hips and knees joint health therapy intensive with...

HIPS AND KNEES Joint Health Therapy Intensive with Justine Shelton

14 ©Copyright 2013, Justine Shelton and YogaVistaAcademy.com

KNEE INJURIES We’ll cover some common knee issues that you have probably had in your classes. The main thing to remember when working with an injury is that circulation is what heals. Movements to increase circulation—while watching the tracking patterns—in addition to creating space and stabilizing and strengthening the muscles around the joint are the intention. In synovial joints, movement and/or isometric strengthening is what increases the synovial fluid, almost like WD-40 for the joint. An important thing to remember with the knee joint is that there are no muscles in the joint itself—so if there is pain in the knee joint a ligament is probably having undue strain put on it. Motto for Yoga - No pain, no pain!

Great poses for increasing circulation and working with the tracking patterns as well as strengthening around the joint:

KNEE CIRCULATION Extending and flexing the knee and hip to increase circulation and work with the biomechanics of movement.

1) The starting position is apanasana, with the hands interlaced around one knee to hold that knee into the chest.

2) On inhale extend the leg straight out, about an inch off of the floor, belly button drawn to spine to protect low back.

3) On exhale raise leg up, heel toward ceiling, toes toward face to increase the stretch to the back of the leg.

4) On inhale lower leg back down parallel to the floor, about an inch off (I am in mid-movement here.)

5) On exhale bring leg back to starting position.

Repeat 6-8 times before moving to the next side.

It is fine if the leg does not completely straighten, work within the para-meters of the practitioner's flexibility.

Having the opposite foot on the floor is an option for people with low back pain, as this more strongly blocks the rotation of the pelvis than holding that knee at the chest.

Joint Health Therapy Intensive with Justine Shelton HIPS AND KNEES

©Copyright 2013, Justine Shelton and YogaVistaAcademy.com 15

Alignment and watching the tracking pattern of the joints of the leg is very important, to improve the biomechanics of movement as opposed to reinforcing negative movement patterns. Notice here that the leg is coming straight out of the socket and the knee and toes are facing the ceiling.

This is my normal release valve pattern, especially with my right hip which has a history of joint displace-ment.

This is awkward for my hip, however some people naturally rotate inwardly. Watch for these patterns, and also encourage your students to pay attention to their movement patterns, to move deliberately with an awareness of their alignment.

If getting on the floor is not possible, knee extensions can be done in the chair. On inhale, extend knee and draw toes toward face.

On exhale, bend knee and lift knee, to get the hip flexors involved as well. Still watch the tracking patterns! Repeat 6-8 times.

Gentle Yoga Therapy with Justine Shelton LUMBAR


LUMBAR DISC DAMAGE Unfortunately this is an all too common injury. It is important to know if a disc is bulging, it CAN heal through proper movement to increase circulation and getting the disc to retract. If the disc is herniated, the herniation is permanent ‐ however, there is much that can be done to increase space between the vertebral bodies and help to get the person out of pain.

SUPTA BADDHA KONASANA – RECLINED BOUND ANGLE I will never forget the first time I did this pose! My back was hurting, and I hadn't been able to lie flat on my back without pain in years. After repeating this , SLOWLY, three times I was able to lie on my back for savasana completely pain free. It greatly increases circulation to the low back. I call it a yoga band‐aid for low back pain.

For lumbar disc damage, or low back pain in general, cue to bring the pubic bone toward the belly button to lengthen the lumbar spine and stablize the pelvis.

If you would like people to notice the difference between the before and after, have them lie flat on their back first and take a mental snapshot of how their back feels. Afterwards, have them lie flat again and notice the difference. My first time was profound!

This pose can be taught several ways. The most important thing is that it is done slowly. Repeat the pose three times. It can be cued to do it three times taking a full minute to come together each time, or you can talk them through it, bringing the knees together first in halves, then thirds, then quarters ‐ a breath for each movement. It takes a while, but trust me ‐ this pose is worth it!

Gentle Yoga Therapy with Justine Shelton Conditions—General Lower Back Pain


TIGHT HIP FLEXORS Tight hip flexors are common in our society due to how much sitting we do, which shortens the hip flexors causing undue flexion in the lumbar spine and contributing to low back pain. The iliopsoas is the largest of the hip flexors, comprised of the psoas major, psoas minor and the iliacus, and is most commonly referred to as the psoas. This lunge modification is aimed to increase circulation to the muscles through repetition, then holding the stretch allows the fascia to release.

EKA PADA USTRASANA - LUNGE Adaptation to increase the stretch to the psoas.

Set the alignment of the pose first. Outer edge of front foot in line with outer hip. On movement forward the front knee stops directly above or behind the ankle, not to the front of the ankle. This will keep stability in the knee and prevent over stretching of the patellar tendon. The knee is most stable when it is extended (leg straight), as it bends, especially after 90 degrees, the potential to move laterally greatly increases putting the stability of the knee joint at risk.

Inhale to come forward, exhale to come out. Repeat 6-9 times then hold pose for 3-10 breaths.

The origin of the psoas is the transverse processes and lateral edge of the vertebral bodies of T-12 through L-5, as well as the diaphragm. Lifting the arm of the back leg in turn lifts the thoracic cavity and diaphragm increasing the length to the psoas. Press center of chest forward to lengthen the lumbar spine and avoid compression.

NOTE: To change the angle of the stretch in the front of the hip, the back foot can move toward the center of the mat rather than straight back. Playing with the angle will allow the practitioner to explore their hip more deeply noting where the best stretch may be.

Yoga for Osteoporosis with Paula & Justine Chair/Mat Poses

Copyright 2013, Justine Shelton, Paula Montalvo& YogaVistaAcademy.com 29

UTTTANASANA ‐ FORWARD BEND WITH BENT KNEES

To transition to standing, tuck the toes under and walk the hands back, pressing up into a standing forward bend with the knees bent generously. Bending the knees takes the hamstrings out of the equation and takes the stretch into the musculature of the low back. If the legs straighten, make sure the pelvis remains in anterior rotation so the lumbar spine doesn't hinge.....the sacrum and the lumbar spine should always be going in the same direction to avoid compression to the vertebral bodies and to keep the discs safe.

WARRIOR I ‐ VIRABHADRASANA I This is a great pose for strengthening the muscles and bones of the lower body. Drawing the shoulder blades together will also help to reverse kyphosis and strengthen the upper back.

Start with feet in hip width alignment, like a narrow railroad track, and a comfortable stance from front to back.

On inhale, bend into front leg as you raise your arms overhead. Make sure the front knee doesn't go beyond the ankle.

Here you can better see the hip width alignment, this is more structurally sound for the body and puts less strain on the knees, sacrum and lumbar spine.

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KNEE EXTENSIONS: URDHVA PRASARITA PADASANA VARIATION

Repeat: 6 times, hold stretch 3‐6 breaths

MAIN TEACHING POINTS

Hold behind knees. Inhale ‐ raise heels toward ceiling, drawing toes toward face to stretch back of legs, exhale ‐ draw knees into chest and belly button toward spine.

Watch the tracking of the legs and keep them aligned, i.e. if practitioner is prone to external hip rotation, keep hips in neutral moving in and out of pose.

Watch tendency to roll onto back of head, keep chin slightly tucked and neck long.

Keep tailbone pressed toward floor throughout movement.

DESCRIPTION AND PURPOSE

Axial extension pose used here to increase circulation to the knees and work with the biomechanics of movement.

BENEFITS

1. Increases circulation to knees after holding internal and external hip rotator poses.

2. Helps open the hamstrings. 3. Increases circulation to hips and low back.

©Copyright 2012, Sherry Zak Morris and www.YogaJP.com 12

NAVASANA What is Navasana doing in a Gentle Yoga class? Building core strength! The full Navasana pose, where the legs are straight and the arms are reaching, is challenging for most people. However, it is a very good core and back strengthening pose. With a few modifications, this pose can be accessible and actually enjoyed.

VARIATIONS TO NAVASANA One of the most common ways a student will compensate in the pose is to round the back and crunch the shoulders to try to stay upright.

If you see this happening, have them try one of the modifications above.

KNEELING POSES Because the core and back are so inter‐dependent, any pose that works these two areas as a stable unit can benefit core strength.

SUNBIRD ‐ This balancing pose is a great core strengthener. Create a flow, by alternating sides with every breath cycle.

THE CRUNCH – To strengthen the external obliques, a key part of

a healthy torso and back, add a diagonal crunch to this flow. Use a chair as an option to make this accessible to everyone.

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