Knee Deep in Yoga

Yoga can be a source of knee pain or the ideal therapy. Here's a primer on keeping the joint healthy on and off the mat.

By Catherine Guthrie

Roughly 21 million Americans have osteoarthritis of the knee—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; age is considered a risk factor, as are obesity and knee injuries.

For years, experts have touted leg strength as one of the best ways to ward off knee problems, including osteoarthritis. This is because the knee's key muscular supports are the hamstrings—which run from the base of the pelvis down the back of the leg to just below the knee—and the quadriceps, the four muscles on the front of the thigh that (among other things) extend a bent leg. At the first sign of the disease, doctors often instruct their patients to build muscle tone and develop flexibility in the legs so as to delay cartilage deterioration and subdue pain.

But the findings of a study published in the Annals of Internal Medicine in April 2003 indicate that in some cases, building leg strength doesn't slow the disease's progression—in fact, it hastens it. Researchers tested 230 volunteers with osteoarthritis of the knee for quadriceps strength and knee alignment, and then retested them 18 months later. The results surprised the medical community: Many volunteers with strong quads also showed rapid cartilage deterioration. But there was a catch—many of those who had strong quads and experienced a rapid progression of the disease also had misaligned kneecaps, a small but significant impairment that intensifies pressure on the cartilage.

You don't even have to suffer from osteoarthritis for misalignment to cause problems in your knees. In fact, Messier says, "misalignment can cause injury and osteoarthritis over long periods of time, especially if you have stronger muscles that are directing the forces improperly." If the muscular contraction between the two sides of the knee isn't balanced, the knee rotates as it bends, which makes the joint pull toward the stronger muscle. Over time, this wears down one meniscus faster than the other and eventually damages the bone the cartilage protects.

While the study points to the problems created by building uneven leg strength, Messier is concerned that its findings will be misinterpreted. "The last thing we want to do is discourage people from getting stronger," he says. What the study actually highlights is the importance of evenly building the leg muscles to keep the joint properly aligned—a task for which yoga is perfect.

One of the Best Antidotes

Whether you're out to guard against injury and disease or regain strength and flexibility after an injury, yoga can be a superb antidote to knee trouble. "Yoga is fantastic for the knees, especially for people recovering from damaged ligaments," says Michael Salveson, who has worked on dozens of yoga students during his 33-year tenure as a Rolfer in Berkeley, California. "Yoga increases the stabilizing action of the leg's big muscles." When the inner and outer quadriceps are equally strong, he adds, they exert an equal pull on the ligaments, which keeps the kneecap in alignment.

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