Is this why my knee is hurting?

My right knee is hurting, again.

As I noted yesterday, there was a little “pop” during a Marichyasana D adjustment, and nothing seemed immediately amiss. But the day after, it’s awfully tender — a very familiar feeling.

And that’s the thing: familiarity. The pain — it may just be discomfort, really — is very specific. It hurts precisely when I bend my leg into half lotus or just in that direction. It has for the past year. Same thing. It gets a bit better and then it gets a bit worse.

Full flexion straight on or in something like Virasana doesn’t hurt. It’s just when I bring my foot and lower leg inside of my thing/femur.

Finally, during lunch today, I thought maybe I ought to see why this is. (Pretty smart, huh?) And I bet you know where that took me:

YogAnatomy.com. And there I found this:

There are two movements that when combined would put the most amount of pressure on the medial meniscus. The two movements are flexion of the knee and internal (medial) rotation of the tibia. In lotus both the femur and the tibia have to rotate externally. If the tibia doesn’t have enough outward rotation, there still could be enough in the hip to make up for it, or vice versa. If however both the tibia and the femur lack in their ability to do external rotation then what you have is more internal rotation, which by itself can put pressure onto the medial meniscus. When you combine this with the knee being flexed, as it is in lotus you end up with even more pressure on the medial meniscus.

I don’t even have to do the test. I know that’s the issue. I’ve seen how, in lotus, my right knee gets no where near the floor.

The question, now, is whether I’m satisfied that all that’s happening is my medial meniscus is getting compressed. Or is it something more (aka a tear)? My guess — and seemingly everyone else’s, from yoga teachers to doctors — is that’s all it is. It doesn’t hurt all the time and, again, it is a very specific movement to pain dynamic.

This particular “stiffness” is proving very hard to undo, though.

And that’s today’s lesson from this infuriating practice.

Posted by Steve

Advertisements

Guru says: ‘Avoidance is not the answer.’ I say: ‘But I’m awful good at it’

A familiar statement from Tim Miller during workshops or teacher trainings is: “Avoidance is not the answer.”

It seems as though this often is spoken in connection with Urdva Dhanarasana. Go figure.

Well, for me, for weeks, if not months now, it has pointedly pointed toward my knees. My right knee, in particular.

You’ve read about Bobbie’s knee surgery. She, literally, has a note from her doctor excusing her from Ashtanga if she wants. She just doesn’t want.

Photo via ashtangaworkshop.com

And then there’s me. A general diagnosis of tendonitis in the right knee, going way back, that I seem to continually re-aggravate. Only the last time, when I really felt what seems to me a near tear, I’ve been extremely careful not to push it again.

That near tear? Not long after my teacher training with Tim in Maya Tulum. And that means we’re probably talking about February.

For several to easily four months, I think backing off was the right thing to do. Even in early August, up at Mt. Shasta, it still was giving me all kinds of problems. The reason seems pretty obvious: I was “recruiting” flexibility in my knee in lotus poses and other extreme knee flexions. (Which is very annoying to me because I actually could do lotus when I started yoga even seven-plus years ago, very casually. Get my heels down in Down Dog? No. Lotus? Yes. It was a little win.)

Tim prescribed as much stretching of my quads as possible — something I’ve incorporated into my Mysore practice, so far without anyone calling me on it.

And that’s helped. My quads and everything around the knees are much more flexibility. But the last time I tried to “push” it into Marichyasana B, I felt that pull still. And so more backing off was coming.

Now, the only baby step I take towards serious bending of my legs is gently getting myself into a loose lotus of sorts for Uth Pluthi.

I’m avoiding, in other words. And I know it.

But I simply can’t make the mental leap to try Janu B (which always was sketchy) or Marichy B, let alone a modified version of D. Or Garba Pindasana. (It was Yoga Mudra where this particular run of hurting knees starting, strangely enough.)

Of course, this Sunday is a perfect day for me to try to push things. On Tuesday, I have my annual check-up with my doctor, so if something is going to happen, this would be the perfect time.

But there’s that… what’s that word? It makes you hesitate, feel uncertain about what you’re doing, makes you not want to do it…

Oh, right: fear. I can’t get past the mental hurdle even though my knee has felt better and better as I’ve done little, teeny tiny steps toward a deeper bend of the knee. But there’s that point — I can see it in my mind’s eye even now — beyond which I don’t want to go.

Beyond which I’m avoiding going.

And every time, I hear Tim’s voice.

Posted by Steve

More on injuries, from someone not too injured

I’d like to add a tad more to Bobbie’s post on injuries below. She’s — unfortunately, fortunately, however you might look at it — much more familiar with practicing while injured than I am.

That said, thanks to my tight quads, I’ve built up a pretty respectable case of tendinitis in my right knee, which is rendering any significant flexion of that knee pretty painful. Out are lotuses and even Janushirasana B.

I’m working on it. And Tim Miller gave me some things to do to try to loosen up those stubborn quads.

David Swenson has this to say in response to someone asking about practicing with a bulging disc and related back problems:

I think that Ashtanga is so special because it is whatever we want it to be. We can make it difficult and dynamic or soft and easy. We can make it into an external display of prowess and physical strength or an internal journey of self-awareness. There are also myriad possibilities between those diverse perspectives. When Pattabhi Jois says “Yoga is not easy” I think this is what he is speaking of. I really do not think he is referring to getting into postures but rather to the internal struggles that manifest within us. These challenging mental and emotional battles many times are triggered from our physical challenges. When we are confronted with bodily pain it is not only that we feel the sensation and discomfort in our body but it is the resultant inability to do what we once could where the deeper pain and frustration resides.

That pretty well sums up my experience with the practice, which — physically at least — comes from a place where finding the full expression of the poses is never easy. And it provides some food for thought when reaching the edge, beyond which lies injury and dis-integrating pain.

Posted by Steve

Of injury, obstacles, and slow wisdom

Ganesha, not only the Remover of Obstacles...

My Ashtanga practice began with two solid years of pain. A degenerative joint condition began unusually early in life (my mid-20s). An enlightened orthopedic surgeon told me I was a good candidate for spinal fusion, but that it probably wouldn’t help and might make it worse. You won’t be able to stop the degeneration he said, but surgery won’t, either. First, he said, try to “totally change your life.” Sounds like a job for Ashtanga, you’re thinking.

When I stumbled into my first Ashtanga class, I was pretty desperate. I had blown a disk. I had bursitis in both hips, along with bone spurs there and in my cervical vertebrae. The first suranamaskara was…very unpleasant. But I felt at home at once, even though I was lost in all the complexity and daunted by the effort in the room–effort combined with grace. I realized that night I’d been worshipping my pain. I was seeing what I couldn’t do, instead of what I could. Ashtanga would make me strong enough to face the pain.

Ten years later. I’ve met many Ashtangis with stories way more dramatic than mine. I learned that the challenge of Ashtanga is in its constant insistence that you remain aware at all times of the line between what Tim Miller calls “integrative pain and dis-integrative pain.” With both too little effort and too much, the attention to detail lags.

I’m currently recovering from knee surgery. The meniscus in my knee had degenerated to such a degree that part of it had to be removed. My practice is slow, deliberate, cautious. I found these inspirational words from Richard Freeman on the question, “Can I practice with an injury?”:

You can still practice, but you might have to modify your definition of what Ashtanga yoga is. Depending on the injury you might have to skip or modify particular postures or sets of postures, but still you can cultivate gazing, bandhas, perhaps pranayama, and intelligent dialectical movement in whatever postures you are able to do. If you are lying in a full body cast, you can still practice mindfulness and discriminating awareness which are the essential underpinnings of Ashtanga yoga.

Ten years later, after torn hamstrings, multiple tendonitis bouts just about everywhere, shoulder and knee surgery, I realize “discriminating awareness” is the very essence of the practice of Ashtanga. Now, when I roll out the mat, I work harder on that than I ever did on any pose, forced into humility by the obstacle (Jai, Ganesha, Lord of Obstacles) of injury. I’ve come to realize that is my practice, and that they don’t call it “practice” for nothing!

Posted by Bobbie

The wireless Ashtangi — Nancy Gilgoff

Nancy Gilgoff teaching, from her Picasa site.

Unlike the other quartet of teacher/students at the Confluence, Nancy Gilgoff doesn’t seem to have a regular blog or anything of the like.

A wireless yogini, indeed, in this day of constant Facebook updates, Twitter feeds and, yes, blogs like this.

I’ll admit I know less about her than I do the other four — perhaps as a result of her not being quite so present online. Yes, her site exists, but the “about” page is pretty short. Perhaps on purpose?

That leads, then, to other searches. I know, from a one-day session with David Williams, that he introduced her to Guruji and that she had a serious of ailments. But I was shocked to find out what they were.

This old Yoga Journal piece lays it out in pretty stark detail. (Note to Yoga Journal: It might be good to date these articles; I have zero idea when it is from.)

Here are some key moments:

The earliest of Gilgoff’s injuries began when she was a child. She loved horseback riding, but it put such a constant pounding on her lower spine that she was left with chronic back problems. “By the time I was a teenager,” she says, “it had manifested in my neck, where a vertebra was jammed forward.” Along with this, childhood dental work had been performed with her mouth left open so uncomfortably, she would literally scream in pain, a torture she believes compounded the neck injury. Later, as a junior in college, she began getting severe migraines she believes were triggered by the then-new birth control pills. This experience left her with jaw pain so intense, she couldn’t open her mouth for days at a time.

[snip]

Her pain was so acute, doctors suggested surgery to deaden places in her brain, in effect to numb the pain. But Gilgoff had other ideas. She had watched a close friend go through hospital treatments for cancer, and the idea of surgery appalled her. “I knew I didn’t want to end up in that situation,” she says, “so I started looking around, taking the first steps to another way of being.”

When Gilgoff left college at age 24, she’d already become a vegetarian, and it wasn’t long after she took up yoga under Williams’ tutelage that the couple traveled to India, where they ended up at Jois’s Ashtanga Yoga Institute in Mysore. The challenge of Ashtanga would change her life.

I’ll be very intrigued to see how that beginning manifests itself in her teaching and what she has to say about the practice; and it makes me a bit disappointed that I didn’t sign up for her Led class.

Her story also reminds me of something else, something that seems strangely common to Ashtangis: A lot of them have had some injury at some point, whether before finding the practice or some time during it. Shoulder and knee injuries are common; I’ve heard stories about recovering from car accidents; there are those who were athletes who got hurt and then found Ashtanga.

Is it, I wonder, because at its heart it really is a healing practice — or is there something about it that attracts folks whose dharma passes through injury?