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Knock-Knees, Lady Gaga, and Yoga

15:10 | Labels: anatomy, Baxter Bell, knee problems, knock-knees, leg anatomy

by Baxter

Lady Gaga Bares Her Knock-Knees*

Don’t know if Nina mentioned it yesterday, but this interest in knees all started with the following question we got last week:

I have a student who has knock knees (genus valgus), a condition that I gather is quite common in women. She reports that aligning her knee with her second toe in standing poses gives her knee pain. Do you or Baxter have a suggestion for her, as well as for an appropriate cue in classes that might include people with this condition?

Also, many men have bow legs (genus varus); I have not yet heard complaints about problems aligning their second toe with their knee but suspect that some compensation might be necessary. If so, do you have a suggestion for them?

Whether you are a yoga teacher or a yoga student, if you don’t have knock-knees or bowlegs yourself, you have probably noticed someone in your public class (or a celebrity like Lady Gaga) who has one of these fairly common variations in leg bone relationships. And it turns out that more women are “knock-kneed” than men, and more men are “bowlegged” than women. However, I have seen cases of the reverse for both.

Without going into to too much detail (but at least a little!), depending on the shape of the upper part of your thighbone, the femur bone, where the short neck of the femur (the part often broken in a “hip fracture,” especially in those with osteoporosis) meets the longer shaft of the lower part of the femur, a person might veer away from the normal angle enough to lead to one of our two conditions. When the femurs move further away from the midline of the space between your legs, referred to as “abduction” in anatomical circles, you end up with bowlegs. When the femurs move closer to the midline space between the legs, referred to as “adduction,” you end up with knock-knees.

In the case of knock-knees, when the femur meets the two lower leg bones, the tibia and the fibula, the inner knee joint tends to open up towards the inside of the knee joint and the outer or lateral joint tends to compress together more than normal. Tight inner thigh muscles and weaker outer hip and leg muscles can contribute to this situation. And with the knees knocking towards one another, you can get more wear and tear on the lateral joint, and the skin of the inner knees can even sometimes rub together in an uncomfortable way on the opposite side of the joint. Julie Gudmestad put it this way in an Taking Care of the Knee for Yoga Journal on keeping the knees healthy:

“…knock-knees … 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.”

The strain of the soft tissue of the inner knee she refers to could mean an over-stretching of ligament on that side of the joint whose job it is to keep the bones in a healthy close relationship. And the increase in the chance of arthritis is why we care about these variations in anatomy!

In knock-knees, in addition to causing the inner bowing the legs of knock knees, the femur bone tends to roll or rotate inwardly, so that when you are standing in Mountain pose the knee caps end up pointing a bit toward one another instead of pointing straight ahead (or in line with second toe, as some yoga teachers recommend). Many yoga students are told to bring the inner edges of their feet very close together at the same time they are told to align the kneecaps with their second toes. In those with knock-knees, this can exacerbate the alignment even more. So, one of the first things I suggest for these practitioners is to separate the feet about hips-distance apart, sometimes with the aid of a block between the mid-thighs. I suggest they hold the block lightly between their thighs (as they may already have tight adductor muscles and we don’t want to encourage more tightness) and imagine that the block is pushing out against the inner thighs. I’d check in at this point and see if the student’s knee pain has disappeared. If it has, I’d recommend they adopt this new stance for future practice.

For Mountain pose (Tadasana) and variations, Standing Forward Bend (Uttanasana) and Downward-Facing Dog pose, Donald Moyer suggests keeping the feet a bit closer together and using a block between the knees. This closer foot position will let the block push the knees apart in the bowlegged direction.

Another option is to forgo the block, but keep your legs hips-distance apart, and place a looped strap around both legs, either mid-thigh or mid-calf, and press outward against the strap, feeling the strap resist that pressure. You are essentially taking the knees a bit towards the bowlegged direction, encouraging a bit of muscular strength in the outer leg muscles and a bit of stretch to the adductors of the inner thigh. You could apply this to other poses with two straight legs such as Standing Forward Bend and Seated Forward Bend (Paschimottanasana).

In his book Structural Yoga Therapy, Muktananda Stiles notes that those with genus valgus (knock-knees) usually have tight adductors (inner thigh muscles), and parts of gluteus medius often are weak. The external rotators of the hip can also be weak and allow for both the knocking and the internal rotation of the thighbone I mentioned above. Muktananda Stiles also relates his personal experience with long standing knock-knees and a pivotal practice session in which he worked with Warrior 2 pose, holding it with close attention to keeping his desired knee alignment, and consciously softening and lengthening the inner thigh muscles and strengthening the outer thigh muscles of his front leg to exhaustion. He claims that as he continued to work with this over time, his knock-knees resolved!

In her article, Julie Gudmestad suggests using the Reclined Leg Stretch pose version with the leg out to the side to lengthen the inner thigh muscles. This works in the standing version of this pose as well.

To strengthen outer gluteal muscles and the external hip rotators, she suggests Warrior 2 with close attention to the knee position and the alignment of the front thighbone with the long edge of your sticky mat.

Other poses to stretch the adductors include:

Triangle pose (Trikonasana), front leg
Extended Side Angle pose (Parsvakonasana), front leg
Widespread Standing Forward Bend (Prasarita Padottanasana), both legs, possibly using your elbows to press your inner knees
Wide-Angle Seated Forward Bend (Upavista Konasana)
Cobblers Pose (Baddha Konasana)

Other poses that could assist in strengthening the outer gluteal muscles and the hip external rotators include:

Half Moon pose (Ardha Chandrasana), both legs (plus, if you get the correct external rotation of the bottom thigh, you will also get some good adductor stretch)
Tree pose (Vrksasana), top leg
Pyramid pose (Parsvottanasana), front leg action at hip
Warrior 1 (Virabhadrasana I), front leg action at hip

I hope these suggestions—while in no way exhaustive—can give you a few ideas on working with knock knees to not only eliminate pain that you or your students have now, but also hopefully reduce the chances of early development of osteoarthritis down the road!

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Bowlegs, Doctor Who, and Yoga

16:45 | Labels: anatomy, bowlegs, leg anatomy, Nina Zolotow

by Nina

I see your bowlegs, Doctor!

When Matt Smith became the eleventh incarnation of Doctor Who, I had a surprising reaction. I didn’t think oh, he’s so cute or, oh, he’s way too young to play Doctor Who or, oh, when are they going to have a female Doctor Who (okay, I did think that). Mainly I thought, oh, my, what bowlegs you have, Doctor! That’s because since taking Donald Moyer’s course called Seeing and Understanding Bodies, I notice a lot of interesting variations in human bodies, and I could see Matt Smith’s bowlegs even through his pants.

Bowlegs (Genum varum) is a condition in which when a person stands with his or her feet together, the knees remain wide apart (see Doctor Who above). Did you know that we all start out life bowlegged because of our folded position in our mother's wombs? By around age three, we can usually stand with our ankles apart and our knees just touching when our feet are together. Hyperextended knees resemble bowlegs in this way, however, so if you’re not sure which you have (or which your student has), see Hyperextension of the Knees and Yoga, which contains a simple test you can do.

I was going to go into a whole long thing about what causes bowlegs (diseases, such as rickets, some professions, like being a jockey—maybe the reason so many Japanese people are bowlegged is because of the way they sit—and possibly the natural anatomical structure of the hip joint and the position of the thighbone within it). But the real question is: why do we care if someone has bowlegs? The answer is that because people with bowlegs tend to bear weight unevenly on their hips, knees and feet (the outer sides of these joints bear more weight), uneven stress and wear on those joints could lead to the early onset of arthritis.

By working with your alignment in your yoga poses, you can learn to bear your weight more even in your asanas and, with that new awareness, in your daily life as well. My teacher Donald has bowlegs himself, so I decided to chat with him about his ideas about working with this condition in yoga practice. And the result is this post.

Bowlegged people tend to stand on the outer edges of their feet with their feet slightly turned out and your feet are your foundation in your standing poses (and while you are walking!), so I’m going to begin with some suggestions about the feet. After that, I’ll make some suggestions for working with your legs.

Working with Your Feet

In Mountain pose (and variations of it), stand with your feet in line with the center of your hip joints, rather than touching each other. This way your legs will be less bowed and you’ll carry your weight a bit more evenly. Then, align your feet by making the second foot bones (the second metatarsal that connects to the second toe) rather than your toes parallel with each other. Once your feet are aligned, consciously bring some weight onto the ball of your big toes and roll your first foot bone (the first metatarsal that connects to your big toe) toward the midline of your body.

In all your standing poses, align your front foot so your second foot bone is parallel with the edge of your mat using the same techniques described above. And for both feet, consciously bring more weight onto the inner edges of your feet, also as described above.

Because people with bowlegs tend to walk on their outer feet, use this new awareness of distributing your weight more evenly on your feet while you move through your day, so you walk on your inner as well as your outer feet.

Working with Your Legs

In your standing poses, after aligning your feet, you should focus on strengthening your inner legs, taking some of the weight off the outer legs. Using props can help you focus on the inner leg muscles.

In Downward-Facing Dog pose (Adho Mukha Svanasana) and Standing Forward Bend (Uttanasana), you can put a block turned on its narrowest side between your upper thighs (and, if you wish, a strap around the thighs to help keep the block in place and give you awareness of your outer thighs). To use this propping in Downward-Facing Dog, you’ll need to place your feet closer together than usual. Then use the touch of the block against your thighs to activate your inner thigh muscles. Use the awareness you develop in these two poses to activate these same muscles in all your standing poses.

You can also use Tree pose (Vrksasana) to help activate your inner thigh muscles, as you press your inner thigh against your raised foot at the same time you press the foot against your thigh.

In standing poses in which you can’t place a block between your legs, such as Extended Side Angle pose (Utthita Parsvakonasana) and Triangle pose (Trikonasana), you can work with a partner. Have your partner stand behind your back foot, and then use a strap around the upper inner thigh of your back leg to gently pull back your inner thigh toward the thighbone.

Because your outer calves are also overdeveloped compared with your inner calves, you can also work on strengthening your inner calves. You can stand with a block between your calves to learn how to activate this area in the same way you did with your inner thighs.

In your everyday life, you can bring this your new awareness of your inner legs into your movements as you walk and go about your day.

In all standing poses, you can bring your legs into a straighter alignment by consciously moving your leg muscles so that the median line of your calves is aligned with the median line of your hamstrings. To do this, move your inner calves toward your inner leg and outer calves toward your outer leg, Likewise, move your inner hamstrings toward your inner legs and outer hamstrings toward your outer leg. How does that feel to you? Is your weight more evenly distributed? You can practice also these same techniques to align your straight leg or legs in seated poses, such as Seated Forward Bend (Paschimottanasana), when you can get a good look at your legs and how your movements affect the alignment.

In general, with all these suggestions, just experiment and see if any of the techniques feel good to you. For example, many people with bowlegs feel a burning sensation on their outer feet in Widespread Standing Forward Bend (Prasarita Padottanasana). Shifting some of your weight to your inner feet (as described above) may alleviate that pain, making you feel more comfortable in the pose. Sometimes the good feeling you have may be just a sensation of energy moving more freely through you. And if anything causes pain or serious discomfort, please come out of the pose or return to another way of practicing it.

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Five Reasons Why You Should Learn Human Anatomy

11:38 | Labels: anatomy, Nina Zolotow

by Nina

The Anatomy Lesson of Dr. Nichlaes Tulp by Rembrandt

A friend of mine surprised me the other day by saying she thought I should blog about anatomy more often. When I said that we’ve got Baxter and Shari to do that and that I thought of my post Hyperextension of the Knees and Yoga as an exception, she replied particularly liked how I wrote about anatomy in layman’s terms, making it very accessible.

The truth is that I find anatomy just fascinating. Years ago when I was in Paris, I went with my friends and family to the Muséum national d'histoire naturelle. In the Great Gallery of Evolution, there was an extensive display of the skeletons of large number of species of living creatures, both great and small. I was so excited to see for myself how all mammals, from mice to whales to humans, have the same bone structure (with different variations in the sizes, shapes, and proportions of the bones). Different species of fish, on the other hand, can have dramatically different bone structures from each other.

And my friend’s comment got me thinking about why I thought human anatomy was so intriguing, how my understanding of human anatomy related to my yoga practice, and why I thought it was a good idea for everyone who practices to learn at least a bit about human anatomy.

1. Improves your alignment. Of course, you can just do the basic shape of a yoga pose without worrying too much about subtle alignment techniques. But working with alignment cues involving specific muscles and bones has several important benefits. First, you can learn to bear your weight more symmetrically in the pose—helping to keep you safer. Then, you can learn to make the pose more comfortable—you can breathe more easily, feel more freedom in the pose, and allow the energy move through you without getting stuck in certain tight areas. (Oh, yes, that feels better, doesn’t it?) See Tucking and Tilting the Pelvis for an example.

2. Enables you to customize your practice. It seems that almost everyone has a little something different about his or her body—something that deviates from the standard, you might say. It could be some usual flexibility, such as hyperextension of knees that I discussed in Hyperextension of the Knees and Yoga or the same thing in your elbows, an asymmetry like scoliosis or one leg shorter than the other, a misalignment, such as knock knees or a carrying angle in your arms—the list goes on and on. When you learn about these differences in your own anatomy, you can use your knowledge of anatomy in general to adapt your asana practice to your particular needs and concerns. For example, in my post Hyperextension of the Knees and Yoga, I talked about how I’ve worked with my knees over the years by focusing on moving individual bones and muscles.

3. Improves your proprioception. Working with individual muscles and bones in your poses helps make you more sensitive physically (you can wake up unresponsive areas by focusing on them). Having more sensitivity in the nerves that tell you where you are in space will, in turn, make you more agile (see Yoga for Agility) and improve your balance (see Balance and Safety).

4. Allows mindfulness. Although you can work with your breath in your poses as a mindfulness practice (see No Control: Watching Your Breath As It Is During Asana), you can also use specific alignment techniques in your poses—changing them from day to day—to focus your mind on a particular body part or sensation. This provides you with wide variety of ways to harness your mind to your body, which can help you from falling into a rut in your practice. As my teacher Donald once said, “Feeling an adjustment is concentration. Feeling the adjustment ripple through your body is meditation.” See What is Mindfulness? for further information.

5. Teaches you to love your body from the inside out. Learning anatomy can give you an appreciation of the marvelous complexity the human body! Just feeling the aliveness of my body as I practice yoga is often a great joy to me. And turning your focus from how you look in a pose to how your anatomy enables you to move into the various shapes of the poses allows you to let go of body image concerns. Like a mouse or a whale or every other human being, you are made up of skin and muscles and bones and organs, all throbbing and pulsing with life. This is the real “yoga body.”

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Ashtanga Yoga and Anatomy with David Keil

09:17 | Labels: anatomy, Ashtanga yoga, Ashtanga Yoga Teacher, David Keil, Purple Valley

Above is a playlist of talks with Ashtanga yoga teacher, David Keil in regards to the Ashtanga yoga practice, specific poses as well as taking a look at anatomy. Good stuff all around.

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All About the Spine: Anatomy and Movements

08:19 | Labels: anatomy, extension of spine, flexion of spine, safety, Shari Ser, spine anatomy

by Shari

Recently in my classes and private sessions I have been receiving a lot of questions about the spine and exactly how it moves in different yoga poses. I thought I would do a blog post to summarize basic spinal anatomy and what the yoga practitioner needs to consider when practicing. I believe it is important for us to learn about spinal movements so we can begin to understand why one movement feels good to do while another movement either hurts or just doesn’t “go anywhere.” Many of our teachers are very skilled in the instructions they give us, but, for me, I always think that it is important to understand the why (I have never been very good about blindly following orders).

Let’s start with the anatomy of the spine. The spine is composed of separate vertebrae, which are separated into five regions of the spine. The cervical spine is the neck area and there are seven cervical vertebrae. The thoracic region is the area that begins at the level of the collarbones (clavicle) and extends all the way down to the waist. The thoracic vertebrae connect to the ribs, and there are 12 thoracic vertebrae and 12 paired ribs. The lumbar region begins at the bottom of the rib cage and extends into the pelvis. There are five lumbar vertebrae and the last vertebra sits on top of the sacrum. The sacrum consists of five vertebrae fused into a single bone (the five are initially un-fused at birth, but begin to fuse in our late teens). It is joined on each side to the pelvis and sits deep to the pelvic basin. At the bottom of the sacrum, we find the coccyx, which is composed of three vestigial vertebrae—our “tail” of bygone days.

It is important when learning about the spine to view it from multiple angles, including sideways, front facing and back facing. When you view it from these three angles, you can begin to appreciate the beauty and complexity of the spine. Some of the things that you may notice immediately when looking at pictures or, better yet, a three-dimensional model, of the human spine is that the various regions look different. The cervical vertebrae are petite and small in size, the thoracic vertebrae are bigger, with longer and more angled spinous processes, and the lumbar vertebrae are much more massive and substantial.

Also, it is apparent that the spine is not a rod but has four basic curves. The cervical region curves inward (concave), the thoracic spine curves outward (convex), the lumbar spine curves inward (concave), and the sacral region curves outward (convex). The shape of the spinal curves are important for transferring the load/weight. Maintaining those curves with weight-bearing forces keeps the spine healthy with minimal deterioration of joint surfaces. The cue that we sometimes hear in yoga class to keep our spine “straight” is a misnomer, because naturally the spine is curved! We don’t want to take the curves away but we do want to balance where the movement occurs.

Another point to consider is that the shape of the spine will change when we move through a range of motion in our daily lives as well as in our asana practice. Whenever we sit, stand, walk, reach, lie down, and so on, we are changing spinal position. Sometimes the adjustments are small and imperceptible, and other times they are much more global. Going from sitting to standing changes the spinal curves in small degrees, while going into a deep forward bend or backbend changes the curves more dramatically. The muscles that attach to the spine are forever working to keep the spine stable in whatever position we are in.

There are four specific movements that the spine moves through. When we bend forward and curve the spine (reversing the lordosis of the cervical and lumbar region and exaggerating the curve of the thoracic region) this is called flexion. We cause spinal flexion in forward bends whether in a chair or seated on the floor. The degree of forward bend is generally limited by our leg and back flexibility. Some very common forward bends that require different degrees of flexion could be Seated Forward Bend (Paschimottanasana) and Plow pose (Halasana), which you could think of as an upside down from of Seated Forward Bend.

Why do I say there are different degrees of flexion? Well, for someone who is very tight in their legs or in their back muscles, just the act of sitting in Staff pose (Dandasana) with a lift under their pelvis is very challenging. Their natural inclination might be to sit in a rounded back or flexed spine position to start and then when they bend forward even more this becomes an unhealthy forward bend because there isn’t good distribution of the change in the spinal curve.

For the tighter student, learning to sit with their spine in neutral curves is the way to begin practice for spinal safety. The student who has a lot of flexibility in their hamstrings may have tight back muscles so when they bend forward there is no change in their spinal curves—both examples are extremes.

The key to healthy forward bends, whether in Paschimotanasana or Halasana, is for there to be “ease” in the bend. The same principles apply to standing forward bends like Pyramid pose (Parsvottanasana). Props like chairs, bolsters, and blocks allow you to find the shape of the pose without the struggle of getting into a pose you aren’t ready for.

The opposite of flexion is extension. In extension, the curves of the cervical and lumbar region are deepened and the curve in the thoracic region is lessened. We extend our spines in classic backbends like Upward Bow pose (Urdva Danurasana) Upward-Facing Dog pose (Urdva Mukha Svanasana), and Camel pose (Ustrasana).

Of course, our spines can also twist, as when we turn to look behind us in a car. We twist our spines in seated twists, such Bhajrajasana, or Marichyasana, and in standing poses, such as Triangle pose (Trikonasana) and Revolved Triangle pose (Parivrtta Trikonasana). And in certain poses we combine both flexion and twisting as in Parivrtta Janu Sirsasana. Poses with both extension and twisting are less common, but one example is the One-Legged Downward-Facing Dog pose with a twist.

Finally, we can side bend, as when we reach down to pick up something like a handbag or grocery bag that is next to our foot. We side bend our spines in side-bending yoga poses, such as Gate pose (Parighasana). And in many poses we combine both side bending and twisting, such as in Triangle pose (Trikonasana) and and Revolved One-Legged Forward Bend (Parivrtta Janu Sirsanana). Generally, we don't purely side bend without some twisting or purely twist without some side bending, though the primary movement will look like side bending or rotation.

The key concept to protecting your spine in all your poses is understanding where we want to encourage the movement and how to distribute the movement so as not to cause excessive motion at one vertebral level. Another key concept is to avoid using momentum to push through “resistance.” When we are overly aggressive in attempting to gain motion this is where injury will surely occur.

So let’s break down this concept of spinal motion a bit more. If we understand that different parts of our spine move more in certain movements, does this mean that certain asanas will affect different parts of the spine differently? Yes, absolutely! The cervical and lumbar regions are concave when the spine is at rest. When we move into a backbend, these areas become more concave in relation to the curve reversal of the thoracic region. Because the thoracic region is stabilized from the front (anteriorly) by the rib cage and from the back (posteriorly) by the long spinous process, there is relatively less curve reversal from convex to concave in this region. As we move into a forward bend, the rounding of the thoracic curve increases into more of a convex shape. The opposite occurs in the cervical and lumbar spines; they start in relative concavity and as the forward bend moves throughout the spine, their shape changes from concave to relatively convex.

In twists, it is important to encourage full spinal involvement, but also to understand that the majority of the twist will occur in the cervical region, followed by the thoracic region and lastly the lumbar region. There is very limited rotation of the lumbar vertebra due to their specific structural construction. Also, please try to avoid allowing your spine to round or flex whenever doing twists. The key to healthy twists is to keep the spine long, with a good conscious control of maintaining the curves as you twist. This is often erroneously called keeping the spine “straight”, but now you know better when you hear this cue from a teacher!

When you practice, try to picture how your spine changes shape from the starting position into the position of the asana and then back to starting position. This is your experiential anatomy lesson of flexion (forward bending) and extension (backward bending), and twists.

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Knock-Knees, Lady Gaga, and Yoga

Bowlegs, Doctor Who, and Yoga

Five Reasons Why You Should Learn Human Anatomy

Ashtanga Yoga and Anatomy with David Keil

All About the Spine: Anatomy and Movements