound Angle Pose)
and Janu Sirsasana
(Head-to-Knee Pose)
These poses can do wonders for the hip joints and
the muscles around them. Unfortunately, many students feel a painful
pinching sensation in the inner knee in all of them. To understand why,
and how to prevent it, consider the underlying anatomy.
The problem starts at the hip joint, where Lotus and its relatives
require an astounding degree of mobility. When you move from a neutral,
seated posture, such as Dandasana (Staff Pose) to Baddha Konasana, the
ball-shaped head of the thighbone must rotate outward in the hip socket
about 100 degrees. Bending the knee and placing the foot in preparation
for Janu Sirsasana requires somewhat less external rotation, but as a
student bends forward in the pose, the tilt of the pelvis relative to
the femur brings the total rotation to about 115 degrees.
Padmasana
requires the same amount of external rotation (115 degrees) just sitting
upright, and the angle of rotation is somewhat different, making it
more challenging for many students. When we combine the Padmasana action
with a forward bend, as we do in Ardha Baddha Padmottanasana, the total
external rotation required at the hip joint jumps to about 145 degrees.
To put this in perspective, imagine that if you could turn your thighs
out 145 degrees while standing, your kneecaps and feet would end up
pointing behind you!
If a student can achieve all of this outward rotation at the hip in
Lotus, they can then safely lift the foot up and across onto the
opposite thigh without bending the knee sideways (see Figure 1). Some
people with naturally mobile hips can do this easily, but for most
people, the thighbone stops rotating partway into the pose. This
limitation may be due to tight muscles or tight ligaments or, in some
cases, to bone-to-bone limitations deep in the hip.
When the femur stops
rotating, the only way to get the foot up higher is to bend the knee
sideways. Knees are not designed to do this-they are only designed to
flex and extend.
If an overzealous student continues to pull the foot up after his
thigh stops externally rotating, or if a student or teacher forces the
knee downward, the thighbone and shinbone will act like long levers that
apply great force to the knee. Like a pair of long-handled bolt
cutters, they will pinch the inner cartilage of the knee between the
inner ends of the femur and tibia.
In anatomical terms, the medial
meniscus will be squeezed between the medial femoral condyle and the
medial tibial condyle. In layman's terms, the inner ends of the thigh
and shin will squeeze the inner cartilage of the knee. With even
moderate force, this action can seriously damage the meniscus. Such
injuries can be very painful, debilitating, and slow to heal.
Poses like Baddha Konasana and Janu Sirsasana can cause similar
pinching. In these postures, we do not usually pull up on the foot, so
the problem comes mainly from the lack of outward rotation of the thigh
relative to the pelvis. Let's first look at Baddha Konasana.
Remember, to stay upright and stable while placing the feet in Baddha
Konasana, the heads of the femurs will turn strongly outward-about 100
degrees-in the hip sockets. Because this requires so much flexibility of
the entire hip region, many students instead allow the top rim of the
pelvis to tilt backward while placing the feet in Baddha Konasana. They
move the thighs and pelvis as a single unit.
This requires little
rotation of the heads of the femurs in the hip sockets, and it demands
little flexibility. It also defeats the aim of mobilizing the hip joints
and causes the entire spine to slump.
As a teacher, you may find yourself instructing the slumping student
to tilt the top rim of the pelvis forward in order to bring them
upright. If their hips are loose enough, this instruction won't create a
problem; the pelvis will tilt forward, the thighs will remain
externally rotated, and the spine will come upright. But if the hips are
too tight, the femurs and pelvis will roll forward as a single unit.
While the thighbones rotate forward, the shins will not, resulting in
the aforementioned pinching in the inner knees. This explains why some
students do not feel any knee pain in Baddha Konasana until they attempt
to tilt the pelvis completely upright.Some students complain of knee pain only when they bend forward in
poses that require external rotation.
That's because a forward bend like
Janu Sirsasana demands even more external rotation at the hip joint.
Again, in the tight student, the pelvis and femur roll forward as a
single unit, pinching the inner knee. Of course, in either Baddha
Konasana or Janu Sirsasana, pushing the knee(s) downward makes the
problem worse, because tight muscles make the femur rotate forward as it
is pressed.
Now back to Lotus Pose. Forcing the knees into Padmasana by lifting
up on the ankles can also injure the outside of the knee. When a student
lifts the shinbone without adequately rotating the thigh, it not only
closes the inner knee, it opens the outer knee, overstretching the
lateral collateral ligament. If a student then forcibly turns the feet
so the soles point upward (which people often do to get the feet higher
up on the thighs), they can worsen the strain.
This action of turning
the soles actually pulls the anklebone away from the knee, creating a
chain reaction all the way up to the lateral collateral ligament.
What's the solution? First, use common sense. Never force a student
into Lotus or related poses, and discourage students from forcing
themselves. Teach students not to push into pain, especially knee pain.
Do not adjust the pose by pulling on the foot or ankle, nor by pushing
down on the knee. Instead, either teacher or student should apply firm
outward rotating action to the thigh, turning the femur around its long
axis, using the hands or a strap.
If your student already has knee pain but can do basic standing poses
comfortably, teach these poses first, with careful alignment. This can
bring her a long way toward recovery. When you reintroduce problem
seated poses such as Baddha Konasana and Janu Sirsasana, use the hands
or a strap to apply the same outward rotating action described above for
Lotus.
For students who are ready to learn Lotus, introduce it gradually,
working from poses that require less external rotation at the hip (such
as sitting in Ardha Baddha Padmottanasana without bending forward) to
those that require more (such as full Padmasana). Wait until last to
introduce poses that require the most external rotation (forward-bending
variations of full Padmasana). As students are learning these poses,
teach them to rotate their thighs outward either with a hands-on
adjustment or a self-adjustment. Instruct them to monitor and avoid
pinching sensations in the inner knees.
Encourage your students to go slowly, be patient, and persist. In
time, they may be able to sit comfortably and meditate deeply in
Padmasana. If not, remind them that true meditation lies not in some
specific posture but in the spirit of their practice. Help them find a
posture that suits them, then guide them to settle in and experience the
stillness that is yoga.