Positive Health Online

At first sight, the knee may appear to be a simple joint, but it is actually quite complex. This complexity also makes the knee susceptible to many injuries, and the knee is often overlooked until something goes wrong. Healthy knees are generally happy knees and keeping the knees healthy is much better than trying to rehabilitate them after an injury.

The knee marks the meeting place of three bones: the shinbone (tibia), the thighbone (femur), and the kneecap (patella). Two crescent-shaped pads of cartilage, each called a meniscus, sit between the shinbone and the thighbone and act as cushions between the bones and shock absorbers during movement. Two sets of ligaments—the crudités and the collaterals—strap all three bones in place. The crudités crisscross below the kneecap; the collaterals run alongside the outside of the kneecap. The leg’s substantial muscles help these ligaments keep the bones properly aligned.

Anatomy

The knee is the largest joint in the body, and one of the most easily injured. It is made up of four main things: bones, cartilage, ligaments, and tendons.

Different views of the normal anatomy of the knee

• Bones. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella);
• Articular cartilage. The ends of the femur and tibia, and the back of the patella are covered with articular cartilage. This slippery substance helps your knee bones glide smoothly across each other as you bend or straighten your leg;
• Meniscus. Two wedge-shaped pieces of meniscal cartilage act as "shock absorbers" between your femur and tibia. Different from articular cartilage, the meniscus is tough and rubbery to help cushion and stabilize the joint. When people talk about torn cartilage in the knee, they are usually referring to torn meniscus;
• Ligaments. Bones are connected to other bones by ligaments. The four main ligaments in your knee act like strong ropes to hold the bones together and keep your knee stable;
• Collateral Ligaments. These are found on the sides of your knee. The medial collateral ligament is on the inside of your knee, and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement;
• Cruciate ligaments. These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee;
• Tendons. Muscles are connected to bones by tendons. The quadriceps tendon connects the muscles in the front of your thigh to your patella. Stretching from your patella to your shinbone is the patellar tendon.

Osteoarthritis of the knee is a degenerative disease in which the cartilage gradually decays and fails to provide the shock-absorbent padding that cushions the bones. Many older people suffer from this painful arthritic condition, and is more common in people who are over 50, overweight, and those subjected to previous injury to the knee.

There are many variables that may predispose someone to knee injuries. Most of these can be corrected or reversed, and prevention is a much better option than repair, especially since one of the risk factors for knee injuries is previous injury (a typical example being that of professional footballers).

Lack of conditioning is a risk factor for knee injury. Any exercise that helps strengthen the muscles, ligaments, and tendons around the knee will help reduce the risk of injury.

Muscle imbalances can also contribute to knee injury. When an imbalance occurs, the stronger muscle may overpower the weaker ones and cause the joint to move in an improper line or at awkward angles. This can cause irregular stress on the joint and the ligaments that hold it together. It also stresses the cartilage and bursae in the knee, which can lead to acute tears or chronic wear issues.

These risk factors can be reduced by improving Strength, Flexibility, Balance and Proprioception - Yoga provides a systematic approach to achieve this goal.

Strength

Strong muscles around the knee provide support by absorbing stress and wear and tear to the joint. Therefore strengthening the muscles around the knee such as the quadriceps, hamstrings, adductors and abductors will help absorb the shock of the forces experienced each time the knee is impacted i.e. when the foot hits the ground or against hyper flexion and hyperextension.

Flexibility

Tight muscles put excessive pressure on the joint because they can pull the joints at unnatural angles, which may contribute to muscle imbalances. Tight muscles are also susceptible to strains which cause further imbalance and continued inflexibility. Flexible muscles are achieved through stretching and warming up cold or under-utilised muscles which allow a wider range of motion and a greater degree of strength at the end of that range. Flexible muscles are strong muscles.

Balance

Good muscle balance around the knee will ensure adequate support when the knee is placed under normal stress. Muscle imbalance quickly leads to injury through irregular stress on the knee. Chronic imbalances can cause damage to the ligaments and cartilage in the knee, as well as putting extra pressure on the bursae. Proper muscle balance in the muscles around the knee as well as the overall balance of muscles in the body (especially. the core) is efficient and helps provide the proper support to the knee.

Proprioception

When a soft tissue injury occurs to the knee, there is always a certain amount of damage to the nerves around the injured area. This, leads to a lack of control of the muscles and tendons and can affect the stability of the joint structure. Without this information the muscles, tendons and ligaments around the knee are constantly second-guessing the position of the joint and limbs (Proprioception) and the risk is a re-occurrence of the same injury. To help retrain the damaged nerves around the injured knee proprioceptive exercises are important, simple balancing postures like standing on one leg and further balancing postures helps achieve this objective.

Whether you wish to guard against injury and disease or regain strength and flexibility after an injury, yoga can be a superb antidote to knee trouble. Done properly, asana practice can shore them up to prevent injuries and slow the progression of some musculoskeletal diseases, but practiced without mindfulness, it can spell disaster for these joints. The guidance of an experienced teacher and certain principles can guide you into a safe, beneficial practice.

A focus on body awareness and allowing slow, deep openings make certain forms of yoga ideal for students recovering from knee injuries. Traditional practices like Hatha and Iyengar Yoga (which focus on attention to detail) provide all the elements required for good practice- If you are recovering from a knee injury or surgery, you might want to steer clear of practices that involve a lot of athleticism and quick transitions between asanas until your recovery is complete.

Poses Beneficial for Knee Pain

1. Standing Mountain 

Standing mountain prevents misalignment by protecting against hyper extended knees, improving posture and increasing body awareness. Separate the toes and evenly distribute your weight on all four corners of both feet. Next, lift up on the arches (this is a very subtle but important action — lifting the arches stabilizes the ankles and unlocks the knees). Then, pull the pelvic bones up and in towards the spine, soften the tailbone and the shoulder blades towards the heels, and lift up through the crown of the head. 

2. Tree Pose

This pose strengthens the calves and shins. Standing in mountain pose, bring your right heel above your left ankle, and engage the right thigh to open the knee towards the right. Keep both pelvic bones squared forward, and lift through the crown of the head.

3. Hero’s Pose

Lengthens the quadriceps and squeezes synovial fluid into every nook and cranny of the knee joint. To get there, place a blanket or something similarly warm and fuzzy beneath your knees and bring your hips to your heels. Sit tall, lengthening upward through the crown of the head. If too much for the knees, increase the cushioning beneath your knees and sitting on a block.  

4. Chair pose

Standing erect, with feet slightly apart, stretch you arms horizontal, bend the knees and gently push your pelvis down, as if you are sitting in an imaginary chair. Focus on lifting the toes and pressing down through all four corners of the feet and Sink deeper into the chair by gradually going down but ensure that your knees don’t go beyond your toes.

5. Bound Angle Pose

Sit with your legs straight out in front of you, raising your pelvis on a blanket if your hips or groins are tight. Exhale, bend your knees, pull your heels toward your pelvis, then drop your knees out to the sides and press the soles of your feet together.

Bring your heels as close to your pelvis as you comfortably can. With the first and second finger and thumb, grasp the big toe of each foot. Always keep the outer edges of the feet firmly on the floor. If it isn’t possible to hold the toes, clasp each hand around the same-side ankle or shin.

Sit so that the pubis in front and the tailbone in back are equidistant from the floor. The perineum then will be approximately parallel to the floor and the pelvis in a neutral position. Firm the sacrum and shoulder blades against the back and lengthen the front torso through the top of the sternum.

Never force your knees down. Instead release the heads of the thigh bones toward the floor. When this action leads, the knees follow. Release by stretching the legs along the floor.

6. Lotus Pose

Sit on the floor comfortably. Assume the simple cross legged pose where the legs are folded.Lift the left leg and place it on the right thigh. Lift the right leg and place it over the left leg. Depending on flexibility the knees may touch the floor.

Pull and adjust the legs so that sole of the feet face upwards and the heels are tucked in at the waist level near the pelvic bone. Straighten the spine, broaden your chest (to avoid stooping) and place the hands in the gap between the feet. Place the left palm over the right palm. Relax the muscles in the abdomen and chest. The shoulders should be absolutely relaxed.

7. Lunge

Keeping your head up, spine in neutral and hands on hips, step forward with 1leg, bending the front knee to a 90 degree angle and drop your front thigh until it is parallel to the ground. Drop back knee behind you, so that you are balancing on the toe of your foot to create a 90 degree angle in your knee joint and a straight line from your spine through your bottom knee.

Conclusion

The standing and sitting poses of hatha yoga provide powerful and effective means for strengthening and stabilizing your knees, helping you to overcome structural imbalances that might otherwise lead to chronic wear and tear (and ensuing pain) in your knees. A little extra mindfulness in aligning and working your legs in these poses will enhance the natural therapeutic benefits these poses have to offer.