I get all types of patients in my practice, and hear all sorts of stories on how people injure their bodies in the course of living an active life. Just a few weeks ago, a 55 year old nurse came in with left knee pain which her doctor had diagnosed as a sprain. When I asked how she injured herself, I was surprised to hear the answer. “Well, I play frisbee golf 2-3 times per week, and while throwing my drive, I fell and twisted my knee. I can still play though,” she said happily, “but I’m having trouble now with my yoga practice.”
“Well, all right”, I thought, “here’s an active lady.”
As the story unfolded, I found out that her yoga instructor recommended that she see me to make sure she wouldn’t provoke the problem with her yoga practice. She told me that since the injury, she’d been having pain especially with Warrior poses when the left foot was forward, and she didn’t want to have to stop practicing.
During the exam, as I expected, she had quite a bit of pain with full flexion of the knee, and also with inward rotation of the lower leg. This is often the case when someone damages the medial meniscus, a fibrocartilage disc deep within the knee. The job of the medial meniscus – along with it’s partner, the lateral meniscus – is to provide stability during movements of the leg, and therefore, it is put on significant stress when we fully flex the knee or when we rotate the body while the foot is firm on the ground.
It was time now to watch her perform some yoga postures. Childs pose was painful when she pushed all the way back into it, because it requires that full knee bending is available, and she can’t do this. That also rules out virasana and supta virasana. She’ll just have to avoid these poses for a while.
But what about the problem she’s having with warrior poses? She got into position, and, ‘boom’ pain immediately.
An interesting thing about the medial meniscus is that when we externally rotate the lower leg, the medial meniscus draws back into the joint a bit. While in Warrior 1 pose with her left foot forward, I had her refine her pose a bit by isometrically turning the left foot in a counter-clockwise direction (externally rotating it). The smile on her face told me we had a solution. She was immediately pain-free! Apparently, the meniscus was being strained or pinched as soon as she got into position, and externally rotating the lower leg snugged it up enough to take the stress off the tissue.
The good news is that she’s been able to keep up her yoga practice; both she and her instructor thought she may need to stop and eventually have surgery. All it took was a little knowledge of anatomy applied to the form of her pose, and she was back in action. In truth, she may eventually have to have the meniscus operated on; tears to this tissue often get worse, but they also respond very well to surgical debriedment. And this is likely the only way she’ll be able to get back to doing virasana.
Not everyone’s as lucky though. Last month, a buddy of mine underwent this exact surgery. Years of running wore his menisci down to nearly nothing, and it was getting hard to walk. What can I do for him? Well, while at the store the other day I saw a new beer called “Twisted Meniscus”.
Cheers Kenny!
