Misalignment of the knee often happens over time, and through hyperextension or overexertion. Our bodies are prone to this misalignment because our hip joints are wider than our knee joints. As we age, this natural shape creates uneven contraction of the quadriceps, which can eventually pull kneecaps outwards. Conditions worsen with hyperextension. Even yoga, often hailed as a cure-all, can tax our knees if it is approached too vigorously, without mindfulness, or without an experienced teacher.
Your Inner Quad: How Yoga Can Help Your Knees
One way to prevent knee pain and injury, or to help recover from these kinds of knee problems, is to strengthen the vastus medialis; this is your innermost quadriceps. This muscle tends to be weaker than the outer quad, and this imbalance contributes to knee misalignment. It needs to be exercised, but is sometimes hard to isolate. The good news is that yoga is an excellent method to strengthen your inner quads. Certain yoga postures ensure your quadriceps (front thighs) are evenly strong which, in turn, means these leg muscles pull equally on the ligaments that protect your knee’s proper alignment.
A Quick Test
In standing poses, yoga teachers will often tell you to “lift your kneecaps and engage your thighs,” because this activates the quads, thereby protecting the knee from hyperextension. Observing this motion can also help you know if your kneecap is misaligned, or if you need to workout your inner quadriceps. If you lift your knees and engage your thighs, do your kneecaps move in an angle and shift toward the outside of your knees? If so, perhaps you need to exercise your vastus medialis. If your kneecaps move straight above your knees—great news!—you are in alignment; strengthening your inner quads can still help you remain healthy in the long run.
In addition to this visual test above, notice if you tend to experience pain in the front of the knee, or just behind your kneecap, especially if this tenderness happens when you squat or climb stairs. If so, gently working the vastus medialis might help. Mindful yoga practice is a low-impact method to stabilize knee joints, a good preventative measure and often beneficial even for those who have suffered knee dislocations.
Osteoarthritis, the Knees, and Yoga
Recent studies have strongly confirmed this approach of working your innermost quadriceps. Osteoarthritis, a common knee ailment, is a condition in which the protective cartilage surrounding your knee has degenerated and no longer absorbs shock or pads the bones. Physicians have long advised that to prevent osteoarthritis, patients should strengthen their hamstrings, the muscles of the back of the thighs, as well as their quadriceps, the front thighs. The medical world, however, was shocked when, in 2003, a study published in Annals of Internal Medicine, revealed that toning the thighs might actually hasten the development of osteoarthritis. Further investigation indentified a deciding factor: the presence of mis-aligned kneecaps alongside exercising the thighs quickened knee degeneration; exercise was not to blame.
And what is one of the most common causes of mis-aligned kneecaps? Imbalanced quadriceps, according to Stephen Messier, a professor of Health and Exercise Science, and director of the J.B. Snow Biomechanics Laboratory, as well as the Runners’ Clinic at Wake Forest University, in North Carolina. If development of the quadriceps is imbalanced, this pulls the knee to one side and, eventually, it also thins the shock-absorbing knee cartilage (the meniscus) of that side more than the other.
The Importance of Warriors: Virabhadrasanas I & II Help Your Knee
Virabhadrasana I and II, poses that are taught in most beginning yoga classes, help strengthen your innermost quadriceps. The knees work hard in these poses, and proper alignment is necessary to protect those precious knees. In the classic pose, the forward knee is bent so that the lower leg is at a 90-degree angle to the floor; the knee is just above the ankle. The knee should not bend further than your ankle. You should always be able to look down at that bent knee and still see your toenails. If your knee is going too far, widen your stance or lift up your torso a bit. When you look down at your knee, it should be above the second toe; the toes, knee, and sitz bone should all be in the same plane.
A common Warrior Pose mis-alignment, and one that stresses the knee, is to let the forward thigh flop inwards towards the big toe. This also over-works your front-most quad (rectus femoris) and your outermost side quads (vastus lateralis), contributing to uneven thigh development. Less common, but just as stressful on the knee, is to allow the knee to turn outward in the direction of your little toe. Always check that your knee, toes, thighs, and hip remain aligned. In order to achieve this, your hips might need to slightly turn.
Feet Matter: Weight should be centered throughout your foot, but the toes should not grip. Ground your inner heel, your big toe, and the outer edge of your foot, while lifting your inner arch. This helps your knee from splaying to either side, and facilitates your balance. Additionally, to protect precious knees, slightly separating toes and pressing through all four corners of your feet works your ligaments (the MCL and LDL, see discussion and image below) evenly on both sides of the knee.
Fierce Pose for Even Development of Your Quads: Another asana (yoga pose) that helps you develop the inner quad is UTKATASANA, when done against a wall. “Utkatasana” translates as “Fierce” or “Powerful Pose.” It is more commonly known as “Chair Pose,” because it looks like you are sitting on an invisible chair. Utkatasana is a wonderful pose for beginners with tons of benefits; practiced with your back against a wall, it also helps you build mindfulness of your quads.
Begin with your back to the wall, as you stand in Tadasana (Mountain Pose) about a foot to a foot and a half from the wall. Take your fingertips back to the wall to steady you, and slowly move your back to rest against the wall. Keep your back pressed against the wall, as you EXHALE and bend your knees. Release your sitz bones down towards the floor. Make cure your chest remains lifted. To stretch further, raise your arms above your head, then join your palms together. To release, INHALE and slowly straighten your legs, coming back into Tadasana.
Know and be mindful of the anatomy of your knees to protect them through proper alignment and specific muscle strengthening asanas (yoga postures). Image source: http://preventyogainjury.blogspot.com/2013/02/3-things-you-must-do-to-keep-you-knees.html
As with any yoga posture, back off if you experience pain in a particular asana (pose). Medical experts and yoga practitioners agree that engaging the quadriceps and, additionally, focusing on even development of the quads are important for knee health. More controversial is the issue of ligaments. Though most argue that gentle yoga helps injured ligaments, many physicians insist that you cannot strengthen ligaments. The general advice—and the instruction given at AHA! Yoga—is to stretch muscles, but not ligaments. A mindful practice where you pay attention to your bodily sensations is how you can achieve this subtle difference. Dr. William Roberts, a professor of family medicine and past president of the American College of Sports Medicine, explains that if your thigh muscles are taut and working, this is great; you should feel it just above your kneecap. If you begin to feel tension on the side of the knees, come out of that position slowly; you are working ligaments—not muscles—too hard.
Kripalu and Iyengar-influenced Yoga: According to Yoga Journal, certain types of yoga are best for students recovering from knee injuries. These include Kripalu Yoga, because it focuses on gentle, compassionate healing suited for your particular body, as well as Iyengar Yoga, because it insists upon details of alignment. Kripalu Yoga and Iyengar-influenced instruction are central to every yoga session at AHA! Yoga. In contrast, yoga classes that include quick transitions between poses might be avoided for those with healing knees. If you want to protect and heal your precious knees, AHA! Yoga is a good start.
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