Knee Pain and Yoga

“Listen to your body.” Yoga students hear this phrase time and time again. I tell my student to back off if they feel discomfort. It’s apparent to do this when one has a sore, achy low back, hips or shoulders. However, sometimes the body part speaking the loudest is not the spine and hips, it’s the knees. These knobby appendages are prone to discomfort. Many yoga practitioners find that certain yoga poses are not friendly to the knees. Why is this? The answer to this question is not simple. The knee seems like a simple joint….it bends, it extends, and has a slight amount of rotation……what could possibly go wrong?

In fact, the knee gets more than its share of misfortune. Positioned in the middle of the leg it absorbs weight from the hips and upper body, bears the brunt of postural misalignment, suffer when the feet become unstable or quickly change direction. Plus knees are prone to many sports injuries.

So, what’s a yogi to do? First of all, if knee pain is a persistent problem visit your doctor or physical therapist for an evaluation. Barring any injury to the knee joint, I can offer you the following recommendations:

First, watch your alignment in standing and kneeling postures. Take a look down at your front foot. You should be able to see your big toe, and part or all of the second toe. This will prevent the knee going too far past the ankle or in toward the mid-line of the the body.

Next, Strengthen ALL the hip muscles. This includes the quadriceps (front of thigh), hamstrings (back of thigh), inner thigh (adductor group) and outer thigh (abductor) muscles. There are several yoga poses that can help you achieve this. I suggest to try holding these poses. Start by holding for 5 breaths, then progress to hold for 10-15 breaths. If there’s any soreness release and re-align. A few poses to try are:

Utkatasana (Chair Pose)
Strengthens the quadriceps, hamstrings, adductors & abductors.
Take care to place weight more in the heels than the front of the foot, and also avoid allowing the knees to flare out the the sides. Sometimes tight lats (a muscle on your back that connects to your upper arm) can make it difficult to raise the arms while coming into this squatting position. Try this pose first by keeping the arms in a cactus, or goal post position, then progress to extended arms.

Virabhadrasana I (Warrior I)

More hamstring and quadricep strengthening in this pose.
You can get a nice stretch on the front hip crease if you slightly tuck your tailbone under. Don’t forget to keep an eye out to make sure your knee doesn’t go past the ankle. For additional stability consider widening your stance.

Trikonasana (Triangle Pose)

Be careful not to hyperextend your front knee. Instead try to engage the hamstrings by having a soft bend in the knee. With the weight of your body forward over your knee, you can easily over-stress the knee joint leading to pain and injury.

Vrksasana (Tree Pose)


Standing balance poses such as this one help strengthen those outer hip muscles, which are so important for the health of our knees. In addition, Vrksasana strengthens the external rotators, and the glut max (the tushie muscle). Try to press the raised foot into the standing thigh while pressing the thigh into the foot. This will help with balance, and strengthens the inner thigh.

Last, but absolutely not least, strengthen your core abdominal muscles. If these muscles are strong, they allow us to move our limbs with strength and stability, thus avoiding possible pain and injury. For more info on how to do this, see my previous post Awakening the Sleeping Giant. http://wellnesswithlorie.com/2018/01/16/awakening-the-sleeping-giant/

When the Heart Goes Pitter Pat….

Go, go , go….this is our modern mantra. We rush here, do this, do that, then rush on to the next thing.

All the while our breath matches our movements….shallow and fast. Sometimes after running around and feeling stressed, I have trouble getting my breath back to a normal pace, even with meditation and pranayama (breathwork). There seems to be a disconnect between my brain and my body, in particular my heartbeat.

But is it really a disconnect? After so much movement (of both the brain and the body) the brain isn’t ready to settle down. Since the nervous system controls muscle action (which includes the muscle fibers of the heart, lungs and other internal organs) it’s not surprising that the heart continues to beat fast, and we may feel breathless. We must calm the mind to calm the heart.

The magical solution to this is slow, mindful yoga. When you slow movements down and match the breath to the movements, the nervous system (specifically the parasympathetic nervous system) signals the body to “rest and digest”. This results in reduced heart rate, decreased blood pressure,  better digestion, and a reduction in inflammation. The benefits of yoga to calm down the nervous system has been likened to getting a massage or spending time in nature.

So next time you’re feeling stressed, take some time to practice slow, yogic movements matched with breath. Your body will thank you!

P.S. My “Unwind the Spine” Fridays at 4:30 at Refresh Studios https://www.refresh-studios.com/classes  practices these principles of slow mindful yoga.

Awakening the Sleeping Giant

If you want to really see the roots of core strengthening, follow a baby through  his or her milestones. The first time they roll over, the core abdominal muscles awaken. They don’t even use their arms or legs….it’s all abs working to move them from the back to the stomach.

Most yoga classes I teach have some component of core strengthening. Recently one of my PTA colleagues and I were having a conversation about this and he said that in his opinion core strengthening seems to be the answer for everything. Really I couldn’t agree more. In fact, I remember when a young patient was evaluated by a PT for ankle strengthening after spraining both ankles doing sports. Although ankle and calf strength was a major component of her home exercise program, the PT also gave her exercises to strengthen her core to avoid future problems.

Why is this? The deep abdominal muscles support the low back, which in turn lend stability and support the pelvis, hips, knees, and even the shoulders and arms. The biggest player in this repertoire is the transverse abdominus muscle (I’ll call it the T.A. for short). The T.A. is in the abdomen and  lies under the rectus abdominus (commonly know as the 6-pack). It is a giant, powerful muscle that wraps around the torso and attaches to the vertebrae. Because of this, when the T.A. is strong it stabilizes the spine. This minimizes the possibility of injury occurring when we move our arms and legs (think….walking, sports, even everyday tasks).

Unfortunatley, this  muscle does not get strong with the  average work-out. This T.A.  is like a sleeping giant, it lays around lazily and lets others (i.e. the 6-pack muscle, hamstrings, low back muscles, etc.) do the work . However, with focus and consistency you can awaken this sleeping giant. Then it can keep all your muscles and joints strong and healthy!

So how do you rouse this muscle and use it to bring strength to the low back and other key parts of your body? Try the following exercises to get the T.A. to kick in.

  • Lie on your back with your knees bent and feet flat on the floor.
  • Place your hands on the front of your hip bones, then move your fingers about an inch in, towards the center of the body, and press with slight pressure.
  • Now cough or laugh. When you do this you should be able to feel a little wiggle or jump of the T.A. muscle.
  • Now that you’ve figured out which muscle to engage, you can start strengthening the T.A.
    • Keeping your fingers on the T.A. muscle take an inhale (the belly will expand), then exhale and tighten the muscle by bringing the belly button towards the spine.  (You should be able to feel the muscle tight under your fingers)
    • Continue to engage the muscle as you take a few breaths. This is by far the hardest part of the exercise. Intuitively we want to hold our breath.
    • On an inhale relax the muscle, then repeat this 10 times.
    • Once you learn how to engage this muscle with breath, try to lift one foot a few inches off the floor.
    • Lower the foot, then lift the other a few inches off the floor.
    • Continue to alternate while you’re engaging the T.A. (This is like marching with small steps). This will train the T.A. muscle to to engage with movement.

Consistent training of the T.A. will reward with less incidence of low back pain or injury of the extremities.

 

The Magic of the Exhale

“Don’t forget to breathe……Are you breathing?”

I often say this to patients as they perform their PT exercises. This statement is usually met with a look of confusion mixed with guilt, then followed by the words, “No….I was holding my breath.” As a smile creeps across their face they mention that they forgot to breathe because they were concentrating on how to do the exercise properly. Once they try the exercise with breath they find that it is less strained and more effective.

In PTA school we learned about respiration in terms of oxygen/carbon dioxide exchange, the importance of this physiological process to the heart and lungs, and the muscles that make all this happen.

Most yoga classes start with focus on breath as a way to quiet and center the mind. Breath is called prana, or a vital  life force. It contains three parts; Puraka (inhalation), Rechaka (Exhalation), and Kumbaka (a pause between inhalation and exhalation). As I practiced yoga one day, it occured to me that the element of Rechaka is magical in its scope of usefullness.

On a physiological level the primary muscle of inhalation is the diaphragm.  In a healthy individual without a compromised respiratory system, the exhalation occurs without any active engagement of muscles. It is a passive activity of deflation of the lungs. So it really just…..happens. Even though there is no muscle action involved, the Rechaka  is powerful. An exhalation can:

  • Relax muscle tension and decrease emotional stress
  • Assist during Exertion
  • Assist in Engagement of Core Abdominal Muscles

Each of these could be a blog post individually. I will definately have another post dedicated to core engagement.  So here I’ll briefly talk about Rechaka’s relationship to the first two.

First, during yoga classes I teach, I talk about the exhale being an invitation for the muscles to relax. A great time to try this off the mat is at bedtime. Once you’re comfortable, close your eyes and notice your breath. Exhale slowly and evenly. Focus on heels or ankles sinking down and relaxing. Continue this with each body part, feet to head. If you’re not asleep by this time, take note of what’s going on in your body, as well as your mind. Rechaka is useful in quieting the mind and releasing muscular tension.

Second, when you need to complete tasks that require physical exertion (exercise, moving heavy objects), exhale as you perform the most physically demanding part of the job. Rechaka can give you an extra boost of power when you need it. Try this next time you perform a challenging yoga pose or at the gym when you’re working out.

Indeed, Rechaka has magical powers. I encourage you to use this readily available, free resource when you need relaxation, release of muscular tension, or an extra surge of energy and power.

Namaste and Be Well!            Lorie