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Alleviating one of the most common causes for knee pain

Hello yogis, and welcome to the first blog of a series on localized pain and how to alleviate it.

I am starting this series based on the many requests and questions I have had over the years about pain. So, picking a pain out the hat, I came up with Knee pain, from Janett in NC.

To be sure my advice is wholesome, I have researched the topic on the internet as well as a few books, and I will reference them here, in a summary for you.

The approach referenced below is based on a few assumptions on why and how you found this blog.

First, you have tried different things to alleviate knee pain and they have either not worked or have only had a temporary effect.

Second, you might have heard of the sometimes scary "knee surgery", and you don’t want that to be the first or second thing you try.

Third, while looking for another way, you heard something about yoga helping to ease many types of aches and pains and wondered, perhaps you too could give it a try. So here we are :-).

There are a few key points to understand about our knees before jumping "two feet in" or should I say "knee deep" in a yoga practice.

Little anatomy lesson:

Our knees are the second major joint starting from the bottom up, first being our ankles. The ankles primary function is mobility, making the knees primary function stability. As a matter of fact, according to ACE, if you visit each major joint from the bottom to the top of your body, their primary function alternates between mobility and stability. So next up from the knee, our hips, are for… you guessed it, mobility.

So the knees are located between two major joints, whose functions are mobility and furthermore can move in all 3 axis. If you ever tried to move your knee in a third direction, you know that it doesn’t feel so good.

Just a little more anatomy YogaInternational teacher Doug Keller:

In Doug's view, the most common cause for knee pain is kneecap misalignment. The kneecap is meant to slide smoothly in a groove in the femur and when it goes off track it tears away at the cartilage. We of course don’t intentionally guide our kneecaps off track. So what does it?

According to Doug, the likely cause lies in the quadriceps. A group of muscle that works together to straighten our legs. The kneecap works much like a pulley between the femur (upper leg bone) and the tibia (shin bone), and adds as much as 30 percent strength to the movement initiated by the quadriceps. Since there are four muscles pulling the tendon that is the "rope" tying the two bones together, any imbalance in strength or tightness in this muscle group will add a sideways force that contributes to the kneecap wear on the cartilage surrounding it creating friction.

So what can yoga do to help correct this? Depending on the extent of the damage, we can train our muscles surrounding the knee to become more balanced, and to aid the correct motion required at this joint.

One last recommendation from Doug Keller: "Misalignments of the knee in various asanas (poses) can amplify the imbalances that lead to injury and can aggravate existing problems instead of correcting them." So watch close, and listen to your body, these asanas are not the most difficult, they just require a little extra attention.

There is much more to read about how the kneecap works and the balancing of our quadriceps, but to keep it short, we essentially need to strengthen the innermost quadriceps (the vastus medialis) to counter the outermost quadriceps (the vastus lateralis) while avoiding hyperextension of the knee.

There are many poses to do this, but here are three most effective you can start today. All you need is a mat and blanket and some relaxing music. No, not for corpse pose (relaxation pose), at least not yet :-).

Staff pose with knees supported:

If this is your first time doing staff pose I recommend checking the link above on how to do staff pose first.

Sit on your yoga mat, or on the floor on a towel.

Roll a blanket or towel and place it under your kneecap to avoid hyperextension.

You find that your knees are now about 15 to 20 degrees bent.

Work on straightening them to 0 degrees, without hyper extending them.

Hold for a few seconds, then let go.

If you'd like, incorporate your breath with the movement. Inhale as you draw the leg up, hold, then exhale release.

See if you can feel the inner quad muscle engage.

Now take your attention to the outer muscle. See that it is not the primary mover for this degree of extension.

Do this exercise daily for a few minutes if you can.

To better your chances of remembering it, add it to the top of something you already do daily, like having coffee.

Warrior II pose:

From Standing, step your right foot forward and bend your front knee until it is over the ankle. 90 degrees (or close) of flexion between the femur and tibia.

Slide your foot back and turn it sideways opening the hip, to look like the picture above.

Breathe and hold for 8-10 seconds, then repeat on other side.

In warrior II, pay close attention to the alignment circled on the upper right of the picture. That is crucial to strengthening the inner most quad. The kneecap should align with the second toe, not the big toe.

You can add a small movement of slightly straightening the front knee and re bending it. Maintain the movement small, otherwise we will be back at strengthening the outer quad.

Again, don't forget the other side.

You can also add to this series your Warrior I or a lunge, to invigorate the practice. Links below:

To round off the list we come to some straight leg poses. Note that here can be harder to pull the inner quad and the knee cap into alignment. We want to again caution on hyperextension. So now that you have learned where the inner quad muscle is, and if you tried all the poses above, you are probably feeling it now. Try a couple of your favorites from the following:

Finish off with a challenge :-)

For more resources and even a larger list of poses check out Yoga journal's list. Once you see it though, you may think "wait, that can be a whole class". And I say, yep :-), come join me for a class sometime.

http://www.yogajournal.com/category/poses/anatomy/knees/

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