Knee pain? Here’s something to think about.

To begin, a brief medical history. And I’ll try to make this as non-tedious as possible. A few years back, I began having some really annoying pain. . .in my knee. This is a dreaded Ashtanga Vinyasa Yoga phenomenon. I’d discovered that under the right (or wrong, depending on how you look at it) conditions, my knees would sublux, and until I put them right again, the pain would stay.

It would be particularly hard to get them back into place after: a strong janushirshasana C adjustment, after a particularly strong bhekasana adjustment, or after a particularly strong kapotasana adjustment. (Noticing a pattern here? Like an idiot, l didn’t.)

Then, after some fierce kapotasana one day, my tibia went one way, my femur another, and I felt the knee pop. I finished practice, and as I limped out of the practice room with Steve, I said to him, “I just blew out my knee.”

Verdict: Torn medial meniscus.

Over the couple of years that I’d been having the knee pain, I consulted a lot of my fellow practitioners. I discovered Ashtanga practitioners are particularly wary of surgery. I knew people who had practiced two, three, four years and more, living with a known tear, refusing the surgery.

Me, I was not so shy. I had a labrum tear in my left shoulder repaired, and that surgery had allowed me to do backbends for the first time in my life. I was not afraid. “Do it,” I said to my surgeon at USC, “How soon can you fit me in?”

Now, a new Finnish study is suggesting that a placebo version of this commonly performed surgery is as effective as the real repair. From the New York Times:

“Those who do research have been gradually showing that this popular operation is not of very much value,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University. This study “provides information beautifully about whether the surgery that the orthopedist thinks he or she is doing is accomplishing anything. I think often the answer is no.”

Does this mean I regret my surgery? The answer here is also no. For this reason:

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

I realized from my shoulder surgery experience that MRI’s are remarkably uninformative. I had two MRI’s on my shoulder. The second showed no labrum tear. The surgeon disagreed, and I went ahead and had the repair. Once he was in there, what had shown as a tear on the first MRI was scar tissue. The real tear was in a totally different spot. It was very confusing. But I knew, after four years of pain, there was a tear in the joint–I could feel it. In the end, it’s up to the patient to understand what’s going on in the joint, how it tore, and what the chances are of it healing correctly. Even what you hope to achieve by having or not having it fixed.

When it came to my knee, I argued with my surgeon, actually, about doing the surgery sooner rather than later. “You should try physical therapy first,” he said, “That may get the pain to a manageable level.” “If what I already do hasn’t helped,” I said, “it’s very unlikely that PT could.” It’s been my experience that doctors don’t have a firm grasp of what we do in Ashtanga.

Turns out my meniscus was so shredded, it had to be partially removed. “You were right,” the he said in my post-surgery appointment, “That never would’ve healed on its own.”

But my sister had the same surgery when she was about my age. She was totally inactive, unlikely to become active, and had never really done anything to create the tear. Should she have had the surgery? Probably not.

After my surgery, I went to my friend and Rolfer Russ Pfeiffer for recovery help. He told me then that evidence was mounting that people do just as well without meniscus repair as with it, and that placebo surgery was just as effective, “But something tells me a placebo probably wouldn’t have worked for you.” I think, like all things, it depends on how seriously you take those words emblazoned over the door of the Oracle of Apollo in ancient Delphi: “Know thyself.”

Posted by Bobbie

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How Ashtanga Can Wreck Your Ego

George Salazar of the cast of "Godspell." Why, I don't know. Via The New York Times.

The New York Times Magazine has an article today titled in typically provocative style, “How Yoga Can Wreck Your Body.” It’s really long, extremely anecdotal (recounting individual cases dating back to the early 1970s), and, as usual, heavily based in the writer’s individual experience. (And in one of those bizarre editorial moves that indicate desperation for zaz on the webpage, seems to be illustrated by the zany antics of the cast of Godspell.)

Anybody who reads this blog has no doubt been injured practicing. I’ll let you judge the essay’s purpose yourself, but it comes down to this:

A growing body of medical evidence supports [yoga teacher Glenn] Black’s contention that, for many people, a number of commonly taught yoga poses are inherently risky.

No kidding? I did not know that.

When I injured my knee last year, a colleague at work asked me how I did it. “I was doing a crazy yoga pose (kapotasana, actually, but “crazy” for short). “I’ve had the same surgery,” he said, “I was chasing my daughter’s pet rabbit in the back yard.”

When I explained what I do to my friend and physical therapist,  Tom Hendrickx, he said, “You don’t do yoga. You’re an amateur athlete.”

We don’t blink when someone says “I broke my leg skiing” or “I strained a hammie kicking a soccer ball around.” Why is it the media seem so shocked when a yogi pushes her body past its limits and, surprise, suffers an injury? When I asked Tom if he thought I should quit Ashtanga, he said, “I think you should do what you love. Just don’t be stupid.”

Exactly. All of William Broad’s stories in the article are studies in stupidity. My own is no exception. It wasn’t kapotasana that tore my meniscus. It was my ego. Broad seems to blame a “naïve” belief  “that yoga was a source only of healing and never harm.” Yoga, like all powerfully transformative philosophies, has an inherent paradox that each practitioner/student must work out: It’s self-interest that gets you to it, but the first lesson is the emptiness of self-interest. The instant your attention flags, your ego appears, and injury is inevitable. Simple as that. And as complicated as that.

Posted by Bobbie