June '08 Practice Notes

On Yer Knees
By Dan Shuman 

Soft-tissue pain is mysterious and misunderstood by many – yet we as yoga practitioners inevitably face it from time to time. I experienced a significant amount of inflammation in my knees recently, and thought sharing some of what I discovered would be helpful to other sufferers out there. In the age of the internet, there is endless advice available, but it’s arguable how much is actually useful.

It’s not the end of the world if you hurt your knees, but it could prove a wake-up call to give attention to certain areas of your practice, or physical habits outside of the yoga shala. The knee joint bears the weight of the entire body and is highly exposed, so it is wide open for all sorts of problems. Anyone could accept that premature entry into a pose such as padmasana might create problems, but sitting for hours on a regular basis can put serious strain on quad muscles over a period of time.

It’s easy to get worked up when the knees get angry, but that’s all the more reason to seek some knowledgeable perspectives on what exactly is going on. In my case, I was relieved to discover that my injury was far less serious than I realized. A good chiropractor can test your knee for major mobility issues and in many cases work with the problem very well. Acute injuries are actually less common in yoga, so it might be better to investigate options that are not invasive first.

One place to examine at the onset of pain is how you are practicing. I contacted Adarsh Williams, a teacher who based in Mountain View, California, about knee maladies.

When I dropped in last summer to Adarsh’s excellent Mysore Class, he made a comment that stuck with me on my way out. “Tight guys like us,” he said, “it a takes a long time.”

Since he confessed to beginning as a tight guy and is now authorized to teach Ashtanga by Patthabi Jois, I wondered if he had any words of wisdom for currently tight folks out there trying. Adarsh gave simple but timeless advice, “Typically, the standing series is what will help make the knees strong and hips flexible. Take your time in practicing these- there is no need to jump into the seated series, traditionally, the aspirant would be well established in all of the standing series before moving onto to seated anyway.” It’s interesting to note the endless articles on the internet written by osteopaths and sports medicine professionals are nearly uniform in recommending a program of strengthening and stretching the quadriceps to protect or rehabilitate knees.

Perhaps ambition was a factor in what lead to my issues. Adarsh continued “I would highly recommend an intelligent approach to a daily practice- one doesn't have to practice the "whole" series to get credit- do what's appropriate for your current circumstances and gradually you will develop in all of the postures and other aspects of yoga.”

Clayton Horton, another fantastic teacher, related a similar sentiment:

“Sometimes teachers will push their students too far, but much more frequently is the case that a student wants to force themselves into the full pose when they are not ready. So often is the case in Ashtanga yoga, the teacher needs to slow the student down a bit so they won’t over do it and injure themselves. Slow, consistent, steady practice is the suggested method of practice rather than the student pushing themselves too hard while showing up for class 2 or 3 times a month.”

Clayton’s insight mirrors what I’ve been telling my music students for years. It can be hard to convince people to practice slowly and evenly.

He also was kind enough to share his own experience with knee injuries. While medial meniscus damage is not uncommon to yoga practitioners, Clayton damaged his medial menisci (the cartilage of the inner knee) on two separate occasions outside of yoga practice.

“I practiced while rehabilitating both injuries as soon as the pain and swelling allowed for some of the Ashtanga practice’s basic movements. I would work to the edge of my comfort zone and then back off a little; sometimes doing little mini practices focusing on dristhi, breath and bandhas.”

The more internal aspects of Ashtanga, he emphasized, are perhaps the most important.

“Seasoned Ashtanga practitioners will admit, being able to do a challenging pose or learn the next advanced posture is not the central focus in this tradition. It is being awake and sensitive to ourselves and others in the moment and our ability to practice consistently while not being attached to the results of our practice that brings about the greatest happiness.”

Horton keeps extremely busy teaching Mysore and lead classes in San Francisco as well as teaching intensive retreats worldwide. He pays close attention to the individual limits of each student. “I usually ask new students if they have any injuries. For those with knee injuries and tight hips I will demonstrate and offer them some modifications – for example using a strap for ardha baddha padmotanasana or offer a level of the pose that is accessible for their condition and ability.” Furthermore, he stresses the importance of mindfulness during practice, “It is important for students to listen and pay attention to the warning signs of misalignments in the quadriceps, pelvis, tight hips and sensitive knees.” 

So while you ponder the wise words of Clayton and Adarsh, here are a few additional ideas that might bring some relief if you are hurting: 

See Someone 
A good place to start is to get some idea of what the problem is. Don’t go at it alone with Google and draw your own hysterical conclusions. I would suggest starting with a chiropractor or related professional who specializes in soft tissue pain. An ethical practitioner will not hesitate to refer you to an osteopath if they feel it is warranted. Very often soft tissue pain can be managed with bodywork, acupuncture and modifying your physical routine. Make sure you choose someone who is yoga-friendly, as I did!

What’s wrong with taking a few joint supplements if you are going to be out there working them hard? The classic family that is recommended again and again is MSM, Glucosamine and Omega 3-rich Oils. There is some debate as to which oil you should use. Fish Oil is touted as being absorbed more successfully by the body, but for strict vegetarians there are others such as Flax Seed Oil. B Stress complex is also highly recommended, as well as MSM which is often taken in powder form.

Two of the cheapest and most powerful therapies – and you will have them recommended to you again and again. Those sports packs I am told are more effective if the pain is deep – the more common types of inflammation actually respond better to raw ice directly on the skin. You can freeze disposable cups of water, then tear away the rim to make an ‘ice cup’, or just grab an ice cube and massage the afflicted area directly, for approximately one to three minutes until the area is numb. One myth is that there is a high risk of frostbite like symptoms, but you would have to keep the ice on the skin far too long for this to be a problem. Ice brings great relief to pain, reduces swelling and stops inflammation. Moist heat in the form of hot water bottles stimulates blood flow and nutrient exchange – but you really have to gauge where your problem is at to decide what you need at the time. Hot baths should not be neglected for their healing properties.

Talk to your Teacher 
Injuries are surprisingly comfortable domains for yoga teachers, and they want nothing more than to see you feeling healthy and developing your practice. Sometimes it can take a lot of patience and exploring – and you might have to ask lots of questions. Injuries can provide incredible opportunities for learning. Lori Brungard, a teacher here in New York, is dizzyingly resourceful, and she’s given me many modifications that have proved very useful. Teachers and health professionals alike encouraged me to keep practicing – you might have to modify or reduce, but generally people seem to think it will speed recovery if you don’t lay off entirely.

Check out this great article This Australian Iyengar teacher deserves an award for this page: http://www.alangoodeyoga.info/articles/knee.html

Adarsh Williams teaches at Yoga is Youthfulness in Mountain View, California as well as retreats worldwide. His website is www.ashtangayogadaily.com. 

Clayton Horton teaches at Yoga Tree Valencia in San Francisco as well as retreats worldwide. 


Dan Shuman is a freelance musician based in Brooklyn, NY.

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