A Yoga Sequence for Knee Health

Please remember that this post only provides general guidance around knee health. If you have had a knee injury or recent knee surgery there are many factors that need to be considered before engaging in any rehabilitative exercise regime and its best to consult your doctor, health-care team or physio before starting yoga. 

It may seem a rather obtuse or clinical title for a yoga sequence – certainly not as sexy as A Yoga Sequence for Better Sleep for example (although that is coming soon!) – but building greater knee strength is a subject matter close to my heart, and has been a massive part of my yoga regime for years.

In fact the whole reason I came to yoga was because I had dislocated my knee several times and I faced the hearbreaking realisation that a dance career was just not going to be for me. Yoga early on presented an alternative. I loved the movement, the mindful connection to breath. The grace. It’s not a coincidence that many yogis and yoga teachers are ex-dancers.

Whilst yoga is often touted for its ability to enhance flexibility and range-of-motion, what I often find gets missed is yoga’s fantastic strengthening and stabilising qualities. To be sure it doesn’t have the grunt appeal or forehead-mopping benefits of lifting heavy weights or working with a resistance band but I believe yoga has a LOT to offer those of us with sore, sensitive or unstable knees.  As always it’s all about what you practice.

 

5 Reasons Why Yoga is Great for Knees:

  1. Its low impact i.e. in most forms and styles of yoga we don’t jump or bounce therefore reducing the amount of load, force and therefore stress on the joint.
  2. We use a lot of Closed Kinetic Chain (CKC) style movements and postures which are generally safer for knees that feel weak or unstable and are easier to control and therefore maintain good form whilst doing. CKC movements involve having the foot fixed on a solid surface e.g. the floor, as you do the movement or posture.
  3. We move slowly and mindfully which gives us a chance to focus on good tracking alignment of the knee (misalignment of the knee is a big factor in weak, unstable or injured knees). By taking our time as we consciously move in and out of positions we can retrain our habits and postural tendencies.
  4. Yoga recognises the holistic nature of the body and that knee problems often have their source in musculo-skeletal imbalances further up or down the body. Remember that the site of the injury is often not the source of the problem. When I have clients come to me with knee injuries, I always look at what’s happening in the position and alignment of their feet, hips and spines.
  5. In yoga we build isometric and eccentric strength which are fantastic for building strength and stability in our joints.
    • In isometric work we are holding the muscles and joints in a loaded static position – think of what happens to the muscles of your legs as you hold a Warrior 2 position for example.
    • In eccentric strength work, we gradually lengthen the muscles as we load them, for example, when we hinge forwards from standing into a forward bend the hamstrings are eccentrically lengthening.

 

Designing a Well-Balanced Yoga Practice for Knee Health

With the above in mind, the following sequence is designed to not only work all of the muscles that surround and stabilise the knee but also some muscle groups that seem relatively distant and unconnected. We will also work on stretching out some muscles that when tight can often cause knee tracking issues. Here’s a nifty table that outlines some of the major muscles and connective tissues you need to address for optimal knee health.

Strenghten Stretch
Quadriceps (muscles on the front of the thigh) Iliotibial Band or ITB (a tract of connective tissue running down the side of the upper leg)
Hamstrings (muscles at the back of the thigh) Outer quadriceps (when tight can pull the knee-cap outwards)
Glutes (your bottom!) Tensor Fasciae Latae or TFL (a muscle on the outer side of the hip)
Adductors (the inner leg muscles) Adductors (the inner leg muscles)
Vastus Medialis Obliqus VMO (a small tear-shaped muscle in the inner knee)

 

A couple of tips for practice:

As always the devil is in the details. I often say to my students – you spend the first 6 months in yoga just learning the basics, where do your hands and feet go, the general shape of a pose, remembering to breathe. You spend the rest of your life learning all the little details that make this practice so rich and exciting!

With that in mind there are a few small alignment tips that I think make all the difference when you are working on knee health.

 

  • Root down through the heel bone. When you press your heel firmly into the floor you will feel the muscles and connective tissue around your sitbone engage helping to strengthen the glutes and stabilise the hips. Strengthening the glutes plays a HUGE role in knee health.
  • Check your foot to knee-cap positioning again and again. The knees are the prisoners of whatever is happening in the feet and the hips! If the feet are turned out but the knees are pointing forwards (or even inwards) then your knees end up taking the strain of this misalignment. Happy knees are ones which track in the same direction as the centre of the ankle/2nd or 3rd
  • Engage the VMO. Getting the VMO (that tiny little tear-shaped muscle at the inner knee) to switch on can be tricky. If you’ve injured your knee it is likely that this muscle won’t be firing properly. Rooting through the heel bone can help to switch this muscle on but I also like to bring my fingertips to the area to help give me tactile feedback so that I know when it’s engaging.
  • Do not lock the knee. There is a tendancy for many students to “lock” the knee cap backwards in standing poses, particularly balance poses. Unfortunately this can often lead to torsion, instability and potential wear and tear of the knee joint. Instead we want to keep what I refer to as a slight micro-bend of the knee joint (the leg will still look straight) whilst engaging ALL of the musculature evenly around the knee (front-to-back and side-to-side).

The following practice gives some ideas for the sorts of poses that I regularly use with clients when working improve knee health. All of the poses/movements are designed to be repeated several times through until you feel a comfortable level of fatigue in the muscles without losing good form and technique. The exception to this is the two standing balances – Standing Quad Stretch Pose and Tree Pose which should be held for 30 seconds on each side, and the supine stretches at the end of the sequence which you can hold for up 1 minute on each side. Enjoy and feel free to leave any questions or comments below! 🙂

 

3 Great Exercises for Core Strength

In my last blog post I talked about how to engage two muscle groups that are responsible for stabilising the lower back, pelvis and torso. The Transverse Abdominals (TA) and Multifidi can be tricky muscles to tune into as their engagement creates a more subtle sensation of stabilisation compared to the muscle burn we might be used to feeling in say a bicep curl or a squat!

Nevertheless these stabilising muscles play a very important role in maintaining good hip and lower back alignment and creating a seamless fluid transition between movements making us more efficient and less prone to injury in daily activities and sport. These muscles are also particularly useful to look at when it comes to rehabilitation after a period of lower back pain.

So now that you are a bit more familiar with the actions of these muscles and how to enagage them in simple postures (if you need a recap click here) let’s take a look at three of my favourite core stabilisation exercises that I use regularly with my clients:

 

Supine opposite arm to leg extensions

Start by lying on your back with your knees bent, feet on the floor hipwidth apart and parallel in constructive rest pose. Bring your fingertips to the skin just to the inside of your frontal hip points. To engage the deep lower abdominal muscles, imagine you’re trying to narrow the hip-points and at the same time zipper the skin of the lower belly in and up towards the naval. The skin under your fingertips should tighten and draw down slightly as the lower back stays in a neutral position.

You will feel your breathe move more into your chest as the belly remains still.  Breathing naturally and maintaining the awareness of the lower belly bracing on your next inhale extend opposite arm to leg out along the floor. As you exhale return to the starting position, arms by your sides, knees bent. Then inhale to switch sides. Continue to go side to side with the breath for about 1 minute.

As you do this movement avoid letting the hips rock or the lower back overarch or flatten. The arms and legs are moving but the torso, lower back and pelvis remain still throughout.

To make this movement more challenging, you can explore hovering the heel away from the floor.

Supine opposite arm to leg extension pose

 

Toe Taps

For toe taps start by lying on your back, bringing your knees up over your hips, shins parallel to the floor and the feet flexed, as if you were sitting in a chair.

Avoid allowing your lower back to hyper-arch away from the floor but also do not flatten your lower back down – try to find a neutral curve in your lower back. At the same time, bring your hands to the skin to the inside of your hip points. Feel for narrowing the frontal hip points and drawing the lower belly in and up. Both these actions will ensure that the transverse abdominals and the multifidi are switching on.

Inhale, and as you exhale lower your right foot towards the floor, tapping the toes whilst keeping the knee bent and minimising any movment in the lower back or hips. On an inhale return to the starting position. Continue going side-to-side for about 1 minute.

If this proves difficult to control and your lower back is starting to over-arch or your abdominals start to bulge out, explore not lowering the legs as far, maybe hovering the foot a few inches from the floor as you lower.

Alternatively if this becomes easy and you want more challenge try straightening out the leg that you lower, floating the leg 1-2 inches off the floor, all the while keeping your lower back, hips and torso still and steady.

 

Toe Taps

 

 

Bird-dog

Start in an all-fours position. Knees hip-width apart and hands under your shoulders with the fingers spread and knuckles rooting into the mat. Gently draw the shoulder blades down the back away from your ears.

Feel for bringing your spine into a neutral position (use a mirror if needed) with its natural, neutral curves intact. Become aware of a long line of energy from the crown of your head out to your tailbone.

To engage the the lower abdominal muscles imagine you are narrowing your waist as if to tie up a belt a couple of extra notches, and at the same time zipper the lower belly from the pubic bone up to the naval. Maintain this abdominal bracing as you continue to breathe steadily in and out through your nose.

Keeping your lower back long in neutral (don’t allow it to overarch), on an inhale slide your right leg back behind you. Lift the leg only as far as you can whilst maintaining length in your lower back and keeping your hips square to the floor.

For more challenge you can reach the opposite arm forwards, spinning the palm to face inwards (like you’re going to shake someone’s hand) keeping the shoulders away from the ears.

Hold for 5 breaths. As you next exhale lower the right leg (and arm if lifted) back to the starting position. Inhale to switch sides. You can also vary this work by moving more fluidly with the breath, going side-to-side for about 1 minute.

Bird-dog

 

Image credits: Tummee 

Core Stabilisation for Back Pain 101

First of all what is core stabilisation?

In yoga, the term ‘core’ is used to broadly describe all of the musculature that supports and stabilises the lumbar spine, sacrum and pelvis. Stabilising muscles do not change length during movement; rather they stabilise and support the trunk during movement, which can be particularly helpful for students in the rehabilitation and prevention of lower back pain.

 

What muscles are involved?

Studies have shown that core stabilisation exercises which train and strengthen the deep abdominal muscle called the Transverse Abdominals (TA) and the deep spinal stabilisers called the Multifidi can be effective in helping to reduce pain and the risk of re-injury. One study, in particular, showed that people who’d been trained to strengthen their spinal stabilisers had only 30% recurrence of lower back pain after one year, versus a control group who were not given any spinal strengthening exercises and suffered an 84% recurrence rate.

The TA is the deepest layer of the abdominal muscles. Its muscle fibres wrap around the spine like a wide belt or corset, attaching at the bottom of the ribcage and at the top of the pelvis all the way around. When the TA engages it has the dual action of:

  • narrowing the waist, as if you were tightening drawstring pants and;
  • gently zippering the lower belly in and up as if you were doing up a tight zipper on your jeans

The Multifidi, on the other hand, are a group of tiny individidual muscles that provide stability to the spine, keeping the vertebrae in a safe position. These muscles come into play when:

  • the lower back is either neutral, such as when you’re standing with good posture in Mountain Pose
  • in slight back-bending or extension movements, particularly performed against gravity, such as Bird-Dog pose.

Bird-dog pose

It’s important to understand that the co-contraction of TA at the front of the trunk and the Multifidi at the back of the trunk will serve to maintain a neutral curve in the lower back and pelvis. Hence core stablisation techniques which work both the TA and Multifidi are all exercises in which the trunk is kept still and in neutral whilst the arms and legs move to provide challenge.

 

How do I engage the Transverse Abdominals and Multifidi?

To get a sense of how to engage these muscles start by lying on your back in Constructive Rest Pose. Have your knees bent, feet on the floor about hipwidth apart and parallel. You should notice that your lower back is in its neutral curve and we want this to remain the case throughout the whole exercise.

Constructive Rest Pose

 

To engage the TA:

Bring your fingertips to the skin just to the inside of your frontal hip points. In a relaxed state the skin beneath your fingers should feel relaxed and soft.

Breathe in allowing the belly to relax. As you breathe out imagine narrowing the hip points towards one another as if you were tightening a drawstring, and at the same time, zipper the lower belly in and up as if you were doing up a tight pair of trousers. The muscle beneath your fingertips should feel like it firms. The belly will also flatten slightly, as if you are sucking the contents of your abdomen up and back towards your spine. However do not flatten your lower back or tilt your hips back during this contraction as this will stop the multifidi from serving their proper function, which is to maintain the neutral curve of the lumbar spine.

Breathe in to release the contraction, as you breathe out repeat. This is a subtle engagement working at about 10-20% of your maximum effort. Repeat for 5-10 breaths.

 

To engage the Multifidi:

Continue with the above exercise but this time, as you breathe out imagine the muscles of the lower back contracting slightly upwards the naval at the same time as the TA engages drawing the naval in and back towards the spine. It’s as if the front and back of your body were coming closer together or co-contracting to meet in the middle of your body each time you exhale.  Again, the engagement is subtle and the pelvis or lower back should not move. Repeat for 5-10 breaths.

 

One final, important word

Whenever we work to strengthen an area of our body it is important to maintain an awareness of the bigger picture or overall intention of a yoga practice. Core stabilisation exercises therefore should become part of a bigger overall practice that serves to create greater function, strength and mobility throughout the whole body in normal everyday movements. As Aline Newton says so eloquently in her book “Stabilisation: The Core and Beyond”:

“ From the perspective of the body in motion, the work of the transversus system is not to make the trunk stable like a fortress, but to help make possible the transfer ot movement been hands and feet. Holding tension in the center of the body severely interferes with smooth transmission of the forces across the joints that is the basis for graceful movement.”

With this idea in mind, in my next blog post we’ll explore some of my favourite exercises for teaching core stabilisation to my clients that train to stabilise the core and lower back whilst mimicing real life movements. Stay tuned!

Credits to Tummee for their awesome images!

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