In this blog I am going to be discussing how yoga can help with knee arthritis.
Difference between a healthy joint and a joint affected by osteoarthritis
What causes knee arthritis?
The most common type of arthritis, osteoarthritis, involves wear-and-tear damage to the knee cartilage – the firm, rubbery material on the ends of bones where they form a joint. Cartilage cushions the ends of the bones and enables frictionless joint motion and serves as a shock absorber. The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).
This can occur over many years or can be due to an injury or infection.
Osteoarthritis effects the whole joint and causes changes in the bones and deterioration of the connective tissues that attach muscle to bone and hold the joint together. It can also cause inflammation of the joint lining.
The most common signs and symptoms of arthritis:
Joint aching and soreness, especially with movement
Pain after overuse or after long periods of inactivity
Stiffness after periods of rest
Swollen joints happen when there’s an increase of fluid in the tissues that surround the joints
Decreased range of motion
Who will be affected by knee arthritis?
Risk factors for arthritis include:
Family history. Some types of arthritis run in families and genes can make you more susceptible to environmental factors triggering arthritis.
Age. The risk just increases with age and more women than men are affected.
Previous joint injury. If you have an injured joint you will be more likely to eventually develop arthritis in this joint. This post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, a vehicle accident, a fall, a military injury, or any other source of physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
Obesity. Excess weight puts stress on joints. The more weight that is on a joint, the more stressed the joint becomes, and the more likely it will wear down and be damaged. Weight plays an important role in joint stress especially the weight-bearing joints, like the knees.
Every pound of excess weight exerts about 4 pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on the knees; if a person is 100 pounds overweight, that is 400 pounds of extra pressure on his knees.
But it’s not just the extra weight on joints that is causing damage. The fat itself is an active tissue that creates and releases chemicals, many of which promote inflammation.
For both reasons – excess joint stress and inflammatory chemicals – fat should be kept in check among all people, especially those who already have osteoarthritis.
How to handle knee arthritis?
There are some exercises which can help to reduce pain and regain more flexibility:
Stretching keeps you flexible and improves your range of motion, or how far you can move your joints in certain directions. It also helps you lower your odds of pain and injuries.
Always warm up with a 5-minute walk first. Lie down when you’re ready to stretch your hamstring. Loop a bed sheet around your right foot. Use the sheet to help pull the straight leg up. Hold for 20 seconds, then lower the leg. Repeat twice. Then, switch legs.
Hold onto a chair for balance. Bend your right leg. Step back with your left leg, and slowly straighten it behind you. Press your left heel toward the floor. You should feel the stretch in the calf of your back leg. Hold for 20 seconds. Repeat twice, then switch legs.
For more of a stretch, lean forward and bend the right knee deeper — but don’t let it go past your toes.
Straight Leg Raise
Build muscle strength to help support weak joints.
Lie on the floor, upper body supported by your elbows. Bend your left knee, foot on the floor. Keep the right leg straight, toes pointed up. Tighten your thigh muscles and raise your right leg.
Pause, as shown, for 3 seconds. Keep your thigh muscles tight and slowly lower your leg to the ground. Touch and raise again. Do two sets of 10 repetitions. Switch legs after each set.
Seated Hip March
Strengthen your hips and thigh muscles. It can help with daily activities like walking or standing up.
Sit up straight in a chair. Kick your left foot back slightly, but keep your toes on the floor. Lift your right foot off the floor, knee bent. Hold the right leg in the air 3 seconds. Slowly lower your foot to the ground. Do two sets of 10 repetitions. Switch legs after each set.
Too hard? Use your hands to help lift your leg.
This move helps strengthen the inside of your legs to help support your knees. Lie on your back, both knees bent. Place a pillow between the knees.
Squeeze your knees together, squishing the pillow between them. Hold for 5 seconds. Relax. Do two sets of 10 repetitions. Switch legs after each set.
Too tough? You can also do this exercise while seated.
Stand tall and hold the back of a chair for support. Lift your heels off the ground and rise up on the toes of both feet. Hold for 3 seconds. Slowly lower both heels to the ground. Do two sets of 10 repetitions.
Too tricky? Do the same exercise while sitting in a chair.
One Leg Balance
This move helps you bend over or get in and out of cars.
Stand behind your kitchen counter without holding on, and slowly lift one foot off the floor. The goal is to stay balanced for 20 seconds without grabbing the counter. Do this move twice, then switch sides.
Too easy? Balance for a longer time. Or try it with your eyes closed.
Do this to strengthen your legs for climbing steps.
Stand in front of stairs, and hold onto the banister for balance. Then place your left foot on a step. Tighten your left thigh muscle and step up, touching your right foot onto the step. Keep your muscles tight as you slowly lower your right foot. Touch the floor and lift again. Do two sets of 10 repetitions. Switch legs after each set.
Other exercises that are easy on the knees include biking, swimming, and water aerobics. Water exercise takes weight off painful joints. Many community and hospital wellness centers, gyms, and pools offer classes for people with arthritis.
Being active may also help you lose weight, which takes pressure off your joints.
For favorite activities, like golf, ask your doctor or physical therapist how to safely make painful moves hurt less.
For favorite activities, like golf, ask your doctor or physical therapist how to safely make painful moves hurt less.
How Much Exercise?
Thirty minutes a day is a good goal. Start small, like with 10 minutes every other day. If you don’t have pain, exercise more to meet the goal.
Some mild muscle soreness is normal at first. It’s OK to work through it. Ice can also help. Don’t ignore pain in your joints, though. Let your doctor know if you have any.
How yoga can ease the pain
Taking Care of the Knee
The right standing poses can help save a lot of pain, both now and decades from now. The culprit is osteoarthritis, the “wear-and-tear” arthritis, of the knees. Good weight-bearing alignment, learned and practiced in yoga class, can help keep the knees happy and healthy. On the other hand, bad alignment in poses can actually contribute to the breakdown of the joint surfaces, and the subsequent painful inflammation, caused by osteoarthritis.
There is a lot of talk about arthritis lately so let’s start by examining its nature. Breaking down the word, “arth-” means joint, and “-itis” means inflammation. Most of the joints in the body are synovial joints. Synovial joints are freely moveable and filled with slippery fluid while the ends of the bones are covered with smooth, whitish hyaline cartilage where the bones come together. With time, injury, or joint misalignment, this cartilage can wear down, which causes roughened joint surfaces. The chips and “dust” of cartilage floating in the synovial fluid irritates the synovial membrane lining the joint capsule, and it produces the pain and swelling associated with this problem. Osteoarthritis gradually limits the joint’s range of motion, and it can be mild, moderate, severe, or eventually bone-on-bone, which is incredibly painful.
Why Yoga Helps
Now, how is yoga going to affect this process? Osteoarthritis occurs at the point on the joint surface that bears the most weight during repeated movements over long periods of time (although injury can also initiate the process). Many people have unhealthy knee movement patterns when they come to yoga, which causes excessive wear on one specific area of the joint surface. They’ll continue using these patterns in their standing poses unless they learn otherwise.
The weight-bearing part of the knee joint is formed between the top of the tibia (shinbone) and the bottom of the femur (thighbone). That end of the femur forms two large knobs, the condyles, which are smooth and covered with hyaline cartilage. There are matching indentations on the top of the tibia, also covered with hyaline cartilage. These two matched sets form the medial and lateral compartments of the knee joint. Ideally, your body weight should be balanced between these two compartments, so that neither side bears substantially more weight than the other.
Additionally, while bearing weight, the knee should move only in flexion and extension (bending and straightening), without twisting or bending to the side. To imagine twisting on a weight-bearing knee, put the heel of one hand in the palm of the other, with your fingers lined up. Then rotate your hands so the fingers of one hand are no longer aligned with the fingers of the other hand. Did you feel the friction between the palm and the heel of the hands? That’s similar to the torsion forces on the cartilage surfaces of the tibia and femur, which can contribute to wear and tear. When the knee is bent and not bearing any weight, the knee can actually rotate moderately, without the destructive combination of torsion and pressure.
To understand sidebending at the knee, picture bowlegs. Bowlegs put significantly increased pressure on the medial compartment cartilage, and they overstretch the ligaments and other soft tissue on the outer knee. Conversely, knock-knees (the opposite problem) put increased pressure on the lateral compartment cartilage and strain the soft tissue of the medial, or inner, knee. This problem is more common in our society, and is associated, as you might expect, with arthritis in the lateral compartment.
Learning Correct Knee Poses
When teaching to align the kneecap with the center of the foot, you’re actually training to avoid rotation of the knee. The usual “bad” habit involves the kneecap, which indicates the position of the femur, turning in while the foot, which generally indicates the position of tibia, turns out. It takes a firm contraction of the buttock muscles-including the gluteus maximus but especially the piriformis and the other five deep hip rotators-to externally rotate the femur against the tight inner thigh muscles. If these muscles, primarily the adductors, are especially tight, your students may need extra work to stretch them in such poses as Supta Padangusthana (Reclining Big Toe Pose)* and Utthita Hasta Padangusthasana (Extended Hand-to-Big-Toe Pose)*, with the leg opened out to the side in both.
If you take the same common (but incorrect) knee alignment into bent-knee standing poses, such as Virabhadrasana I and II (Warrior Pose I and II)*, the knee is again rotating but also bending to the side. Again, strong external rotators are required to pull the femur into line. A good way to practice the proper alignment is to set the pose up with your back to the wall, right buttock on the wall, right foot turned out, and left foot turned in. Getting ready for Virabhadrasana II, notice that, in order to align the kneecap and the foot, the left pelvis needs to move a little bit away from the wall (the pelvis will not be parallel to the wall—also true in Trikonasana (Triangle Pose)*. As the right knee bends, the femur should stay parallel to the wall, keeping the back knee straight as the student presses out into the left foot.
It’s even more challenging to keep healthy knee alignment during transitions from bent-knee to straight-knee standing poses, such as Trikonasana to Ardha-Chandrasana (Half Moon Pose)* and Virabhadrasana I to II. It’s difficult for most of us to keep the knee from turning in, and even experienced people may need to work with support, such as having their backs to the wall for Trikonasana to Ardha Chandrasana. Students can practice bending and straightening the standing knee in Virabhadrasana III* with their hands on a ledge or wall, while keeping the lifted leg straight and strong. In both cases, you usually need to look at your front knees in the beginning, to confirm that they’re holding the alignment during the transition.
As you remind yourself to be mindful of knee alignment in standing poses, you’d be performing an invaluable service if you also keep the same alignment in your activities off the mat. If you practice the movement you have learned while ascending and descending stairs, getting up and down from chairs, and any time you need to step up or down, not only will you be avoiding the pain and limitation of arthritis, but you will be practicing yogic awareness all day long.
* PLEASE SEE ALL MENTIONED YOGA POSES
Reclining big toe pose
Extended hand to big toe pose
Half moon pose
Warrior pose 1 Warrior pose 2 Warrior pose 3
If you suffer from knee arthritis, try to start gently with the various exercises and poses and see if it gets better – a good way to reduce pain and swelling is also by taking some natural remedies like turmeric which helps to relieve the inflammatory symptoms. Turmeric contains a compound called curcumin, which has anti-inflammatory properties.