EDITOR’S CORNER – Lessons Learned: Yoga and Joint Pain

Lessons Learned: ‘Joint Lessons’ on Yoga and Health

~Abha Gupta, Ph.D., Editor-in-Chief YSN
(YSN Vol. 1, No. 1 – Nov. 2013)

I recently hurt my knee while working out on the elliptical machine, instantly experiencing a new kind of pain. My orthopedist identified the injury as a localized medial joint line meniscus tear, with inflammation of the knee membrane – a case of synovitis. As a Certified Yoga Instructor, I had heard many times from attendees in my yoga session that they suffered from a backache, knee pain or a frozen shoulder, and was always able to tell them in a very matter-of-fact way to be gentle with their bodies, and go easy on certain postures. Now, from my own experience with knee pain, I am able to truly understand the depth of these words, and I have learned new lessons about yoga-āsana-s, as a result.

Lesson #1: The Equity of Āsana-s: All āsana-s are equal; there are no “difficult” or “easy” poses. Whether a pose is difficult or easy depends entirely upon the individual’s state of body and mind while performing the āsana. Until now, like most yoga practitioners, I believed there were easy poses and difficult poses depending on what the majority of people can and cannot easily do. However, with an injured knee, I realized this is not the case. What were apparently simple āsana-s — like sukhāsana (cross-legged pose), baddhakonāsana (bound angle pose), or dvichakrik āsana (bicycle pose) — had become painful to perform. On the other hand, I found myself doing the so-called ‘difficult’ pose, ‘shirshāsana’ (head-stand), relatively easily!

This made me reflect. What made me believe shirshāsana was a difficult pose in the first place? Deep down, it was my own inability to do the pose in the beginning that caused me to think of the pose as difficult. With a daily practice of the pose, my body became more and more flexible, more balanced, and eventually I was beginning to do the headstand. It was not the āsana that was difficult; rather, the difficulty lay in my mind-body state.

Interestingly, when my state of mind-body changed with the knee injury, my perception of the difficulty level of an āsana changed. Now, with an injured knee, it was the sukhāsana (sukha = comfort / bliss) that began to sound like ‘dukhāsana’ (dukh = pain / discomfort) to me, while the headstand became a breeze! Because I no longer associated pain with the headstand, there was a shift in my perspective about it. A beginner level pose (such as sukhāsana) may be considered a difficult or advanced pose for someone with arthritis, while that individual may do a headstand, which is traditionally considered an advanced pose, easily.

The labeling of yoga postures in terms of basic and advanced began to lose definition. An āsana is as it is; there is no judgmental qualifier to it, in terms of easy, difficult, simple, complex, basic, and advanced and so on. These adjectives and qualifiers have been accepted because we typically weigh āsana-s from our generic human mind-body perspectives. Instead, it is the individual’s bio-mechanics and state of mind that determine the level of difficulty of a posture.

Lesson #2: Halt When it Hurts: As yoga teachers and practitioners, we all know how some postures focus on targeting certain body parts, whether it is the joints, muscles, specific internal organs, or the movement of fluids in the body. However, despite the anatomical focus for an āsana, we need to keep in mind that it requires the support of many other body parts in order to carry out the specific movement in a posture. Injury is not the recommended way to find out the entirety of anatomical aspects of an āsana, as I did, but it helps to know when to stop.

Postures that involved bending, folding, twisting or turning of the knee were not necessarily the ones that hurt. In fact, I was able to do vajrāsana (thunderbolt), jathara-parivartanāsana (spinal twist), and pavanmuktāsana (knee-chest pose), all of which incorporate a bent knee. On the other hand, I could not do baddhakonāsana, which primarily targets the pelvic joint (hip joint). My pelvic joint was not hurting, so I thought I should be able to do that easily, but I was wrong. The knee muscles and ligaments are stretched as well. Even though the āsana itself does not target the knee as its therapeutic focus, it does incorporate the support of knee muscles, tissues and ligaments to execute the posture.

Similarly, the wheel pose (urdhva-dhanurāsana or chakrāsana), which is primarily a full backbend focusing on strengthening the spine and hands (wrists), one wouldn’t normally associate with the knee. The other āsana-s that I had to discontinue were ‘dhanur-āsana (bow pose) and ashva-sanchalan āsana (horse riding pose) in surya namaskār.

The bottom line is: Read up, research, talk to your doctor and your yoga instructor, but in the end, make sure you listen to your body. Back off, when it hurts. Otherwise, one can further worsen the injury and extend the recuperation process. Pain or discomfort is the body’s way of talking to you and telling you something important that only you can hear, so listen up. Only you know when it hurts, so pay close attention to the body, and learn to halt when it hurts. In fact, in Patanjali’s Yog Sutrā (Sutrā 2:46), the classic yoga scripture, it states, “sthir sukham āsanam” which literally means stability, comfort, āsana — implying that stability and comfort in a pose should be factored into practice.

Lesson #3: Gratitude: We tend to pay attention to things when they break or cause trouble. The knee injury turned out to be a humbling experience, as it resulted in a new sense of gratitude for the āsana-s that I was able to do with ease. I was less dismissive of them as too simple or basic. The fact that out of 360 joints in the body, it was only one joint that hurt, filled me with a sense of gratefulness for the 359 that were operating smoothly.

Revelations aside, it is important to recognize that the knee is a complex structure, and its accurate diagnosis by a physician is critical to any knee injury. Depending on the specific diagnosis, create a therapeutic routine of āsana-s for yourself. Accept new limitations, whether short- or long-term; tune in with your body; breathe; and allow the healing process to unfold.