Saturday, April 25, 2015

Is Yoga a Good Idea for Bad Knees?

This is a short post mainly meant to spark a dialogue.

Have you found yoga to be useful in taming chronic knee pain? I’m interested in comments from people who have tried it, with success (what kind of yoga did you do and which poses, and how often?), as well as from those whose experience has been that it’s useless/harmful.

I never did yoga for my knee pain. I can imagine reasons why it would be beneficial; I can also imagine reasons why it might not be. Anyway, the University of Minnesota did a study (small, and apparently with no control group) that found that the 36 participating women reported better knee health after taking a one-hour yoga class each week for eight weeks. The women were 65 to 90 years old; they all had knee osteoarthritis. Most of the subjects had less pain and stiffness at the end of the two months.

This seems like a very short, maybe not-that-rigorous study, so that’s why I offer the results more as a conversation starter. Yoga for bad knees? Yes or no? What do you think? Please weigh in below.


  1. Hi Richard,

    I found yoga to be completely useless and in some instances aggravating. My former PT is also a yoga instructor and swears by it so I tried her class for 7 weeks (1session per week). Poses included: Warrior 1&2, Tree, Cow, Cat, etc. I found for the kneeling poses such as cat, childs pose - I could not partake in as I can not kneel and put any weight on my knees. I am also curious what others experiences were/are with yoga? I find the only thing that gives some relief is walking in moderation.

  2. I've not tried Yoga but I can categorically say that in my case, anything that involves kneeling or squatting or prolonged 'greater than walking pressure' on a knee is detrimental to my knee situation. My knee symptoms are identical to those Richard described in his book, quite likely with the same cause (hard cycling).

  3. Quick comment on NSAID's- Imagine the litmus test would be those physicians (OS') who had "SAID" information and continued to implement a protocol that apparently accelerates degeneration. Am waiting to see the study that establishes a relationship between chondral shaving (arthroscopy) and accelerated degeneration, as that is part of the once runaway train I have been slowing down over the last 3 plus years. BTW, I also was prescribed a strong NSAID 6 weeks post surgery and then given a cortisone shot about 3 months post-surg and had a brief brush with BAD PT: those are some of the long odds stacked against my recovery. Fortunately I read SMK around that time and well, what with all the resources "out there" am slowly improving and definitely not getting worse.
    As for yoga, yes I do a custom routine. Probably looks more like a combination of convulsion and self-harm to the untrained eye. Guess my point is, that when trying out an activity when your knees are wonky (a word I picked up, courtesy the good folks at KneeGeeks) you start new routines with caution and trepidation. By analogy- Sort of like getting up to use the restroom in the middle of the night in an unfamiliar house. You don't know where the light switches are and the hallway is long and technical. So one proceeds with caution, touching the wall lightly with one hand and picking ones way with a carefully extended big toe. Cartilage will willing hurt itself for you and not let you know for a day or two. It was my good fortune and luck a year and a half ago, to see a good, forward thinking OS who gave me the advice to "exercise" lightly every other day and to use the intervening hours to assess the outcomes. As for "yoga," I'm big on planking and trying to bend the experiment in those directions that run contrary to my habitual motions. I also discovered early on, a few years ago when I was having a hard, painful time just walking, that stretching (pain-free) aka yoga, helped get the endorphins flowing and sometimes I think I may have even meditated against my own intentions.
    Finally. I shudder to think of someone with severe chondromalacia going into a yoga class where the instructor didn't have prior knowledge of the disease and it's state, as well as a protocol to address those limitations. A person could do a lot of damage in one class. As for me: Generally I stretch/ do yoga on soft surfaces and try to keep the kneecaps from direct pressure on those surfaces. Common sense stuffs here about imposing strange point loads on struggling cartilage.

    Good luck to everyone healing their knees, Racer (more like Fast Walker/Slow Rider-X these days) X

  4. I used to do yoga quite intensely (6 days a week) long before I was a runner. It was great for awhile, until it started to mess with my knees. For awhile I could do some more advanced poses, but because I have very little external rotation through the hips, my knees were making up for the flexibility required for poses by being twisted and torqued. Eventually, I couldn't do the same poses that seemed so easy a few months before because it hurt my knees too much. I stopped doing yoga for other reasons, but didn't seem to have any lingering knee issues from it (although maybe it's now all part of the larger story of why my knees gave out). These days, I can only do sun salutations, as long as I'm careful to move slowly through the motion. Any other poses would be unthinkable. Staying in a plank position for more than a few seconds is too hard on my knees too.

  5. runnerD,

    I am sorry to hear about your struggles.

    First off, I am reluctant to post here, partly because I myself am in a state of uncertainty about those processes that have lead to my cartilage improving. Uncertainty, an aquired disposition that has served me well over time, as I am always questioning... why?

    When I started "yoga" it was a pretty small enterprise. Like you, planking was painful for me. The first several weeks, I mostly just sat and that first time, when I "assumed the position," (crossed legs) I could hardly walk when I got up, so I assumed that position no more. At that time I had gotten to the place where any constructive motion HAD to be enough. My point is, that I had been convinced, thanks to Richard and the one good OS I met on this journey, that pain was bad, so I avoided those activities that promoted pain, even when they ran contrary to my deeply engrained, type A competitor habits... Anyway... I lit candles, played Enya and turned myself inside out, praying for endorphins and thankfully a few strays jumped across my synapses.

    Back to my difficulty posting here. I think that cartilage can heal (and I believe that Richard healed his knees) and I know that my knees have greatly improved, but that said, in my case, that I cant say, in all honesty, that I know with certainty, why my cartilage is getting better. I have a lot of "crazy" theories: about mold and food allergies to name two, but have no falsifiable hypothesis to support my claims. In my defense, when you're losing your knees (which for the lifelong bike racer, is the equivalent of their life), you suss the dregs of misery to tweak the experiment, however farfetched and unlikely the connections between what you think are cause and effect might be.

    Do I think that cartilage can heal? Absolutely. Do I think I can, in my case, know why? With certainty and honesty, I do not. Do I think that there are cases where we can know why? I do. Unfortunately, the knowledge that rules the paradigm, errs in favor of ignorance toward harm, as opposed toward healing.

    Hope this helps more than hurts.

    Good luck to all healing their knees, Racer-X

    1. Racer-X, have you made a full recovery and are able to resume all your previous activities? Or does knee pain still occasionally haunt you? I completely agree with you about the uncertainty of it all. I find it hard to believe in the possibility of a full recovery if I don't really understand why it happened. Or why there was a problem to begin with. If I ever do recover, I will probably always worry about a relapse. But I guess that's a far better fate than never recovering, so I'd take it in a heartbeat anyway..

    2. I know how you feel runnerD. I went from the best race of my life if Feb 2012 to a fairly simple single knee surgery (medical meniscus trim) in April 2012, to hobbling around with double kneecap pain by June 2012. Like some sort of sudden cartilage implosion. How it happened so fast is beyond me. Almost like an auto-immune response?

    3. runnerD, I have "post-operative changes." AKA a bad surgical result. For a lot of reasons, that's mostly all I have to say about it these days. Was a super-fit going into an elective procedure and super-screwed afterward. Don't think I'll ever be super-fit again in my old ways: race the old guy's criterium as warm up for the pro 1/2 affair, but am so much better off than a few years ago when I was being told it was as good as it gets- Me on the examination table, only able to lift my severely atrophied leg/knee 10ish degrees because of bone pain and patella lock. Which I can do today- Lift, extend and lock out the knee, easily. And I have normal, although not athletic muscle mass.

      Don't sell yourself short and keep looking for answers. A change in diet? Turn over all the stones, even something like artificial sweetener can potentially contribute. Are you night-shade sensitive? Leaky-gut? Etc. Did you move to new environs? Try a new activity? OK, so you over baked it, have hope and rest and keep trying out various protocols. Wouldn't it be OK to heal and not know why? I have to get off my duff and post a YouTube video of my rubber-band exercises. Here's one example of thinking "inside the box." I built a "cartilage cage" that provided me with resistance when walking was too painful a few years ago. Kiln dried fir, stainless steel hardware, bands and a climbing harness.

      To answer Tri's and part of your question too- I think that structure is part of the chondromalacia equation and sometimes even the greater part, but I think there are a potentially lots of other reasons why cartilage goes bad. Unfortunately, in my opinion, we live in the dark ages of understanding the role of, say immune function and degeneration. Also unfortunately, only time will tell if that is the case and who here has time to wait for answers while their cartilage is winding down? That and the $ is placing their bet on titanium and carbon bits and pieces. 800K TKR this year? Do the math.


  6. Be interested to hear any thoughts on this:

  7. I followed the rabbit hole from Richard's book to this paper which doesn't paint a great picture for chondral shaving...

    1. Hmm. You're right, that does put chondral shaving in a rather unfavorable light. This line jumped out at me: "There was no evidence of repair tissue in the defects at either four or twelve weeks after chondral shaving, regardless of the postoperative treatment."