Having just finished teaching anatomy to a fantastic bunch of soon to be practicing yoga teachers, I have been inspired to finish 2016 with a series of articles covering some of the more frequent yoga injuries I get to see in clinic. I hope that even if you do not practice yoga you will find the thought process interesting and it might spark an interest for a new year’s resolution to take a class or two.
While I will be the first to admit that I do not practice regularly enough myself (my Lululemon mat is currently strategically placed under my treatment room door to block the winter breeze inviting itself in) I have spent time getting my head around the differences between a ‘downward facing dog’ and a ‘cat cow’ and the kinetic chain of relative joint motions and muscle reactions involved in these poses. When we know what we are asking all our joints to do during a pose and how a limitation in one area can effect another, it soon becomes possible to figure out who isn’t playing game when we move and who has to take up the slack. Let me give you a clue…that painful meniscus or achey shoulder joint is probably not the culprit and more likely the area that is over working in order to pick up the slack.
The knee
We are going to begin our journey down at the knee, and more specifically at the meniscus. First a gentle reminder of its anatomy.
The knee joint is made up the femur, tibia and the patella. It is predominantly a hinge joint so if you look at it from the side you will notice that it flexes and extends, however if you cross one leg over the other to stabilise the thigh and keep the ankle flexed you will also notice that you can rotate the tibia a little as well (notice the little is in bold!) Rotation is important as it allows the knee to lock up into full extension (saving energy when standing) and to unlock as we walk to unleash a cascade of bone motion and subsequent muscle reaction which enables locomotion.
Our meniscae sit on top of the tibia and resembles 2 C shaped rubber washers which shock absorb through the knee, guide movement and create stablity. We have a medial and lateral meniscus within which the 2 condyles of the femur nestle ready to roll and glide as they move on the tibia below. All being well the meniscae can distort and change shape a little to accommodate the movement of the femur on the tibia and we have a happy knee…then we decide to attempt the Lotus! (ok I am scare mongering a bit for dramatic effect, but in my experience most bodies do need more preparation before attempting this advanced pose).
Lotus
The lotus position has become the poster pose for Yoga studios up and down the country. It looks incredibly impressive so who would not want to be able to fold their legs like they would fold their arms and sit in calm serenity?
“My knees only feel bit achey afterwards, and that slowly dissipates after walking around…surely that is a ‘hurt so good’ as opposed to a ‘hurt so bad’?”
Then one day “POP!”
As someone who has spent the last year recovering for medial meniscus problems (even the thought of a basic Child’s pose would fill my knees with agony) I implore you – please learn from my mistakes and treat your knees from this day forwards as your best friends. I promise that you will not realise how much you miss them till they do not do the stuff you need them to do. Yoga should not hurt, and if it does your body is sending you a message:
“Oi – you up there! If you keep doing this to me day in day out we are going to have a problem. I am not supposed to move in this way and I am doing my best to help out but I can’t keep helping for much longer!”
So how do we figure out a solution?
Hip Hop Pop
In order to even contemplate a full lotus your hips have to be incredibly flexible and if they are not then this is where you are going to invest your time. Resist the temptation to jump ahead to desert before you have finished your main course!
If you look at the video below of myself and my good friend ‘Bendy’ demonstrating a lotus you will notice how much the hips have to be able to externally rotate. To put this in context I was reading an article which stated that in order to do a half bound lotus standing forward bend you need 145 degrees of hip external rotation. This means that if you were standing up you would have to be able rotate your hips so that your knee caps and feet were actually pointing behind you. I am not sure I have met any one with such impressive contortionist skills.
So what happens if we do not have the pre requisite hip rotation? Well we can crank on our lower leg and crow bar the foot on top of the thigh, which looks kind of similar, however we are now asking the knee to make up the range of motion that is missing at the hip. The result is a knee that has to rotate and side bend (adduct) into a pathological range, with a meniscus that is sandwiched in the middle between the femur and the tibia and wrenched and squeezed till… “POP!”
Another point worth mentioning is that if we then proceed to move into a forward bend, then the pelvis is going to rotate over the femurs, which will require even more relative external rotation at the hip joints. You can experience this by lying on your back and pulling your feet up and together and letting your knees and hips drop out (kind of like a lying Baddha Konasana) and notice how far your knees are from the ground. Now sit up tall on your sit bones and see how far the knees then rest off the floor. Now if you are slightly more flexible you can hinge forward by tilting your pelvis and see what happens to the height of the knees from the floor now (make sure you hinge from the pelvis instead of just flexing your back). Unless you are super flexible you will hopefully notice that each progression needs more and more rotation at your hips as the pelvis continues to move over the femurs.
So how can we work towards the necessary hip mobility required to achieve this monumental feet? Like I mentioned above, I teach anatomy to yoga students and treat a lot of people who enjoy yoga, but I do not regularly practice yoga myself, hence a good teacher will be able to guide you through the progressions necessary to explore your hips and eventually lotus. I personally enjoy the work of a Canadian chiropractor called Andreo Spina who looks a lot at how to improve flexibility and more importantly how to create strength in that new found range. The video below is how I start to coach people to own their hip external rotation so this might be an exercise you might like to explore.
One final thought is that not all hips are built the same. The anatomy of the hip socket and rotations through the femur and tibia can be different from person to person and some people may simply not be built for extremes of external rotation. Sometimes we just have to accept the hand that anatomy has dealt us and move on gracefully (maybe an even greater achievement than actually mastering the pose itself).
Conclusion
The Lotus position is not inherently bad for the knees, it is just that some hips are not ready for the Lotus. Earn the movement pre requisites necessary then get a good teacher to guide you through the techniques. Enjoy.