Protect the Knees in Lotus and Related Postures
Fortunately, there are techniques that make Padmasana much safer to learn. Even if you don't teach full Lotus, you can use the same techniques to protect students in related postures, such as Ardha Baddha Padmottanasana (Half-Bound Half-Lotus Forward Bend), Baddha Konasana (Bound Angle Pose), and Janu Sirsasana (Head-to-Knee Pose). These poses can do wonders for the hip joints and the muscles around them. Unfortunately, many students feel a painful pinching sensation in the inner knee in all of them. To understand why, and how to prevent it, consider the underlying anatomy.
The problem starts at the hip joint, where Lotus and its relatives require an astounding degree of mobility. When you move from a neutral, seated posture, such as Dandasana (Staff Pose), to Baddha Konasana, the ball-shaped head of the thighbone must rotate outward in the hip socket about 100 degrees. Bending the knee and placing the foot in preparation for Janu Sirsasana requires somewhat less external rotation, but as a student bends forward in the pose, the tilt of the pelvis relative to the femur brings the total rotation to about 115 degrees. Padmasana requires the same amount of external rotation (115 degrees) just sitting upright, and the angle of rotation is somewhat different, making it more challenging for many students. When we combine the Padmasana action with a forward bend, as we do in Ardha Baddha Padmottanasana, the total external rotation required at the hip joint jumps to about 145 degrees. To put this in perspective, imagine that if you could turn your thighs out 145 degrees while standing, your kneecaps and feet would end up pointing behind you!
If a student can achieve all of this outward rotation at the hip in Lotus, they can then safely lift the foot up and across onto the opposite thigh without bending the knee sideways (see Figure 1). Some people with naturally mobile hips can do this easily, but for most people, the thighbone stops rotating partway into the pose. This limitation may be due to tight muscles or tight ligaments or, in some cases, to bone-to-bone limitations deep in the hip. When the femur stops rotating, the only way to get the foot up higher is to bend the knee sideways. Knees are not designed to do this-they are only designed to flex and extend.
If an overzealous student continues to pull the foot up after his thigh stops externally rotating, or if a student or teacher forces the knee downward, the thighbone and shinbone will act like long levers that apply great force to the knee. Like a pair of long-handled bolt cutters, they will pinch the inner cartilage of the knee between the inner ends of the femur and tibia. In anatomical terms, the medial meniscus will be squeezed between the medial femoral condyle and the medial tibial condyle. In layman's terms, the inner ends of the thigh and shin will squeeze the inner cartilage of the knee. With even moderate force, this action can seriously damage the meniscus. Such injuries can be very painful, debilitating, and slow to heal.
Poses like Baddha Konasana and Janu Sirsasana can cause similar pinching. In these postures, we do not usually pull up on the foot, so the problem comes mainly from the lack of outward rotation of the thigh relative to the pelvis. Let's first look at Baddha Konasana.
Remember, to stay upright and stable while placing the feet in Baddha Konasana, the heads of the femurs will turn strongly outward-about 100 degrees-in the hip sockets. Because this requires so much flexibility of the entire hip region, many students instead allow the top rim of the pelvis to tilt backward while placing the feet in Baddha Konasana. They move the thighs and pelvis as a single unit. This requires little rotation of the heads of the femurs in the hip sockets, and it demands little flexibility. It also defeats the aim of mobilizing the hip joints and causes the entire spine to slump.
As a teacher, you may find yourself instructing the slumping student to tilt the top rim of the pelvis forward in order to bring them upright. If their hips are loose enough, this instruction won't create a problem; the pelvis will tilt forward, the thighs will remain externally rotated, and the spine will come upright. But if the hips are too tight, the femurs and pelvis will roll forward as a single unit. While the thighbones rotate forward, the shins will not, resulting in the aforementioned pinching in the inner knees. This explains why some students do not feel any knee pain in Baddha Konasana until they attempt to tilt the pelvis completely upright.
Some students complain of knee pain only when they bend forward in poses that require external rotation. That's because a forward bend like Janu Sirsasana demands even more external rotation at the hip joint. Again, in the tight student, the pelvis and femur roll forward as a single unit, pinching the inner knee. Of course, in either Baddha Konasana or Janu Sirsasana, pushing the knee(s) downward makes the problem worse, because tight muscles make the femur rotate forward as it is pressed.
Now back to Lotus Pose. Forcing the knees into Padmasana by lifting up on the ankles can also injure the outside of the knee. When a student lifts the shinbone without adequately rotating the thigh, it not only closes the inner knee, it opens the outer knee, overstretching the lateral collateral ligament. If a student then forcibly turns the feet so the soles point upward (which people often do to get the feet higher up on the thighs), they can worsen the strain. This action of turning the soles actually pulls the anklebone away from the knee, creating a chain reaction all the way up to the lateral collateral ligament.
What's the solution? First, use common sense. Never force a student into Lotus or related poses, and discourage students from forcing themselves. Teach students not to push into pain, especially knee pain. Do not adjust the pose by pulling on the foot or ankle, nor by pushing down on the knee. Instead, either teacher or student should apply firm outward rotating action to the thigh, turning the femur around its long axis, using the hands or a strap.
If your student already has knee pain but can do basic standing poses comfortably, teach these poses first, with careful alignment. This can bring her a long way toward recovery. When you reintroduce problem seated poses such as Baddha Konasana and Janu Sirsasana, use the hands or a strap to apply the same outward rotating action described above for Lotus.
For students who are ready to learn Lotus, introduce it gradually, working from poses that require less external rotation at the hip (such as sitting in Ardha Baddha Padmottanasana without bending forward) to those that require more (such as full Padmasana). Wait until last to introduce poses that require the most external rotation (forward-bending variations of full Padmasana). As students are learning these poses, teach them to rotate their thighs outward either with a hands-on adjustment or a self-adjustment. Instruct them to monitor and avoid pinching sensations in the inner knees.
Encourage your students to go slowly, be patient, and persist. In time, they may be able to sit comfortably and meditate deeply in Padmasana. If not, remind them that true meditation lies not in some specific posture but in the spirit of their practice. Help them find a posture that suits them, then guide them to settle in and experience the stillness that is yoga.
Roger Cole, Ph.D., is a certified Iyengar Yoga teacher and a research scientist specializing in the physiology of relaxation, sleep, and biological rhythms. He trains yoga teachers and students in the anatomy, physiology, and practice of asana and pranayama. He teaches workshops worldwide. For more information, visit http://rogercoleyoga.com.