Tuesday, February 26, 2013

3 Things You Must Do to Keep Your Knees Safe in Yoga



Here's two important things to consider: 1) The knees are engaged by a majority of yoga asanas and 2) knee injuries and pain are one of the most common joint issues reported by patients to their doctors. What does that mean for your yoga practice? Simple, you should educate yourself about knee safety. Here's a few tips for protecting your knees or working around an existing injury.



1) Understand How Your Knee Works 


I found this great graphic online that explains precisely how the knee works. Study it. Major takeaways: The most important thing to understand about the knee is that it's a hinge joint, and naturally has a limited range of motion. Any movement that works against the natural range of motion is bad for the knee and should be avoided. The most common example in yoga is Tree pose. It seems like half of the photos of tree pose circulating on the internet are totally incorrect and unhealthy for the knees. I found the ones below by Google searching "yoga tree pose" all on the first page of search results.  




The photos above depict alignment that puts the knee in danger because the knee does not bend in the direction that force is being applied. Here's a few examples of Tree pose foot placement that are correct and healthy for the knees.


Students practicing in a studio hopefully have an instructor who corrects their alignment, but those practicing at home or studying yoga online could easily be misled to think that the correct tree position is with the foot on the inner knee. That's why it's important to educate yourself on knee anatomy and use common sense when attempting new poses.

2) Know What Poses Engage Your Knee and Avoid or Modify Accordingly


There are so many asanas that engage the knee and specific guidance for modifications for each one is included in the chapter on Knees in The Contraindication Index. Here's some general tips and a list of poses that may need to be modified or avoided depending on the severity of the knee issue or injury presented. In general, there are two ways the knee can be aggravated in yoga.

  • Application of Direct Pressure: Some students experience pain or discomfort when the knee is supporting body weight since direct pressure is applied to joint and the patella (think Table, Cat, Cow).
  • Aggravation of Range of Motion: Other students experience pain or discomfort when the knee joint is moved beyond a comfortable range of motion (think Full Lotus), locked straight (think Standing Forward Bend), flexed for an extended period of time (think Child's Pose) or their injury has limited the range of motion of the joint.

Poses that Engage the Knee: Bound Angle, Bridge, Camel, Cat, Chair, Child's, Cobbler, Cow, Cow's Face, Crescent Lunge, Cross Legged, Eagle, Extended Puppy, Extended Side Angle, Fire Log, Frog, Garland, Gate, Goddess, Half Circle, Half Frog, Happy Baby, Head to Knee Forward Bend, Hero, Heron, King Pigeon, Knee to Chest, Lotus, Low Lunge, Monkey, One Legged Pigeon, Powerful, Rabbit, Reclining Bound Angle, Reclining Hero, Rotating Standing Leg Stretch, Runner Lunge, Sage Bharadvaj, Seal of Yoga, Squat, Sun Bird, Supine Head to Toe, Table, Thread the Needle, Three Faced Forward Bend, UpwardFacing Bow, Warrior I, Warrior II, Wheel

3) Use Props to Modify and Add Comfort


The good news is that just about every asana can be modified to accommodate a knee injury, pain or discomfort with a few simple props that are cheap and commonly available in studios. Students may have to try several different modifications before finding the one that provides comfort, so trial and error is in order. 

Yoga blankets, blocks and bolsters  are standard props in studios. If you experience discomfort when applying direct pressure (think Table, Crescent Lunge, Cat/Cow, etc) modify by simply folding the blanket and placing under the knee to provide additional cushion. If extreme flexion of the knee causes pain or discomfort (think Child's or Hero) then you can sit up on the block or bolster or roll the blanket up and place it between your lower calf and thigh close to your bottom to reduce the bend in the knee.You don't need a "yoga" blanket or bolster necessarily, if you have a home practice, any thick throw blanket or extra firm pillow will do. If you want a "yoga" blanket, you don't need an expensive one. Mexican-style blankets are popular and commonly used because they are thick and provide good cushion. One drawback though - they are bulky and need to be refolded and repositioned over and over, which can get in the way during a more fast paced class. Check out this option from Peace of Mind Yoga Gear if you're looking for a slim, more easily maneuverable knee pad. Bonus: it doubles as a mat carrier and features a removable strap!
  
Remember, even when you go to a yoga class at a studio or gym, it's your practice. The teacher and the students around you can't feel what's going on in your body, only you can, so listen to it and respond accordingly. Never feel embarrassed or judged for using a prop or an aid or skipping an asana altogether, if that's what you need to do. At the end of the day, you are responsible for your own yoga safety. Take care of yourself. 

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Victoria McColm is a consultant, connector and entrepreneur with a passion for yoga - and making it safer. She founded Prevent Yoga Injury and serves as Editor. She is the author of The Contraindication Index for Yoga Asanas - an essential reference guide to injuries, ailments, and medical conditions that can be exacerbated by certain yoga postures. 

Victoria entered teacher training with a consultant's mindset and immediately saw gaps in available yoga resources, as well as disconnects in the yoga community and industry at large. A problem solver by nature, she set out to fill these gaps and facilitate a needed dialogue on the issues of yoga safety. Her vision is to build Prevent Yoga Injury into a one-stop-shop for reliable and pragmatic information on best practice, yoga safety, injury prevention and contraindications. She is a registered yoga teacher with 200 hours of training and is a member of the Yoga Alliance Standards Committee Advisory Group.




7 comments:

  1. This is a great article and I love this series. I would have liked to learn about another common debate: whether the knee should or shouldn't extend past the toes (in weighted standing poses like Warrior I and II, and unweighted poses like Crescent Lunge). Also, what about engaging quadriceps and not locking the knees in straight leg poses? What about stacking joints, as in keeping the knee over the ankle in Warrior II? I know this blog is focused on preventing injury, but are there poses that can help the knees? Thank you!

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  2. Hi! Thanks for your comment. Stacking joints is the rule. It provides for greater stability. That's also why the knee shouldn't extend past the toes in the poses you mentioned.

    As for locking knees - check out Dr. Summers' article on that precise topic. ;-)

    http://preventyogainjury.blogspot.com/2013/03/lock-your-knees-what-not-to-do-during_2.html

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  3. My right knee has no cartilege and is damaged from an injury. I find I cannot put full body weight on it especially if it is on that knee alone even with a yoga pillow. I'm wondering if maybe yoga is not a good exercise for me. I recently went to a beginning yoga class and at least half of the asanas involved putting weight on the knee. Can you recommend any ways to get the benefits of yoga without further injuring my knee?

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  4. My right knee has no cartilege and is damaged from an injury. I find I cannot put full body weight on it especially if it is on that knee alone even with a yoga pillow. I'm wondering if maybe yoga is not a good exercise for me. I recently went to a beginning yoga class and at least half of the asanas involved putting weight on the knee. Can you recommend any ways to get the benefits of yoga without further injuring my knee?

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  5. Today I did 1/2 peguin and wondered why all teachers say square your shin with the top of the mat. It seems to twist the knee outside of its range, maybe w/ better hip flexibility I could do it. Anyway, my left knee bothers me and feels loose a lot. I find myself trying to square my knee and I hear noises that quickly make me stop. I actually just go into swan pose and keep my knee in flexion and closer to me. Its more comfortable, not as much of a hip opener, but at least my knee does make any noise!!

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  6. I was taught to engage the muscles around the knee to avoid the knee locking. It seems to take a lot of practice before we remember to do this, students often relax knees even moments after a reminder. Thanks for this article. Om Shanti

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  7. very informative . Thank you

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