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My client Sarah (not her real name) was in her late 40s and had been a distance runner since she was a teen. She also did a lot of cross training-- swimming, yoga, and weight-lifting. After a typical trail run, she noticed her left knee was feeling stiff and swollen. She was traveling for work the following week so she decided to take it easy for several days.
Walking while she was out-of-town felt fine. When Sarah returned home, she jogged for less than 30 minutes-- half her normal distance. Her knee felt fine during her run, but the next morning she woke up with more swelling. And it was painful as she took two flights of stairs up to her office.
Sarah went to her doctor who referred her to an orthopedist. She had X-rays and an MRI--which she was told were both “normal.” At her orthopedist’s recommendation, she went to physical therapy twice a week. A month later, she received a cortisone injection and went back to physical therapy for another month. She saw a chiropractor, an acupuncturist, and a massage therapist. And she underwent laser and heat treatments. Nothing she tried eliminated her left knee pain.
Feeling frustrated, Sarah made an appointment with another orthopedist to get a second opinion. She had a second MRI, and this time it showed some cartilage damage. She was told she wasn’t a candidate for surgery and was given another referral to physical therapy.
Sarah was wary of trying physical therapy a third time. She was unimpressed with the exercises she was given to do while lying on the tables at the clinic. And as soon as she tried to perform the shallow squats that were recommended, her symptoms returned with a vengeance.
Scouring the internet, Sarah began reading blogs, responses to questions posted on knee pain forums, and eventually my colleague’s book. The concepts in The Runner’s Knee Bible made sense to Sarah, but she wanted someone to answer questions that were unique to her situation.
Over the first month that we worked together, Sarah eliminated the stiffness, swelling, and pain in her left knee. And while she had not yet returned to trail running, she was back in the pool swimming laps.
In a previous post, I explained how activating core muscles is important for people with knee pain. So I prescribed core exercises for Sarah.
Sarah asked if she could return to her favorite yoga class instead. (In her mind, yoga would accomplish the same thing as core exercises.) Sarah’s question was a good one, but it didn’t have a straightforward answer.
Sarah and I discussed the pros and cons of returning to yoga-- including the poses that she could perform safely, those that she would need to modify, and the poses she would need to avoid for a while longer.
Sarah recalled that her favorite yoga instructor often had the class rest in Child’s Pose or sit in the Lotus position. These were relaxing for Sarah, but I explained that both of them placed more pressure on her knee than it would currently tolerate. Both of these poses would likely cause pain either during or afterwards. Instead, I suggested she rest in Corpse Pose or sit in Staff Pose.
However when performing Tree Pose, I recommended that she modify it by placing the bottom of her left foot just above her right inner ankle rather than on her right inner thigh. This would protect her left knee because she wouldn’t need to bend it as much.
I also explained that to prevent knee pain, she would need to avoid poses that required her to sustain body weight on her left leg while that knee was bent-- such as during Warrior I, Warrior II, and Eagle Pose.
Sarah was concerned that she would spend too much energy during yoga class evaluating what was okay for her knees. She decided the modifications would disrupt what she valued most about yoga-- what she described as “the absence of thought and being present in the moment.”
Even though some yoga poses would strengthen her core, Sarah held off on resuming her practice. She continued to work with me until her left knee joint was healthier and she could complete a yoga class without causing knee pain.
Watch these two videos to see some of the core exercises that Sarah performed:
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