Friday Q&A: Strengthening the Legs

Q: “I am having knee problems and can’t bend my knees very deeply. But my legs are very week overall, especially my inner legs and I want to strengthen them. What poses do you recommend for strengthening my quads, my hamstrings, and my inner legs?"

A: The timing of this question could not be better, as I have been preparing this week to teach my almost annual workshop Yoga for Healthy Knees  at Mountain Yoga in Oakland, CA. So, I have already been thinking a lot about the health of our knees, one of the essential joints that allow us to walk upright. And so many of my students struggle with the same issue of limitation in bending (flexion) the knee joint. The underlying causes are varied, from wear and tear arthritis to a variety of injuries, especially meniscal tears and anterior cruciate ligament injuries, to other less common reasons. 

However, regardless of why your knees might not be able to bend easily, the good news is that you can certainly do many poses that can help address the leg weakness that our reader would like to improve. Some of these poses can be performed reclining, others on hands and knees (I am going to assume that most readers can bend the knees safely to 90 degrees of flexion and can tolerate kneeling if using a blanket for padding), and still others standing. Today I am going to limit myself to more common poses that Nina and I are including in our list of YFHA recommended poses (something we are organizing for our upcoming immersion in August). 

To start, as a way to start thinking about how yoga builds strength, you might want to take a moment and review my overview of strength Yoga for Strength: An Overview

Next, I’ll give you a few general guidelines. Generally, I suggest coming into and out of all of these poses with your breath for 6-8 rounds of dynamic movement, and then coming into the fullest version you can safely perform and holding the posture for a while, gradually working your way up to 90 seconds or so before releasing. In this way you will get both the dynamic effects of what are technically known as concentric and eccentric muscle contraction and the static effect of isometric muscle contraction, all of which will contribute to better overall strength of your targeted muscles. 

Now let's look at a few poses that you can do lying down, on all fours, or standing that can build strength in the front hip muscles, home to not only the quadriceps, but also the equally important psoas, the back hip muscles, the hamstrings, and the inner thigh muscles, the adductors.

Reclining Poses

Reclining Leg Lifts (Urdhva Prasarita Padasana). This pose builds strengths in the quads and psoas. You can do these leg lifts one leg at time or with both legs simultaneously. If you want to add in adductor strengthening, use a block between your thighs for the two-legged version. If you have a week or painful lower back, use caution with two-legged version if you have a weak or painful lower back.

Locust (Salabhasana). This pose builds strength in hamstrings and back hip muscles. You can do Locust one leg up at time or with both legs simultaneously (see Featured Pose: Locust for basic instructions). For additional adductor strengthening in the two-legged version, you can squeeze a block between your thighs. This pose is generally safe for all, especially the one-legged version.

Bridge Pose (Setu Bandha). This pose another good hamstring and back hip muscles strengthener, and if you squeeze in a block between your thighs, you can add more adductor strengthening. If you have neck issues, be cautious about how high you lift into the backbend.

Poses on All Fours

Hunting Dog Pose. This pose strengthens the hamstrings and back hip muscles along with a whole bunch of other muscles as well. See Featured Pose: Hunting Dog basic instructions. I don’t usually do this pose dynamically, so let’s stick to having you hold it statically for at least 6 breaths on each side.

Downward-Facing Dog (Adho Mukha Svanasana). This pose strengthens the quads, psoas, and adductors—pretty much any version you do can help to strengthen the quads. If you start from Hands and Knees position, you can do a nice dynamic version, inhaling into a bit of the Cow position (see LINK), and then exhaling up into Downward Dog. Move back and forth from Hands and Knees pose to full Downward-Facing Dog a few times with your breath, before coming into the static version. In the static version, actively contract your quads (front thigh muscles) while you hold the pose. To work the adductors, once again, squeeze a block between your inner thighs. See Featured Pose: Downward-Facing Dog for basic instructions on the pose.

Standing Poses

Generally, practicing the following basic standing poses while engaging the muscles of your upper legs will building strength in the desired muscle groups:

• Mountain (Tadasana)
• Standing Forward Bend (Uttanasana)
• Powerful pose (Utkatasana)
• Warrior 1, 2, & 3 (Virabradrasana)
• Extended Side Angle pose (Utthita Parsvakonasana)
• Pyramid pose (Parsvottanasana)
• Wide-Legged Forward Bend (Prasarita Padottanasana)

Today, I will focus on just a few recommended standing poses.

Powerful Pose (Utkatasana). This pose strengthens the quads, psoas, and adductors. You can do this pose with or without a block between your thighs, but, as you are beginning to see, squeezing a block between your thighs in the poses helps to address the adductor muscles directly. And you do not need to bend the knees much to get some good results. You can also do this pose with your buttocks on a wall. See Featured Pose: Powerful Pose for basic instructions.

Warrior 3 (Virabhadrasana 3). This pose strengthens the hamstrings and back hip muscles. Your lifted back leg is where you will getting the most hamstring action, but you also will get a some quad strengthening in your supporting leg. If your balance is poor, consider doing a wall version with your hands on a wall in front of you. See Featured Pose: Warrior 3 and Featured Pose: Warrior 3 (Wall Version)for basic instructions.

As you can see, there area lot of different poses to play with, so start by picking a handful that you can begin your journey with, and as you get better at those, add another one or two into your home practice. Try to practice every other day, allowing either a rest day in between or doing a more restorative practice on your strengthening “off” days. Don’t be surprised to find that the strength in your legs starts to improve rather quickly, despite your limited knee flexion ability!

—Baxter

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Do You Really Need Knee Replacement Surgery? Maybe Yoga Can Help Instead

by Nina

Nude Woman on Her Knees by Michelangelo

“If you do not have bone-on-bone arthritis, in which all of the cushioning cartilage in the knee is gone, think about consulting a physical therapist about exercise programs that could strengthen the joint, reducing pain and disability, Riddle says.” —New York Times

I’m sure that by now we all know someone who has had a knee replacement due to arthritis of the knees (see Arthritis and the Knee and Yoga for background information). And while some this procedure is a clearly life changing for people who advanced knee arthritis, there is growing evidence that people may be electing to have the procedure prematurely gaining limited benefits from it. So many people considering the procedure might be better off finding other ways to improve their knees, such as strengthening the muscles around their knee joints and moving their knee joints regularly through their complete range of motion.

A recent article in the New York Times Think Twice Before Choosing Knee Replacement discussed two major studies published this year, in which researchers at Virginia Commonwealth University in Richmond conducted a surgical-validity assessment. In the studies Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. and Using surgical appropriateness criteria to examine outcomes of total knee arthroplasty in a United States sample., the researchers concluded that knee replacements should be judged appropriate for only those whose arthritis in the knee was “medically proven to be advanced.” (“Medically advanced” in this context means not just having severe pain but also being impaired in your physical functioning as well, such as, being unable to climb stairs, get out of a chair, or walk without aid.) The reason for this was that only those with advanced arthritis actually saw significant benefits from the surgery:

“The same researchers also found that people who were good candidates for surgery — basically, they had really bad knees — benefited substantially from the surgery, reporting much less knee pain and much better physical functioning in the months immediately following the procedure and again two years later. On one commonly used measure of knee function, their scores improved by about 20 points on average. By contrast, subjects whose surgeries the scientists deemed inappropriate did not improve much. After a year, their scores on knee function had risen by only about two points.” —New York Times

For people whose arthritis of the knees is not advanced, the New York Times recommended questioning the need for surgery and consulting your doctor to learn how advanced your arthritis really is. And if you make a decision to postpone the surgery and try exercise instead, yoga has a lot to offer you. Start by reading Baxter’s article on knee arthritis Arthritis of the Knee and Yoga for background information on the condition and to see which poses and practices he recommends in general.

Although this NY Times mentioned only strength building as a way of helping to manage arthritis of the knee, Shari says in her post Yoga for Osteoarthritis that moving joints through their range of motion is also essential for keeping them healthy. And this is where yoga can be especially beneficial, because the wide variety of poses allows you to move your knees through their full range of motion.

“People stop moving with arthritis because it hurts, but when you stop the joint motion you decrease the nutrition to the joint structures. The body tries to repair the area by laying down more bone to protect the area and the result is spurring, which then cause more irritation from the “bones rubbing.”

When the cartilage has deteriorated and there is no movement, the synovial fluid that bathes the inside of all synovial joints decreases, which then decreases nutrition to the joint and the cycle reinforces itself with pain=no movement=more pain with swelling and inflammation=even less movement. 

Yoga is so perfect for arthritis because it can stop that cycle by providing infinite variations in joint mobility and ways to maintain the joint alignment to improve joint weight bearing. You need to keep the joint moving in its full range of motion to keep the joint healthy, and yoga allows you to do that.” —Shari Ser

You should also consider your particular anatomical structure when thinking about managing your arthritis of the knee joints. Do you have bowlegs or knock-knees? Or do you typically hyperextend your knee joints? (If you don’t know, ask your yoga teacher or health professional to help you assess your knees for these conditions.) Because these three conditions are quite common, we’ve written specific posts on them. See:

1. Hyperextension of the Knees and Yoga by Nina
2. Bowlegs, Doctor Who, and Yoga by Nina 
3. Knock-Knees, Lady Gaga, and Yoga by Baxter 

Here's to happier, healthier knees through yoga!

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