Working with Students Who Have Yoga Injuries, Part 2

Awareness of contraindications, as well as a few principles for dealing with specific injuries, can help you design a therapeutic routine.

By Timothy McCall, M.D.

In Part 1, we discussed general principles of working with yoga injuries. In this and the next column, we'll cover some specifics for a few common injuries, stressing how to avoid making them worse as you try to make them better. Since individual injuries vary as much as the individuals who have them—and because there are many useful approaches within the worlds of yoga—consider what follows simply as rules of thumb, not rigid principles. As always, what you observe and your students' actual experiences will trump any ideas about what's supposed to be therapeutic.

Knee Problems

If the knee is swollen or shows other signs of inflammation (see Part 1), you may need to avoid most active asana practices, instead focusing on restoratives and breathwork. Until fully recovered, students should step, not jump, into poses. Be particularly careful with squats such as Utkatasana (Chair Pose) and Malasana (Garland Pose), as these can cause shearing forces (horizontally across the joint) on the knee. You may also need to avoid one-legged poses such as Vrksasana (Tree Pose), since the joints in the standing leg are under twice as much pressure. This is particularly true of students who are overweight (common in people with knee injuries).

If poor alignment of the knee is an issue, rather than going directly after the knee, especially in the early stages when swelling and inflammation are present, turn your attention to the foot and ankle and the hip. Misalignments in these neighboring joints can lead to knee misalignment, while correcting them can make a big difference in knee function. If tight hips are contributing to misalignment, a variety of hip openers may be useful. One that I like is the supine pose sometimes called Threading the Needle, in which, from a supine position, you first bring the right ankle over the bent left thigh, holding onto the back of the left thigh, moving the left knee toward you and the right knee away from you, before repeating on the other side. Although Virasana (Hero Pose) can be therapeutic for students with knee problems, you'll usually need to support the hips with blankets or a block or you risk torqueing the knee, potentially exacerbating the problem. In this and other bent-knee poses, some students with knee pain benefit from placing a tightly-rolled washcloth or other prop behind the knee to create additional space in the joint.

If the knee joint is painful but not acutely inflamed, several brief repetitions of standing poses may be preferable to longer holds. You can take some of the burden off the joint in standing poses by supporting the body's weight. In Virabhadrasana II (Warrior II Pose), for example, have your students place their hands on a table or platform behind them, or use a chair under the front thigh. Even using a block under the hand in Trikonasana (Triangle Pose) can take some of the weight off the knee. In Triangle and other poses, be sure your student is not locking the front knee, as this can compress the medial meniscus, the cartilage that cushions the portion of the knee closest to the body's midline. If you find this pattern, instruct the student to place more weight on the ball of the front foot and less on the heel, and to keep a "micro-bend" in the front knee (which actually isn't a bend at all; it just feels that way if your habit is to hyperextend the joint). For a student who has trouble breaking this habit, try wedging an angled block between the floor and the student's front calf.

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