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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Friday Q&A: Balance Poses for Larger Practitioners and Those with Knee Problems

From the Yoga for the Larger Woman Calendar

Q: I would like to know what are the implications of the balance poses for people who are overweight or are beginning to develop knee-related problems. What precautions would you advise while doing such poses?

A: This is a great question! Let me start by addressing the issue of larger practitioners learning balance poses. For larger yogis, the same basic principle for balance poses applies as it does for average-weight practitioners: by practicing balance poses regularly, especially trying out slightly different and more challenging balancing poses, you are more likely to maintain or improve your overall balance, and by extension, reduce you chances falling. According to some recent studies, reducing your chances of falling turns out to be more important in lowering the incidence of negatively life-altering fractures (like hip fractures) than treating osteoporosis with medications. Regardless of size, everyone benefits from working on balance poses, so in general I don’t advise any special precautions for larger practitioners who don’t have knee problems.

If the larger practitioner or anyone new to balance poses feels vulnerable or unstable, position yourself near a wall, either facing the wall or with your back to the wall so that you can easily bring your hands to the wall if you feel like you are losing your balance. This can reduce the anxiety or fear of falling and allow you to start to practice balance poses more safely. 

For people who are beginning to develop knee-related problems, which are more frequent in larger people, some common sense guidelines can be helpful.

(“Knee-related problems is a pretty general term, and in my mind could include painful conditions, as well as biomechanical changes to function, and it is beyond the scope of this post to illuminate the long list of possibilities. However, arthritis is the most common cause of knee-related dysfunction and pain, and our post Arthritis of the Knee and Yoga) can give you an idea of how to use yoga to affect improvement, although not directly related to balance.)

Here are my guidelines for keeping people with knee problems safe in balance poses:

1. Notice if knee pain or instability are related to the knee joint being fully straight or partially bent. If the knee problems only occur when there is a slight bend to the knee, for example, work on balancing poses that involve straight knees first until you find out from your doctor what the underlying cause of the knee issues are.

2. If muscular weakness around your knees seems to be contributing to your knee problems, work on yoga poses that help to strengthen the various groups of muscles that keep the knee joint stable. To strengthen the inner thigh muscles, practice Mountain pose with a block between your mid-thighs, squeezing the block to activate and strengthen the adductors groups. To strengthen your hamstrings, practice poses where you lift one leg up behind you, such as Locust pose, Hunting Dog pose, and Downward-Facing Dog with one leg lifted. For your front thigh area and the quads and their helpers, reclining supine (on your back) straight leg lifts are a simple, stable way to improve the strength of the knee extending muscles. For your outer thigh muscles, side-lying straight leg lifts are great to firm up the gluteus muscles and the tensor fascia latae muscles.

3. Most importantly, if it hurts, don’t do it! There are plenty of traditional yoga balancing poses to play with, and by the end of 2015, I hope there are at least 52 new ones (see Balance Pose of the Week). So find a few you can play with safely as a starting place for your balance work. 

—Baxter

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Knock-Knees, Lady Gaga, and Yoga

by Baxter

Lady Gaga Bares Her Knock-Knees*

Don’t know if Nina mentioned it yesterday, but this interest in knees all started with the following question we got last week:

I have a student who has knock knees (genus valgus), a condition that I gather is quite common in women. She reports that aligning her knee with her second toe in standing poses gives her knee pain. Do you or Baxter have a suggestion for her, as well as for an appropriate cue in classes that might include people with this condition?

Also, many men have bow legs (genus varus); I have not yet heard complaints about problems aligning their second toe with their knee but suspect that some compensation might be necessary. If so, do you have a suggestion for them?

Whether you are a yoga teacher or a yoga student, if you don’t have knock-knees or bowlegs yourself, you have probably noticed someone in your public class (or a celebrity like Lady Gaga) who has one of these fairly common variations in leg bone relationships. And it turns out that more women are “knock-kneed” than men, and more men are “bowlegged” than women. However, I have seen cases of the reverse for both. 

Without going into to too much detail (but at least a little!), depending on the shape of the upper part of your thighbone, the femur bone, where the short neck of the femur (the part often broken in a “hip fracture,” especially in those with osteoporosis) meets the longer shaft of the lower part of the femur, a person might veer away from the normal angle enough to lead to one of our two conditions. When the femurs move further away from the midline of the space between your legs, referred to as “abduction” in anatomical circles, you end up with bowlegs. When the femurs move closer to the midline space between the legs, referred to as “adduction,” you end up with knock-knees.

In the case of knock-knees, when the femur meets the two lower leg bones, the tibia and the fibula, the inner knee joint tends to open up towards the inside of the knee joint and the outer or lateral joint tends to compress together more than normal. Tight inner thigh muscles and weaker outer hip and leg muscles can contribute to this situation. And with the knees knocking towards one another, you can get more wear and tear on the lateral joint, and the skin of the inner knees can even sometimes rub together in an uncomfortable way on the opposite side of the joint. Julie Gudmestad put it this way in an Taking Care of the Knee for Yoga Journal on keeping the knees healthy: 

“…knock-knees … put increased pressure on the lateral compartment cartilage and strain the soft tissue of the medial, or inner, knee. This problem is more common in our society, and is associated, as you might expect, with arthritis in the lateral compartment.” 

The strain of the soft tissue of the inner knee she refers to could mean an over-stretching of ligament on that side of the joint whose job it is to keep the bones in a healthy close relationship. And the increase in the chance of arthritis is why we care about these variations in anatomy!

In knock-knees, in addition to causing the inner bowing the legs of knock knees, the femur bone tends to roll or rotate inwardly, so that when you are standing in Mountain pose the knee caps end up pointing a bit toward one another instead of pointing straight ahead (or in line with second toe, as some yoga teachers recommend). Many yoga students are told to bring the inner edges of their feet very close together at the same time they are told to align the kneecaps with their second toes. In those with knock-knees, this can exacerbate the alignment even more. So, one of the first things I suggest for these practitioners is to separate the feet about hips-distance apart, sometimes with the aid of a block between the mid-thighs. I suggest they hold the block lightly between their thighs (as they may already have tight adductor muscles and we don’t want to encourage more tightness) and imagine that the block is pushing out against the inner thighs. I’d check in at this point and see if the student’s knee pain has disappeared. If it has, I’d recommend they adopt this new stance for future practice.

For Mountain pose (Tadasana) and variations, Standing Forward Bend (Uttanasana) and Downward-Facing Dog pose, Donald Moyer suggests keeping the feet a bit closer together and using a block between the knees. This closer foot position will let the block push the knees apart in the bowlegged direction.

Another option is to forgo the block, but keep your legs hips-distance apart, and place a looped strap around both legs, either mid-thigh or mid-calf, and press outward against the strap, feeling the strap resist that pressure. You are essentially taking the knees a bit towards the bowlegged direction, encouraging a bit of muscular strength in the outer leg muscles and a bit of stretch to the adductors of the inner thigh. You could apply this to other poses with two straight legs such as Standing Forward Bend and Seated Forward Bend (Paschimottanasana).

In his book Structural Yoga Therapy, Muktananda Stiles notes that those with genus valgus (knock-knees) usually have tight adductors (inner thigh muscles), and parts of gluteus medius often are weak. The external rotators of the hip can also be weak and allow for both the knocking and the internal rotation of the thighbone I mentioned above. Muktananda Stiles also relates his personal experience with long standing knock-knees and a pivotal practice session in which he worked with Warrior 2 pose, holding it with close attention to keeping his desired knee alignment, and consciously softening and lengthening the inner thigh muscles and strengthening the outer thigh muscles of his front leg to exhaustion. He claims that as he continued to work with this over time, his knock-knees resolved! 

In her article, Julie Gudmestad suggests using the Reclined Leg Stretch pose version with the leg out to the side to lengthen the inner thigh muscles. This works in the standing version of this pose as well.

To strengthen outer gluteal muscles and the external hip rotators, she suggests Warrior 2 with close attention to the knee position and the alignment of the front thighbone with the long edge of your sticky mat.

Other poses to stretch the adductors include:

• Triangle pose (Trikonasana), front leg
• Extended Side Angle pose (Parsvakonasana), front leg
• Widespread Standing Forward Bend (Prasarita Padottanasana), both legs, possibly using your elbows to press your inner knees 
• Wide-Angle Seated Forward Bend (Upavista Konasana)
• Cobblers Pose (Baddha Konasana)

Other poses that could assist in strengthening the outer gluteal muscles and the hip external rotators include:

• Half Moon pose (Ardha Chandrasana), both legs (plus, if you get the correct external rotation of the bottom thigh, you will also get some good adductor stretch)
• Tree pose (Vrksasana), top leg
• Pyramid pose (Parsvottanasana), front leg action at hip
• Warrior 1 (Virabhadrasana I), front leg action at hip

I hope these suggestions—while in no way exhaustive—can give you a few ideas on working with knock knees to not only eliminate pain that you or your students have now, but also hopefully reduce the chances of early development of osteoarthritis down the road!

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