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

Sandy Blaine is a good example. As a teenager, she enjoyed dance and gymnastics. By her early 20s, she'd dislocated both knees on several occasions. Searching for a low-impact way to stabilize her joints, Blaine tried Iyengar Yoga when she was 26. She was initially surprised by the discipline's difficulty, yet what impressed her more was how remarkably good she felt afterward. Within six months of attending two to three Iyengar classes a week, Blaine found that her knee pain had vanished. Today, at 42, she still sounds as if she can't believe her knees are pain-free, calling the result "an absolute miracle."

"I was looking at a lifetime of being very constrained," says Blaine, who is now an instructor at the Yoga Room in Berkeley and regularly conducts workshops on yoga and knee health. Regaining healthy knees "was an incredible relief," she adds.

To evenly engage the leg muscles, Blaine does Utkatasana (Chair Pose) with her back against a wall. She focuses on lifting her toes and pressing down evenly through all four corners of her feet. Otherwise, the outer quadriceps do all the work and old patterns are reinforced, she explains. Another way Blaine works on equalizing muscle use is by balancing on one foot with her eyes closed. "Without the orientation of the eyes, your feet and ankles have to find a true alignment to come into balance," she says.

Robust ligaments are also essential for healthy knees. Less elastic than muscles and tendons, ligaments can give a little and bounce back to their original shape. But trouble brews when they stretch too far: Like a rubber band that's lost its snap, they lose their shape, leaving the joint loose. Salveson, who is also an instructor at the Rolf Institute in Boulder, Colorado, compares the microtears a ligament sustains in an injury to frays in a rope; when a few strands snap, the rope lengthens. After a torn ligament heals, one side may always be a little longer and, therefore, more susceptible to reinjury. "You can make it stronger," he says, "but you can't make it shorter."

Knee experts are actually divided about whether ligaments can be strengthened. "We know that you can increase muscle and bone strength," says Angela Smith, M.D., a clinical associate professor of orthopedic surgery at the University of Pennsylvania School of Medicine. "Intuitively, we think that the other structures of the knee—ligaments and tendons—get stronger as well."

Blane, for one, is convinced that years of Iyengar Yoga have toned her knee ligaments. "At first, my feet, ankles, and knees were so weak that the standing poses were sheer torture," she says. "My ligaments and muscles were strong on the outer leg and weak on the inner leg, which pulled the knee joint to the side. Yoga helped me strengthen those weak areas. It taught me how not to go with the path of least resistance." Her ligaments used to be so weak that she once dislocated her kneecap tripping on a curb. But since committing herself to a regular yoga practice, she hasn't suffered a knee injury in years.

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