By Christine Jablonski, a certified Yoga Tune Up Teacher
Knee pain, ranging from general discomfort to consequences of traumatic injury, is one of the most common reasons people seek medical attention. Treatment often includes physical therapy and sometimes includes surgery (according to the American Academy of Orthopedic Surgeons, 600,000 knee replacements are performed every year in the United States alone). But people are also increasingly looking to yoga. A recent Yoga Journal survey suggests over 15 million people currently practice yoga and at least that many more are very interested in beginning a practice. These populations will likely collide. If you do not have a client with knee issues in class now, chances are you will. And soon.
If you are a yoga teacher you are uniquely capable of helping your students address the pain, fear and frustration associated with injury, surgery and recovery. You can be even more effective, however, whether you are a Yoga Teacher or just someone who wants healthy Knee joints, if you understand some knee anatomy and mechanics. There’s a lot going on in that hinge between the thigh and shin.
Let me introduce you…
Four bones: the femur, tibia, fibula and the patella are all held together by a few ligaments. The collateral ligaments hug the knee joint from thigh to shin to stabilize the side-to-side movement. Two cruciate ligaments cross under the kneecap like an “X” to stabilize the knee’s forward and back movement. Two crescent-shaped cartilage discs (aka meniscus) sit between the tibia and femur to distribute weight.
Eleven muscles act upon the knee joint. The quadriceps lift the kneecap, extend the knee and converge above the kneecap to become the quadriceps tendon. The quad tendon flows over the kneecap and becomes the patella tendon (like when street names change across an intersection), which attaches the kneecap to the tibia. The three hamstrings flex the knee, run down the back of the thigh from the sit bone and attach at different points on the tibia. Two adductors (gracillis and sartorius), the popliteus (a small muscle behind the knee that runs to the ankle) and the gastrocnemius (your prominent calf muscle) are also knee flexors. All of the flexors except the gastroc medially and laterally rotate the knee a little–only when it is bent–if you can rotate your knee when it’s straight, get thee to a doctor. Now.
In short, the muscles on the front of your knee straighten it, the muscles on the back of your knee bend it; muscles that attach on the sides of the knee move your shin side to side. The entire structure is held together by a few ligaments and padded with a few discs.
Injuries you might see as a yoga teacher include cartilage tears caused by poor alignment, ligament tears due to side impact when the knees are bent, or joint replacements to relieve arthritis and long term degeneration.
Whether your clients are turning to yoga to “pre-hab” as a way of avoiding surgery, or have gotten the green light to resume yoga after surgery, consider what poses and exercises will be complimentary to their healing process. Knee rehabilitation often includes stabilizing the knee by strengthening and tightening the quads and hamstrings, but it is equally important to stretch those muscles as well as attend to the adductors so the knee doesn’t become imbalanced by being overly tight on one side and slack on the other. In addition, breaking up scar tissue and improving circulation in the knee will help the recovery process.