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Knee Question
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   Fitness -> Injuries and rehabMessage format
 
LNP20
Posted 2006-06-09 10:51 PM (#55375)
Subject: Knee Question


When I do asana in which I put my left foot in lotos position,and while sitting I put my right foot to stand on the sole so i get more extension in the left foot,I always hear a somewhat clicking bone-jumping sound in the left knee. The pain isnt really unbearable,and there isnt really the pain as such,only a slight discomfort,but it really irritates me. When I do the same thing but with the feet switched to left to right,my right knee doesnt have that problem,it all goes smoothly. So is there any exercise to strengthen the muscle around the knee and prevent it from jumping in&out? The thing that falls to my mind is to hold position of squat for certain period of time,putting more pressure on the knees and making the muscle around it stronger. Would that help? Also would like to hear some other interesting suggestions
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tourist
Posted 2006-06-10 10:09 AM (#55393 - in reply to #55375)
Subject: RE: Knee Question



Expert Yogi

Posts: 8442
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LNP - it sounds like you have very unstable joints, judging from your post about the dislocated shoulder. First of all, I would suggest not doing the pose you mentioned at all until you have strengthened that knee. Learn how to support the knee by engaging the quadriceps in standing poses. I hope Nick or one of our other anatomist types comes and gives you more instructions on this
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LNP20
Posted 2006-06-10 1:49 PM (#55413 - in reply to #55375)
Subject: RE: Knee Question


Oh my shoulder problem post was posted from the person who have been to the
other side and came back in full effect =) I can do the pretty much all of the asanas
I have encountered so far,from those shoulder stressing like bhujapidasana,ashtavakra,
and baka asanas and variatons, for holding each for at least a minute at once,to all
kinds of warriors and asanas where knees are more challanged. as a matter of fact,
thats the first asana in which I encountered some knee problem at all. I usually can hold
ordinary full lotos position for both right foot over the left and left foot over the right for
at least half an hour+,with no pain or discomfort (working on a computer or watching
television while sitting in lotos rocks ,lol) .And I agree with the point,gonna hold my left
knee from doing that asana described in the first post,and also decided to do passive
and active version of squats for at least 1,5-2 months,half an hour each day,so I`ll let
you know the result after that amount of time passed. But that anatomist instructions
would also be quite nice heh

Edited by LNP20 2006-06-10 1:50 PM
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Nick
Posted 2006-06-11 2:53 AM (#55450 - in reply to #55413)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi LNP20,
One rather meagre anatomist here! If I had your knee in my hands, I could perhaps give an accurate appraisal of what is going on-I'll do my best. Joint sounds (crepitus) are not necessarily associated with pathology-many people have crepitus their whole lives with no associated pain. Since I have been associated with yoga, however, I have come to believe that crepitus can indeed be a sign of something declining within the joint. Lotus could negatively affect the lateral collateral ligament on the outside of the knee, the anterior cruciate ligament because of the knee flexion, the medial meniscus from shear and torque on the knee. The knee is an 'at risk joint' in yoga because it is at the end of two of the longest levers in the human body, the femur and the tibia. One of these levers has the most powerful muscles in the human body at one end, and the tibia transmits forces to and from the ground.
What is of primary importance for the knee is good alignment whilst loading. And squatting on one leg is considered the best way of strengthening the knee. Get several weights, medicine balls are best, and try extending and bending your knee-do it in front of a full length mirror and keep your kneecap facing forwards-good to put some tape on the front of the kneecap aso you can see if it deviates. Squeeze the floor with your foot. It's best to practice several times a day if possible. Do both legs an equal number of times. Any pain is not good, discontinue the exercise or make sure you are doing it perfectly.
That's the easy bit!!-the next bit is taking apart your yoga practice so that you basically rehab your knee with brilliant alignment during all yoga postures. Otherwise you will eventually give up yoga as you find out it is impossible to do without pain. This is a great challenge, because ti may mean that you cannot practice certain postures for a while that you can do easily already.
For some instant help-try standing on one leg and pulling one foot up into lotus without using your arms to pull the foot up. You now have an accurate portrayal of what your hip and knee muscles and joints are capable of. it will take years, in most cases, to take the foot up to the outside of the hip. When most people do this posture, they grab their foot, internally rotate the tibia, lift the knee-all thes give perfect conditions for causing knee pain-if I wanted to torture somebody by causing them knee pain, this would not be a bad way to start-but it is done thousands of times a day by yoga practicioners all over the world-no wonder many end up eschewing all other forms of exercise-they're probably in too much pain to run or cycle (just a personal opinion!).
So when you take your foot up,b try to keep your knee almost at the same height as its opposite number. You will see that rather than the knee swinging through an arc, now the foot goes through an arc movement, starting from the ground it swings onto the outside of the opposite knee before going up to the hip. Because you have now found out what your leg is capable of, you can use your hand to pull the foot up into the position which it will be capable of achieving by itself as you train it. So one of the answers to making lotus safer is to not use the arms to create movement conditions on the legs which the legs are not designed to cope with. Rather, use the arms to accentuate the moveemnts of which the legs are capable of doing.
Take care
Nick
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LNP20
Posted 2006-06-11 7:15 AM (#55454 - in reply to #55450)
Subject: RE: Knee Question


Nick - 2006-06-11 2:53 AM

Hi LNP20,
One rather meagre anatomist here! If I had your knee in my hands, I could perhaps give an accurate appraisal of what is going on-I'll do my best. Joint sounds (crepitus) are not necessarily associated with pathology-many people have crepitus their whole lives with no associated pain. Since I have been associated with yoga, however, I have come to believe that crepitus can indeed be a sign of something declining within the joint. Lotus could negatively affect the lateral collateral ligament on the outside of the knee, the anterior cruciate ligament because of the knee flexion, the medial meniscus from shear and torque on the knee. The knee is an 'at risk joint' in yoga because it is at the end of two of the longest levers in the human body, the femur and the tibia. One of these levers has the most powerful muscles in the human body at one end, and the tibia transmits forces to and from the ground.
What is of primary importance for the knee is good alignment whilst loading. And squatting on one leg is considered the best way of strengthening the knee. Get several weights, medicine balls are best, and try extending and bending your knee-do it in front of a full length mirror and keep your kneecap facing forwards-good to put some tape on the front of the kneecap aso you can see if it deviates. Squeeze the floor with your foot. It's best to practice several times a day if possible. Do both legs an equal number of times. Any pain is not good, discontinue the exercise or make sure you are doing it perfectly.
That's the easy bit!!-the next bit is taking apart your yoga practice so that you basically rehab your knee with brilliant alignment during all yoga postures. Otherwise you will eventually give up yoga as you find out it is impossible to do without pain. This is a great challenge, because ti may mean that you cannot practice certain postures for a while that you can do easily already.
For some instant help-try standing on one leg and pulling one foot up into lotus without using your arms to pull the foot up. You now have an accurate portrayal of what your hip and knee muscles and joints are capable of. it will take years, in most cases, to take the foot up to the outside of the hip. When most people do this posture, they grab their foot, internally rotate the tibia, lift the knee-all thes give perfect conditions for causing knee pain-if I wanted to torture somebody by causing them knee pain, this would not be a bad way to start-but it is done thousands of times a day by yoga practicioners all over the world-no wonder many end up eschewing all other forms of exercise-they're probably in too much pain to run or cycle (just a personal opinion!).
So when you take your foot up,b try to keep your knee almost at the same height as its opposite number. You will see that rather than the knee swinging through an arc, now the foot goes through an arc movement, starting from the ground it swings onto the outside of the opposite knee before going up to the hip. Because you have now found out what your leg is capable of, you can use your hand to pull the foot up into the position which it will be capable of achieving by itself as you train it. So one of the answers to making lotus safer is to not use the arms to create movement conditions on the legs which the legs are not designed to cope with. Rather, use the arms to accentuate the moveemnts of which the legs are capable of doing.
Take care
Nick


Thanks for the time you took to write this,many interesting points reside inside it.
I dont want to spend time making comentaries about the things you wrote that are
alone self-obvious,so Im just going to say that Im certainly going to try that one-legged
squat with weights.And also tried that method of standing on one leg and bringing the
other foot up in the lotos without the help of hands.I measured it,and when doing it with
each leg,both come to the pretty much the same height,and that is 7.8 inches beneath
my hip,and 5.1 inches above my knee. So Im guessing thats not a pretty bad result,and
looking forward for more heh. So,again,I appreciate the info, and gonna keep you posted
on progress.

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Nick
Posted 2006-06-11 7:56 AM (#55455 - in reply to #55454)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi LNP20,
Glad to have been of service (hopefully, fingers crossed!). I would just like to say that in rehabilitation, as in yoga, it is important to make progress, obviously-so exercises are made difficult enough for the neuromusculoskeletal system to be stressed, but not so much as to cause further injury. Then it is important to make the exercises harder, so that the joint, muscles, bones and nerves continue to get back to 'normal,' or in the case of an athlete, "super-normal."
In the case of a squat, for example, the progression could begin by standing in a doorway, and simply bending the knees, using the doorframe for support. Then progress to doing the squat in the middle of the room. Then progress to one-legged squats. Ultimately, and this is probably very important, you do it with the eyes closed. Many postures and movements have a balance component, and if balance is less than optimal, then so is one's ability to perform the posture well-and hence the posture is not so good for you. Closing the eyes forces you to rely on what is called proprioception, the nerves that tell you where you body parts are aligned, spatially and temporally. Then, when you do the yoga postures with your eyes open, you should find that you can perform them with greater success.
If I tell you about squats, I'm afraid I'm also going to have to tell you to learn to use your gluteal muscles. As you bend your knee, tilt your hips so that your torso is at ninety degrees to your thighs and your lumbar spine is in the neutral position. The squat then becomes a premier exercise for the gluteals-if these are weak, then the low back and hamstrings are often tight (the lower crossed syndrome described by Janda), so for the purposes of yoga, at least, it is best to give these muscles the functional importance they deserve. the importance of having strong hips is also apparent in saving your knees-if the hip muscles are dysfunctional, then the knees may mis-align, causing strain on the structures of the knee-look at how tight hamstrings can affect both the pelvic tilt and the stability and movement of the knee.
Hope that helps to make squats clearer-if everone learned to do squats properly from an early age, the world would be a much better place With lots of very unhappy chiropractors, touting for business outside the supermarket!
Take care
Nick
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LNP20
Posted 2006-06-13 10:55 AM (#55688 - in reply to #55375)
Subject: RE: Knee Question


Oh doing it for two full days already =)
My programme for now is 10(5x2) minutes of passive squats and 100 (50x2) of dynamic
squats on both legs, and 2.5 minutes of passive and followed by 100 dynamic (50x2) for
each leg. My knees really feel alive after that =) Now what Im interested..will constant
strenghtening of knees have the bad impact on some postures,like muscles becoming
more shorter and for example not being able to go so deep into postures like lotos,
and if thats the case,what are the exercises to counter this?
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Nick
Posted 2006-06-13 4:20 PM (#55709 - in reply to #55688)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi LNP20,
I'm not really up to speed on the weight training terminology-what are passive squats? It sound like you are a weight-trainer? I would like to say to be careful of using weight-training programs, becuase the body-builder's aims of hypertophying the muscles have infiltrated both athletic and physiotherapeutic arena, so that you can have athletes who believe that having bigger muscles will make them functionally stronger-this is not the case. Just a word of caution.
When I was talking about squats, I was talking about dynamic ones-I would be careful about holding a squatting posture, as this may do more harm than good.You mentioned your concern that the knee strenghtening would lead to your flexibility decreasing-not if you do it properly!-in fact done properly, your flexibility of your whole body may increase-with better knees you have better balance and can put yourself into postures which would normally have you falling over.
In the case of lotus, the knee strength and better alignment may mean that lotus position does not harm your knees, but will hopefully teach you good knee alignment. In this case the muscles begin to act as 'extensible ligaments,' protecting the knee joint from being pushed into extreme ranges of movement. You might think of the increased neuromuscular control as being like a pair of reins on a horse, which serve to control the horse's movement and direction.
One of the dangers of lotus is tearing of the anterior cruciate ligament-because the ACL merges with the hamstrings, the increased neuromuscular efficiency of the hamstrings that the squat develops may serve in reducing shear force which would otherwise tear the ACL.
Will mail you tomorrow, I've got one or two ideas that I think you will be very interested in..
Nick
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LNP20
Posted 2006-06-13 8:06 PM (#55732 - in reply to #55709)
Subject: RE: Knee Question


Nick - 2006-06-13 4:20 PM

Hi LNP20,
I'm not really up to speed on the weight training terminology-what are passive squats? It sound like you are a weight-trainer? I would like to say to be careful of using weight-training programs, becuase the body-builder's aims of hypertophying the muscles have infiltrated both athletic and physiotherapeutic arena, so that you can have athletes who believe that having bigger muscles will make them functionally stronger-this is not the case. Just a word of caution.
When I was talking about squats, I was talking about dynamic ones-I would be careful about holding a squatting posture, as this may do more harm than good.You mentioned your concern that the knee strenghtening would lead to your flexibility decreasing-not if you do it properly!-in fact done properly, your flexibility of your whole body may increase-with better knees you have better balance and can put yourself into postures which would normally have you falling over.
In the case of lotus, the knee strength and better alignment may mean that lotus position does not harm your knees, but will hopefully teach you good knee alignment. In this case the muscles begin to act as 'extensible ligaments,' protecting the knee joint from being pushed into extreme ranges of movement. You might think of the increased neuromuscular control as being like a pair of reins on a horse, which serve to control the horse's movement and direction.
One of the dangers of lotus is tearing of the anterior cruciate ligament-because the ACL merges with the hamstrings, the increased neuromuscular efficiency of the hamstrings that the squat develops may serve in reducing shear force which would otherwise tear the ACL.
Will mail you tomorrow, I've got one or two ideas that I think you will be very interested in.. :D
Nick



Oh not really weight trainer as such, just incorporate it to one point in my practice besides
my power/ashtanga yoga ,to help myself in some asanas which demand increased level of
strength. Passive squats is in my view just a synonim for static squat, or as you mentioned
after,that means holding a squatting posture.Its an ordinary practice in Tai Chi and some
other types of martial arts, like shaolin kung fu. For example (a bit extreme example lol,but
no matter) shaolin monks use to stand in that kind of squat position on two wooden pilliars
for up to 2 hours (!) . Beneath their bottoms is a sharp bamboo stick,making sure that they
dont be tempted to go down too much or they will land on it,and on their head they hold a
bowl all the time,making sure that they dont make it easier for theirselves by going up,or the
bowl will drop down. Needless to say,training doesnt have to be such rigorous as that
one lol, but it really does much for the endurance and firmness of body-to-the-ground
connection,even more when mixed with sets of active squats. Anyways,thanks for clearing
up the rest and looking forward to those one or two ideas ;)



Edited by LNP20 2006-06-13 8:07 PM
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Nick
Posted 2006-06-14 2:08 AM (#55770 - in reply to #55732)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi LNP20,
My brother used to have a book of kung-fu exercises, one of which involved dragging along a boulder tied to the testicles-not sure if this one is ever going to make it into a physiotherapeutic setting!
You mentioned the placing of a sword under the buttocks-it is possible to get a similiar effect much more safely-did I mention that the squat should progress to eyes closed. Closing the eyes makes you very aware of your body's movements, just as placing a sword beneath you would-blindfold makes this even harder.
Take care
Nick
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LNP20
Posted 2006-06-14 11:37 AM (#55816 - in reply to #55770)
Subject: RE: Knee Question


Nick - 2006-06-14 2:08 AM

Hi LNP20,
My brother used to have a book of kung-fu exercises, one of which involved dragging along a boulder tied to the testicles-not sure if this one is ever going to make it into a physiotherapeutic setting!
You mentioned the placing of a sword under the buttocks-it is possible to get a similiar effect much more safely-did I mention that the squat should progress to eyes closed. Closing the eyes makes you very aware of your body's movements, just as placing a sword beneath you would-blindfold makes this even harder.
Take care
Nick


So you want to say to me that you have something against dragging along a 140 pounds
boulder tied to your testicles?! =)))) but putting that Iron Balls skill to the side lol,of course
their whole training is extreme,but if you take some parts of it and simplify it a bit(or 2,or
3..heh) you get out of it some interesting and effective exercises. And of course I noticed
that closing the eyes makes balancing a lot harder,especially when doing poses like dig asana,
(http://www.ashtanga.hr/imagesasane/dig.jpg) . That blindfold thing sounds interesting,
especially if you have a female to practice with you at the same time ;)
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Nick
Posted 2006-06-15 11:11 AM (#55884 - in reply to #55816)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi LNP20,
And the female is presumably there to make it even harder to balance? Should be easy to spot the fetishists in class by their remarkble balance Not that I'm saying that a blindfold is fetishist or anything
Nick
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bstqltmkr
Posted 2006-06-15 2:52 PM (#55903 - in reply to #55375)
Subject: RE: Knee Question


At least lucky for her she gets out of that boulder dragging thing. I wonder do those guys suffer separation anxiety?
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Nick
Posted 2006-06-15 3:09 PM (#55905 - in reply to #55903)
Subject: RE: Knee Question



20005001002525
Location: London, England
Hi bst,
It's when they drop the boulder over the edge of the cliff that they find out who the true maters are
Nick
And every year the masters gather to play boulder conkers over the canyons

Edited by Nick 2006-06-15 3:12 PM
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Donut
Posted 2006-06-17 9:14 AM (#56052 - in reply to #55375)
Subject: RE: Knee Question


Just wanted to add my two-cents, along with Nick's suggestions for squats. the pactice of "wall squatting" may be very beneficial for your knees. I sometimes use them for a warm-up to my pactices. D. http://www.geocities.com/bgaughr/wall_squatting.htm
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