Primary Friday: Appeasing the Knees

Whew!  It's been another big week for my Ashtanga practice.  I'm suddenly binding all over the place, my hamstrings are long and strong, and even the lotus postures are comfortable... or were comfortable until yesterday, that is.

I had a really lovely Primary, apart from a fiasco with my knee.  The Mysore room was lively, with a large group of beginners on one end and the rest of us on the other.  I really admire teacher 'T' for handling the room the way she does, instructing the group of newbies as one and then visiting the rest of us individually.  I can't imagine how difficult it must be to have so many things going on at once, so many different practices to keep an eye on.  Students spread all over the place.  Compared to teaching Vinyasa classes where everyone moves as a group, teaching Mysore must be a whole different ball game.

The standing sequence was especially comfortable.  Just breathing and observing the heat, observing the sensations.   I no longer feel the breath shortening after Parivrtta Parsvakonasana and I was surprised yesterday at how fresh and light I felt during the Utthita Hasta Padangusthasana series, which has always felt like a bit of a slog, a hump to get over before carrying on.

Seated was pretty nice, as well, but I noticed my right knee feeling stiff right away in Ardha Baddha Padma Paschimottanasana.  I treated it nicely, easing my way into the postures, but every time I came to a lotus or half-lotus position, the knee felt a little less stable.  I made it all the way to Karnapidasana without incident.  Then came Urdhva Padmasana.  Having just recently found the full expression in reach, I was perhaps too eager to take the full pose.  As I put the right foot into position, the knee clicked a bit, but didn't feel any differently than it had for the rest of the practice.  Then, as I moved to fold the left foot in, the knee made a loud crack, which hurt a bit and seemed to significantly shift the alignment of the lower leg.  I was horrified and frozen in a very sloppy rendition of Urdhva Padmasana as I tried to assess the situation.  I skipped Pindasana and carried on slowly through the rest of finishing, taking a half-lotus position with the left foot on top instead of Padmasana for the final three postures to aleviate the pressure in my knee.

And now the knee is tender and inflamed behind the joint.  There is pain on the lateral side if I try to rotate the foot too far to the left or right, and there is some firm swelling impeding full flexion.  Walking and basic, linear movements are okay, but the joint feels strangely unstable.  This may be a significant setback.  I experienced something similar during teacher training in my other knee and it took a few months to completely heal.

So now the knee therapy begins.  I'll be sitting in Virasana for meditation instead of Siddhasana as my first step.  I've noticed this pose tends to relieve pressure in the knee joint built up from too much external rotation since the lower leg is (very slightly) internally rotated.  And I'll definitely be modifying any lotus postures in my Primary for a while.  Any other suggestions for healing the knees?


  1. I am I physical therapist and yogini!
    From what you describe, your knee definately needs to be paid attention to. Often clicking is associated with a meniscal problem, but since I'm not seeing and examining you, I would have no idea what is going on with you, but if you have that much swelling, somthing is obviously crying "help". Sounds like you may already be doing this, and this is the hardest, but so it can heal you need to not do ANYTHING that aggravates it all, even slightly. Even if you have to use props or modify a pose while teaching, you can explain to the students what is going on, which actually would be a great learning experience for them...that whether we like it or not - we always have to respect what our bodies are telling us. This may be difficult, but if you keep straining it, you will just draw out the healing process.
    Check and double check that in poses that require rotation of the leg that you are rotating from the hip, and not at the knee. Also in standing poses where you are putting weight on a bent knee, such as Warrior 2 or crescent, that your knee is in good alignment - I use "knee cap over the second toe".
    And ice, ice. For sure after class or practice, and as often as you want (ice for 15-20 minutes.

    If it is no better after 6-8 weeks, then you should definatley have it looked at. Hopefully uou can avoid that by resting it as much as possible now. Good luck!

  2. p.s. again!!
    Since I am a physical and yoga practitioner, I would love to combine the 2 and be certified as a yoga therapist. Do you have any suggestions/comments, advice, whatever? There are so many different programs now offering training, I want to make sure I get good training and/or not overpaying for a program that might not me as good.
    I welcome any feedback!

  3. Agree with Ellen - NOTHING that aggravates it!

    Are you taking glucosamine/chondroitin/MSM? These make a definite difference in the stability of the joint, but you need to take them for a few weeks before they start to take effect.

    Placing a small towel tightly rolled in the knee crease during virasana might feel good.

  4. Hi Ellen - Thanks so much for the input! I think you may be right that it's a meniscus issue. Major modification will be needed to accommodate the angry knee in my Ashtanga practice, but alas, sometimes this is how we must learn. I have pretty limited external rotation in my right thigh for some reason, so I'll take this time to try and build mobility in the hips as I pamper my knees.

    As for combining your physical therapy experience and yoga, I think it's a great idea, though I don't know a lot about yoga therapy training programs. It may be difficult to navigate the more credible programs from the not-so-credible ones since yoga therapy is not well defined, as yet. One program I do hear a lot about is the Phoenix Rising yoga therapy training, which incorporates yoga asanas, physical therapy, and psychology as a three-pronged approach to awaken and access the wisdom of the body.

    Beyond that, I can only suggest that you do your research diligently, and try to talk with respected yoga therapists in your area, if possible, about their experience with the programs available.

  5. Susananda - Great suggestions! Thank you.

    I am not taking glucosamine/chondroitin/MSM, but I was thinking about picking some up. I'm generally very skeptical of dietary supplements, but willing to try something in this case since this has been a recurring problem (first the left knee, now the right).

  6. What is it about Ashtanga Yoga and the knees?! The only conclusions I have come to is that my hip was/is not open enough to do lotus positions. So I add more hip openers on my own as well as spending a little more time in any poses that stretch the inside of the leg too (I've found that area to be very tight and if it's really tight I notice my knee tends to hurt a little more). My knees started hurting almost immediately into the Primary Series and I've modified quite a few postures. Just in case you need some ideas, here are the modifications that I do:

    -->Any half lotus positions get a pigeon-leg like variation, where the leg is horizontal across the opposite knee. EX: ardha baddha padmottanasana looks more like I'm doing a prep for galavasana. Gets a similar stretch to the hip without aggravating my knee. Ditto for the seated version. For full lotus, I either take half, simple cross leg, or double pigeon (with a prop under the more sensitive knee).

    -->partial bend in the sensitive knee during forward bends. I don't know if this rings true for you or not, but because my hamstrings are very open I have noticed a tendency to start hyper-extending my knees in a forward bend...which definitely aggravates a sensitive knee. That may be true for you too or not, my knee sensitivity is on the inside edge of the knee.

    Good luck, I hope it heals soon.

  7. Hi Tara - Ashtanga is extremely hard on the knees, particularly for those of us with tight hips. Interesting that your inner thighs and hips are tight and you feel pressure on the inner knee, while my outer hips are tight so I feel the pressure in the outer knee.

    Thanks for the excellent modification advice. I'm trying my hardest not to feel despondent about my Primary, knowing it won't be quite the same without the lotus legs. I keep reminding myself that, with patience and practice, my lotus will return.

  8. Everything said so far is good.

    Yes to:

    1. take it easy, all the time, every time
    2. glucosamine (if I can be uptight, I recommend glucosamine sulfate vs. the other one, some people say it's more effective)
    3. be careful of virasana, because many people find it a knee tweaker as well
    4. the "galavasana" prep, which some call thread-the-needle, is a marvelous lotus or half-lotus substitute, and I recommend it to my students.
    5. What really cracked open my hips for lotusing was pigeons, pigeons, pigeons. For over two years in one hip's case.
    6. You don't "lose any points" for not being able to do lotus postures. Say this in every ashtanga practice, because it's true. This is also something I tell my students.

    oh and p.s.
    See you in June at CHY.

  9. Hi Patrick - Thanks for list of tips. I'll be sure to look for glucosamine sulfate first. Long sits in Virasana seem to relieve the pressure in my knee because of the opposite rotation, but I always modify it by sitting up on a block (or dictionary) since full flexion has always been hard on my knees. I've never been able to sit on the floor between my heels.

    You're definitely right about pigeon as an effective hip opener in preparation for lotus, but even that position causes pain in my knee at this point. I'm not sure how I'll work on opening the hips while this knee is out of commission -- all the deep hip openers that come to mind right now seem to involve the same positioning of the lower leg -- but it will be a fun project to look for some that don't.

    I will take your advice and tell myself that I'm not losing points for no lotus postures in my Primary. Thanks for the reminder. I'll be needing it.

    Hooray! Ashtangis converge! I'm so excited.

  10. Aren’t all the seated posture (and standing postures) working on hip opening.
    If you stop to do other postures, aren’t you getting out the flow and reducing time spent on ‘Primary’. ‘Practice and all is coming’. I think it can be too easy, especially in a ‘talk through’ to have a sense of only superficially being in the difficult postures if you can’t get them straight away, and blurring through them to the next posture that you can do. For example in Marichyasana A, if you do it right, and accept you limitation, it might be enough to get you leg/knee up straight, anything beyond that is just a mash up, but of course we all want to make it look like the real thing so we do some sort of fold forward. The real thing, at your edge, does the business of that posture, but a knee down mash squash might not. Adding extra postures wont get you a visit from the yoga police but it could undermine ‘Primary’ in the practitioner. Students ask questions about lotus, knees and ankles all the time and I would love to tell them an easy answer, but it really comes down to ‘Practice and all is coming’. This is an ego battle as much as anything, that is to learn to take the mental hand brake off.

    Another issue:
    Ellen said...
    “I am I physical therapist and yogini!”
    Ellen you are already in a fantastic position to be a yoga therapist. Why do you need an extra qualification? I don’t live in the USA but Yoga is physical therapy isn’t it. If any patient could do Primary or similar, that is what they should do, so a yoga therapist can teach somebody who isn’t ready for that, an easier alternative. That might be a 20 minute routine or an hour’s, but you surely are already qualified to advise. Experience is by far the most important qualification here.

  11. Hi Mark - Thanks for the comment, and it's true that most of the postures in Primary are hip openers, but.... who said anything about extra postures?

    I stay with the breath and practice Primary, every pose of it, albeit with appropriately and safely modified postures for the sake of the knees. If I practice other hip openers, it's as part of a separate, restorative or flow practice to keep me healthy and balance the strength of my Ashtanga practice.

    Are you suggesting that I NOT modify and force myself into the "real thing" just so that I can call my practice the Primary series? Careful there, sir.

    I would argue that, for someone like myself, prone to push through postures and pain, and tip over the edge rather than hold back (hence the busted knee), my practice is to put ON the "mental hand brake," as you say, not to turn it off.

  12. Megan, Hope the knee continues to mend. As I've gushed awkwardly to you at BSY before, every time I search something ashtanga related, your blog comes up :) -- I sent my boyfriend to his first ashtanga class on Friday (he was one of the beginners you speak of) and he raved about your practice. I just wanted to pass on the compliment. When I started yoga almost 15 years ago, I began with Ashtanga -- I'm currently in the process of re-visiting/finding/gaining it again. Hope to run into you soon!

  13. Hi Brooke - I'm so delighted any time a local finds the blog. So far, the knee is coming along faster than I had hoped. Thanks for the well-wishes.

    That's funny, there was a moment last Friday when I thought I saw a vaguely familiar face (via fb, I think) peaking at me from across the room. ;)