The Bee’s Knees

Bring You to Your Knees

Do you know which part of the human anatomy, from a movement perspective, makes us unique, from other primates? Quite simply, it’s the knee. Our ability to fully extend and lock our knees is what allows us to walk on our two legs. Though it appears to be a small joint, the knee is one of the key facilitators of mobility. Yet its overwhelming importance to our general wellbeing belies its vulnerability to injury, both unintentional and intentional. Other than a bony armour known as the patellar or kneecap, that sits in front of the knee joint, which itself is at risk of fracture, your knees are in a sense exposed. Nowhere is this more violently illustrated in pop culture than in a Tarantino movie. No surprises here.               

I Count 6 Shots

Who can possibly forget that scene in Django Unchained when Jamie Foxx blows out Samuel L. Jackson’s kneecaps, one at a time, bringing the authoritative senior house slave literally to his knees and to a slow and brutal death? Kneecapping as it is known, is a tactic frequently employed by terrorists to immobilise their victims. Aside from the tremendous degree of pain inflicted upon the victim, kneecapping, has in addition, that symbolic significance that equates with surrender. This tortuous punishment is a fate thought of in some cultures as being worse than instant execution. In a less dramatic context, the vulnerability of the knee to injury in sports or daily movements resulting in quite high stakes debilitation makes this a joint worth paying regular attention to in one’s physical training. Either way, your knees are your gateway to mobility, and thus freedom. Most of the time, people only begin to realise the significance of this joint when things fall apart and basic daily movements are threatened.

From a yoga perspective, the knee plays a pivotal role in the lotus pose –  one of the most  revered poses and commonly referenced yoga postures in mainstream culture. Its connection to the seated posture in meditation makes this an important posture for many aspiring practitioners. Yet in our aspirations to achieve this pose, injuries to the knees also become commonplace. 

This month, the knees take centre stage in our practice. Let’s take a closer look at the anatomy of the knee. 

The Anatomy of the Knee Joint

The knee is a hinge joint that connects the femur to tibia (shinbone). The patellar (kneecap) which sits anteriorly over this joint along with the fibula, the long thin bone that sits laterally and runs parallel to the tibia, complete the bones of the knee joint. The knee joint complex houses a series of ligaments, tendons and cartilage that provide stability and shock absorption to this joint which is subject to heavy loading and impact from daily activities.

Intracapsular ligaments include the Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL), two crisscrossing fibrous ropes that connect the femur to the tibia that prevent excessive back and forth sliding of the two bones. Similarly the MCL (Medial Collateral Ligament) and LCL (Lateral Collateral Ligament) are two  extracapsular ligaments that help stabilise the knee joint whilst preventing excessive side to side movement. Awareness of these ligaments have increased in mainstream media largely as a result of high profile athletes having their careers interrupted as a result of injuries here. More concerning is the rising rates of ACL related injuries in amongst teen athletes not related to impact. Read my earlier article which touches on this trending phenomena. 

In addition to these ligaments, the meniscus is a type of shock absorbing crescent shaped disc and cartilage that facilitates friction between the bones of the knees. Meniscus tears can happen in the sports field when there is a forceful twist or rotation of the knee coupled with a full load on the knee joint. Cartilage degeneration as a result of ageing can also make one more vulnerable to a meniscus tear. The double whammy here is that ligamental and meniscus tears are associated with lower levels of proprioceptive awareness in the knee joints as a result of trauma to nerve receptors within these cartilage and ligamental structures. 

It is thus important that once past the acute stage, to avoid further risk and exposure to injury that the knee complex is subject to retraining and strengthening. Yoga with its rich spectrum of leg-balancing postures lends itself very well as a form of rehabilitation training for those who have suffered knee related injuries. Aside from the strengthening and flexibility benefits, the breath regulation systems and strategies associated with the yoga discipline enhances neuromuscular awareness which can help elevate proprioceptive response.

Key muscles affecting the knee joint include the Quadricep along the front and the Hamstring in the back. When it comes to these muscles, the key word here is balance – balance as between strength and flexibility as well as balance of strength and flexibility  between the quadricep and the hamstring. Overdeveloped quadriceps illustrate this problem as overtraining the quad without balancing it with stretching or strengthening the hamstrings can lead to a host of potential knee injuries including patellar femoral tracking and exposure to a higher risk for ACL tears. 

Yoga and Knee Health

Yoga is know for its rich spectrum of postures beneficial to knee health. Other than its emphasis upon joint alignment, which can only help with proper loading on the knee joints, the leg-balancing postures which yoga is so well known for can help tremendously with building strength in the knees and ankles. From a symmetrical pose such as Utkatasana (Fierce Chair Pose) to a more advanced leg balance such as Bird of Paradise (Svarga Dvijasana), the yoga discipline is well known for its library of leg-balances for beginners through to the more experienced.

However strengthening is only half the story. Stretching the muscles around the knee joint as we have established is important for reducing risk of injury also. Hence, the value of yoga as a comprehensive training system for knee health cannot be overstated. Between strengthening and stretching, the key goal is ultimately balance and balance is key. Typical postures you might encounter in your yoga class are helping you stretch your hamstrings and quadriceps regularly. These include simple standing poses such as Uttanasana (Forward Fold) which effectively stretches the hamstrings and the seated pose Vajrasana (Thunderbolt Pose) which help stretch the quads. Thus from strengthening through to stretching, yoga combined with its breath regulation strategies, provide comprehensive physiological benefits that also extend towards greater neuromuscular awareness, making it a very attractive one stop shop from a time saving perspective.

Finally, a typical yoga class integrates functional movement training that includes and more importantly emphasises all three types of contractions – concentric, isometric and eccentric. Eccentric training of hamstrings in particular is known to reduce exposure to knee injuries. Studies have linked eccentric training with sarcomerogenesis (Lynn & Morgan, 1994); the regeneration of basic muscle units responsible for voluntary movement, namely muscle contractions, which in turn has been linked with increased muscular flexibility (O’Sullivan, McAuclliffe, De Burca, 2014). In yoga, the eccentric phase of training is of equal importance to both the concentric and isometric phases. A typical yoga sequence includes many opportunities for hamstring eccentric training such as forward folding in standing within the Sun Salutation Sequences, through to any of the wide legged squat positions in Prasarita  Padotanasana where the hamstrings are having to engage even as it’s lengthening as the weight moves forward into flexion. Through timed breath regulation, each phase of the movement is given equal attention and so eccentric training is executed just as effectively and not treated  as a bridge or transition to concentric training. Take chatturanga for example. The lowering phase from high plank to low plank is where eccentric training of the tricep takes place. This lowering down phase is usually done to timed breathing and executed with focus and attention. Conversely, in a typical gym workout involving pushups, it’s the concentric push up phase which is normally given the full attention and the lowering down part where the eccentric training of the triceps start, is often done without any real engagement.

Kick Ass Knees

Don’t wait for an injury to happen before you include the knee joint complex in your daily physical training regime. Work on both strengthening and flexibility of muscles surrounding the knee joint but also identify weaknesses in surrounding muscles so you can work on bringing balance to this crucial joint. 

All this May, at Ewa Bigio Yoga, we are working through sequences and postures with the health of the knee joint complex in mind.