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yin yoga and strained knees
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Sat Aug 08, 2009 7:50 pm    Post subject: yin yoga and strained knees Reply with quote

i have strained my knees (inner knee) in my yang and yin practice and
wonder what is best to get back to normal.
since i overstrained them once in a full tree after not being warmed up enough (stupid, i know) and overbending without engaging the thigh muscle enough in the standing postures, they had become sensitive as they not were before. maybe to get my attention and asking for proper standing and careful bending the knees
i heard that standing postures where you engage the thigh muscles with lifting up the knee cap without overbending, are supposed to be healing; done in a yang way with stimulating muscular tissue and being aware of warming up before and in a comfortable warm surrounding.
my question is about the postures with open knee joints. a therapeut told me, that it is better not to go under 90 degrees bending for some time and since you can variate the postures concerning the extremeties, you can practice safely-but then you would need to exclude some effective postures like saddle and sleeping swan to a certain degree
i keep his advise very much in mind but remember also what Paul Grilley was saying on his yin yoga DVD, 1. part,
that you need to stimulate and stress tissue in order to regenerate and not serve the immortality. so i would like to know, what is a safe way to not build up this "i have sensitive knees mantra" and get back to normal, elastic and strong. so i assume that it is not the best to take it absolute and avoid bending the open knee joint postures completely.
concerning yin yoga practice i observed for myself that:
-japanese style sitting is ok (better like in child then in the short beginning meditations)
-sleeping swan feels better, if the foot is a bit more up
-saddle, only the sitting on the feet version, knees wide apart, and then very delicate; being warmed up
-with half saddle i'm very insecure: feels much stronger for the thighs and knees and i can variate the pressure. but can that pose help to regenerate inner knee tissue? would be great if so.
-dragon is great with thighs engaged.
i would be very grateful, if you have some ideas.

all the best!
Gregor
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Sun Aug 09, 2009 6:56 am    Post subject: Yin for the knees Reply with quote

Oh those knees! What an unstable joint.

You have asked many questions, and - as always - I am not a doctor and can't diagnose you via the internet (nor even in person for that matter!) All I can do is give you some suggestions, and you need to work with your health care practitioner and figure out what will work for you in your particular case. It may be helpful to know a bit about my own knee experiences.

I tore both my menisci by being overly aggressive early in my yoga practice. I learned the hard way why the saying "no pain/no gain" really should be translated as "bullshitihi". After crushing my menisci, I went on a search for years to find a way, through yoga and supplements and anything short of surgery, to heal my knees. After several years, I gave in and had arthroscopic surgery. I am glad I did. While the immediate pain did go away (after about 6 months of rehab to regain my original range of motion) the knees will never be as they once were. I have to continually be careful of being overly aggressive with external rotations of the hip/femur, to avoid too much stress in the medial knee.

After the surgeries, I did discover that, while many yoga poses didn't cure my original problem, these poses did help me avoid further problems. Here are several of the things I did, which worked for me, with my problem (ie: there is no guarantee that this will work for you with your unique body, so treat these as simply ideas for investigation.)

- strengthening the leg muscles, especially the quads: Standing lunges and chair poses, without bending the knee beyond 90 degrees. Warrior 1 and 2, Side angle poses (parsvakonasana) and ukatasanas. These helps stabilize the knee joint muscularly
- opening the hips: In my case it was very tight hips that caused me to over stress the medial meniscus, and thus tearing them. So now I do lots of hip openers. I find that yin yoga poses work best for me for this: Swan, Shoelace, Winged Dragons. These are very juicy for me, but they definitely helped take pressure off my inner knees.
- opening the knee: My x-rays and the arthroscopy showed incipient arthritis. Because the meniscus are thinner, and the distance between the femur condyles and the tibial plateau (ie: the ends of the upper and lower leg bones) being much shorter, I do a lot of work to open the space in the joint. Here I find that sitting in virasana (Japanese style as you called it) with a wooden doweling tucked into the back of my knee has really helped. You can substitute rolled up socks or towels. Hold for just a couple of minutes at first. As my ability to stay increased, I stay longer. This allowed me to do the Saddle pose, which has also helped me a lot.
- strengthening the medial ligaments: I have discovered, for me, that Straddle poses has strengthened my inner knee ligaments. Holding this pose (with side variations) for 10 to 15 minutes can be quite nice (ie: juicy.)

Again, this worked for me, but every body is different. You will have to try it carefully and see what works for you. As general guiding principles, remember that:

- you need to have the muscles strong to support the joint: yang yoga!
- you do need the ligaments strong as well: yin yoga!
- when an area is damaged and swollen, that is not the best time to exercise it. Better is to do some restorative work there.

Restorative work could include some continuous passive movements, not quite to the full range of motion. Icing the area to reduce inflammation, and also spending time with the legs up the wall every day, also to reduce inflammation will help.

I hope you find your way to healthier knees. They are priceless gifts!
cheers
Bernie
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Thu Aug 13, 2009 3:03 am    Post subject: thanks Reply with quote

Dear Bernie,

thank you so much for this very profound answer!!!
it helps me very much to get this bunch of informations and i will apply them after my bodies needs.
and i will also check it medically, to know where i am.
so also thanks a lot for your advise, concerning what i should take care of applying your personal experiences about that issue.

with best regards,
Gregor
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Fri Aug 28, 2009 6:37 am    Post subject: Reply with quote

one more add to the knee story:

swimming works very well for me as restorative work.
doing movements in water while swimming with yoga approach is extremely exciting-a lot to discover...

all the best!
gregor
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Tue Sep 21, 2010 3:00 am    Post subject: More on the meniscus Reply with quote

Here is a short exploration by Leslie Kaminoff into the knee and the meniscus in particular.

http://yogaanatomy.net/video-knee-injuries/
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Sat Sep 25, 2010 8:02 pm    Post subject: yin yoga and strained knees Reply with quote

Dear Bernie, thank you so much about the short anatomy lecture! very good information! i think it was a great idea to do the athroskopic surgeries on both knees. the recovering went quite fast and i found a wonderful building up possibility in combining weight training in a very slow motion (in Germany known as Kieser Training) and the opening posture in Japanese style with a rolled towel and sitting on a pillow. soon i could do yang and yin yoga in almost full range.
in a two weeks period i had not the chance to do the weight training, because i was traveling and doing concerts. in that time i focused on the opening posture.
lately i could lower or even take away the pillow but still with a rolled towel.
i even took in the Virasana pose, also with a rolled towel.
these opening sessions last 1 to 2 min in 2 or 3 sets.
in those two weeks i could feel that those first so extremely beneficial poses suddenly turned to harm the knees.
even though i was very gentil in my approach i could feel that this was not having the good effect only but also sensibilising the earlier painful area.
so i took a step back and im very careful again.
how is it possible that the same posture with the same conditions, being so beneficial is suddenly having such a different effect?
i hope i did not tear cartiladge again and what is hurting is scar tissue from the operations.
i will see soon.
Some time ago i heard about Michael Meliani a chiropractician from Berlin who is having a long experience in using the Chinese Tui Na technics. he uses bamboo sticks to remove scar tissue or even light torn tissue. i don't know how, but i heard that from many people who are in volved in dance or yoga, who went to him and were very satisfied. they said it is a very painful treatment and it helps. his site is not containing much information but it is possible to contact him. he is some time of the year in China. then it is difficult to reach him.

http://www.meliani-heilpraktiker.de/Website_2/Heilpraktiker_Michael_Meliani.html

it is maybe not so useful for the people living in America, since Berlin is not around the corner, but i think it is good to know, that there might be also alternatives.

all the best!
Gregor
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Mon Sep 27, 2010 6:25 am    Post subject: knees and recovery Reply with quote

Quote:
in those two weeks i could feel that those first so extremely beneficial poses suddenly turned to harm the knees.


Hi Gregor

As the body recovers and repairs, its tolerance changes. Right after your surgery there would have been a lot of swelling and inflammation, which slowly goes away. Your range of motion is decreased due to inflammation, so you may not have been stressing the injured tissues too much. As the inflammation went down, the stress may have started to become too much for your knees, thus making the same exercise that was okay earlier, not so good now.

You intuitively did the right thing: back off and take it slow. Don't measure your recovery by a calender but by how it feels. The objective is to heal, not to heal by a certain magical date.

I am glad to hear it is going well for you.
Cheers.
Bernie
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Wed Sep 29, 2010 7:46 am    Post subject: Reply with quote

Thank you so much Bernie!!!
i will have one more MRT tomorrow just to check, also because i will move away and want to have clarity before leaving the country for longer. the whole knee story is big learning field.

Cheers and all the best!
Gregor
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gregor



Joined: 07 Aug 2009
Posts: 21
Location: germany

PostPosted: Tue Jan 04, 2011 5:40 am    Post subject: tui na treatment of old inuries, regain full range of motion Reply with quote

Dear Bernie,

i consulted your side often while i was in the process of healing my torn menisci.
i was lucky to find a good advisor in you.
now everything is fine and i enjoy a solid yin and yang pracise.
all the things that i mentionend earlier have helped on that way.
but especially one treatment was helping amazingly in getting back to the old pain free range of motion.
in one of the earlier articles i mentionend the chiropractician Michael Meliani from Berlin.
He is a Kng-Fu master in monkey style with ca.25 years of experience and a physician in chinese medicine. He treated me twice with his bamboo sticks knocking method and it helped incredible, just after one time.
Now it is like before the inury and i'm so happy to know that guy.
He treats most areas of the body with old inuries.
I posted his addres earlier, for anybody that is interested.
All the best for the new year to everybody!
Lokah Samasta Sukinoh Bavantu and Namastedji!
Gregor
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Wed Jan 16, 2013 10:33 am    Post subject: Microfracturing to help heal cartilage Reply with quote

On the topic of torn cartilage and menisci - this recent study offers a lot of hope for the near future: basically by combining a new type of hydrogel and an adhesive tape to hold it in place with punching small holes in the bone, to allow stem cells to leak into the cartilage, people are able to regrow their cartilage. Looks promising!

Tissue Engineers Report Knee Cartilage Repair Success With New Biomaterial

Jan. 14, 2013 In a small study, researchers reported increased healthy tissue growth after surgical repair of damaged cartilage if they put a "hydrogel" scaffolding into the wound to support and nourish the healing process. The squishy hydrogel material was implanted in 15 patients during standard microfracture surgery, in which tiny holes are punched in a bone near the injured cartilage. The holes stimulate patients' own specialized stem cells to emerge from bone marrow and grow new cartilage atop the bone.
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craftsrus



Joined: 14 Apr 2013
Posts: 2
Location: United states of america

PostPosted: Sun Apr 14, 2013 9:32 pm    Post subject: Yin yoga & knees Reply with quote

I have a long tale for you that relates to this subject and a request for advice.
Seven years ago I rolled my right ankle while walking to work. Over these last seven years this has necessitated three separate surgeries and I am still not able to walk any distance or stand for any length of time without pain and fatigue. I had one surgery in 2007 and two in 2011.
When this injury occured I was involved with martial arts and yoga. Since then I became a yoga instructor, specializing in restorative yoga. After the last ankle surgery in December of 2011, during physical therapy suddenly my right knee began to hurt pretty dramatically. I was referred to a specialist and as it turns out the right knee gave over to the left and it was decided that I most likely needed a replacement or two.
In 2012 I had two knee surgeries, one arthroscopy and the replacement in December. Needless to say all this down time due to surgeries has wreaked havoc on my yoga practice and after sitting and watching martial arts classes for two years I have had to call it quits. I am now 4 months post knee replacement and may have to have the right knee replaced in the near future.
If you were my instructor and / or mentor, how would you suggest that I get back to my practice? What steps would be reasonable and necessary to bring myself back to homeostasis?
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craftsrus
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Mon Apr 15, 2013 3:41 am    Post subject: Getting back to normal Reply with quote

If I was your mentor, as you imagine, I would suggest you start by revisiting your intentions.

I can not give you adequate medical advise for your various challenges because, despite your detailed description, I don't know you and your body. You have seen doctors and specialists who know far more about you than I can possibly know. If you are not happy with your progress, you are certainly right to seek new advisers: I would suggest you find some physiotherapists who can work directly with you to help you out. Ask around locally and don't just settle from someone but ask whomever you choose to work with you to obtain your goals.

What I can do is guide your awareness back to your intention: what do you intend? You talk about being able to get back to your practice, the practice being your martial arts training and yoga. Is that really a skillful intention to work towards? In time we all lose our ability to do what we used to do: I used to love playing ice hockey and tennis, but can no longer do those sports due to my knee injuries. I miss them but I am not trying to get back to them. Instead, my intention to maintain optimal health for this period in my life, not to recapture what has been lost and left behind.

At some point we all find that what we used to be able to do is no longer available: this is not the end of life! It is a signal to move on and find other joys and practices. While I no longer play tennis, I love the physical yoga practice that I can do. Yoga is not just about asanas, as you well know but may have forgotten for a moment. Yoga is about mind/body/heart/soul work. Getting "back to my practice" may be as simple as remembering why you do yoga or martial arts: is it just for the physical benefits? And even so, there are always physical benefits even in the most gentle practice.

I am not saying "give up" on ever doing your martial arts practice, but what I am suggesting is that you practice non-attachment to whatever physical practice you are missing. The time will come when we can no longer do the things we love and knowing how to deal with this loss is part of practice too.

Good luck
Bernie
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craftsrus



Joined: 14 Apr 2013
Posts: 2
Location: United states of america

PostPosted: Mon Apr 15, 2013 3:52 am    Post subject: Yin Yoga & Knees Reply with quote

Bernie;
Your reply is not surprising to me, it cuts to the chase and hits the nail right on the head. There is grief and loss in my inability to be involved in the same level of martial arts training and yoga as previously. The idea that there is an 18 year old inside who's saying "I can do that" lives on!
I have a great body worker who is helping me phase back into "real life" and I understand that I am not yet ready to return to practice as usual. Accepting and allowing are two of my most challenging concepts.
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jessofwight



Joined: 16 Jul 2013
Posts: 12

PostPosted: Tue Aug 13, 2013 6:40 am    Post subject: utkatasana v lunge Reply with quote

Apologies for resurrecting an old thread, but the previous posts touch on my question a little.

When working with a lunge based asana its always taught not to let the knee come forward of the ankle.

But in utkatasana - or squat based asanas - clearly the knee does go forward.

So my question is what is different in the two types of asana? I'm aware of the risks of knee injury, ACL tears, etc. Thinking as I type, is there less stress on the knee in the utkatasana asanas as the quads and related fascia are relaxed at the insertion?
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Bernie



Joined: 23 Sep 2006
Posts: 1002
Location: Vancouver

PostPosted: Tue Aug 13, 2013 7:35 am    Post subject: Where should the knee be? Reply with quote

The quickest answer as to why some teachers insist that the knee not go forward of the foot in poses like Warrior is basically esthetics! It doesn't looks good. This gets rationalized by saying "it is less stressful for the knee," which is true, but exercise is stress and to not stress the knee makes no sense. We need to stress our tissues, but we want to avoid over-stressing them. Teachers tend to be overly cautious at times, and yet - at other times, they happily allow the knees to come forward of the foot. For some reason, many teachers have not noted this inconsistency in their own instruction.

You are correct: in squat, in chair pose, and even when you walk up and down stairs, your knee is in front of the foot and is being stressed. My suggestion would be, in your own practice and assuming your knees are happy with this degree of stress, go ahead and allow the knee to come forward of the foot. It is a deeper stretch and greater stress: in other words, it is more advanced. There are many pictures of yoga teachers from the 1930's to 1970's doing this, but after that time, the "proper" forms of alignment abolished this positioning. However, if you have knee issues that doesn't allow too much stress, then keep to the alignment of knee over foot.

Cheers,
Bernie
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