Meniscus and lotus pose

Knee pain problem is very common especially for marathon runners &  elderly people. Of course, there are also other groups of people which I did not mention here.

Majority of the people complaint about the pain in their knee which is the medial side of the knee. However, there are a minority group expressing the pain is outside of their knee & also about pain running through thte centerline of the knee or around the knee cap. These 3 areas mentioned are due to stress in the knee in different ways.

In yoga, pain inside the knee is the most common problem and is mostly associated to the leg being in a half or full lotus position. This is mainly due to the compression of the medial meniscus. However, it does not mean that the meniscus is torn , it could simply mean that this area has been irritated repeatedly.This knee pain could also be related to  hamstring or adductor  & hence, a good assessment is the key for knee injury.

 In this article, only medial meniscus will be discussed as there are many stories of knee problem in the lotus position. This could be indicated by the swellingin the back of the knee and sometimes regular clicking sound that follows the pop. However, again, good assessment of the injury is needed and the best option is to seek the doctor and if needed a MRI  will be done.

 Before we go deeper into meniscus, below is a brief explanation in anatomy context:

 In anatomy, a meniscus (from Greek μηνίσκος meniskos, “crescent”[1]) is a crescent-shaped fibrocartilaginous structure that, in contrast to articular disks, only partly divides a joint cavity.[2] In humans it is present in the knee, acromioclavicular, sternoclavicular, and temporomandibular joints;[3] in other organisms they may be present in other joints (e.g., between the forearm bones of birds). A small meniscus also occurs in the radio-carpal joint.

 In the knee structure, there are two separate pieces of cartilage that make up the meniscus. Each is an additional piece of cartilage that sits between the femur and tibia and this is where the two bones come together and form the femorotibial joint ( knee joint). The function of this cartilage is to add cushioining to the joint and allow the knee to flex, extend and rotate.

The shape of the meniscus is crescent shaped and sits on top of the tibia which is referred to as tibial plateau. One of the meniscus is on the inside ( medial) while the other is on the outside ( lateral) which makes up the anterior & posterior.The MCL (medial collateral ligament) attaches to the medial meniscus, which is why injuries to these structures may occur at the same time. The MCL runs up the inside of the tibiofemoral joint. On the outside runs the LCL (lateral collateral ligament) which has no attachment to the lateral meniscus. The lateral meniscus does, however, attach to another structure called popliteus. Popliteus is a muscle that covers the back of the knee and helps “unlock” the knee from a fully straightened position. It is also thought to help pull the lateral meniscus out of the way during knee bending, so to avoid pinching and subsequent tearing of the meniscus .The area of the meniscus with the most problem is the posterior portion of the medial meniscus especially in the lotus scenario.

 

Can torn Meniscus heal?

This is a very common question and the answer is dependent on the degree to which the meniscus is torn.If the tears occur on the outer edge of the meniscus, it can heal on their own as there is a small blood supply that feeds the outer edge to help it heal.If the inner part is badly torn, surgery could be required as joints should not have friction and a tear will cause an increase in friction which will then result in swelling, irritation and pain. If unattended, the tear could grow in size and damage the cartilage on the femur that has slide over to the torn area.

 Medial meniscus and lotus pose

There are 2 movements that would put tremendous pressure on the medial meniscus which are the flexion of the knee and the internal( medial) rotation of the tibia.In lotus position both the femur and the tibia have to rotate externally. Hence, if the tibia does not have enough outward rotation, there should be enough in the hip to make it up.In order to avoid any injury while doing the lotus pose, we will need to understand the problem. The degree of mobility for Hip joint is very important in this pose. 

 Meaning:

Lotus Pose (Padmasana) is a supreme position for meditation, and Lotus variations of other asanas can be profound. However, forcing the legs into Lotus is one of the most dangerous things you can do in yoga. Each year, many yogis seriously injure their knees this way. Often the culprit is not the student but an overenthusiastic teacher physically pushing a student into the pose. Below are some variations which we could do in the lotus pose:

 Variations:

    1. Ardha Baddha Padmottanasana (Half-Bound Half-Lotus Forward Bend),
    2.  Baddha Konasana (Bound Angle Pose):As one move from the Dandasana( staff pose) to baddha konasan,the ball-shaped head of the thigh bone must rotate outward In the hip socket about 100 degree
    3. Janu Sirsasana (Head-to-Knee Pose):Bending the knee and  placing the foot in preparation for  Janu Sirsasana requires somewhat less external rotation, but as a student bends forward in the pose, the tilt of the pelvis relative to the femur brings the total rotation to about 115 degrees

Padmasana requires the same amount of external rotation (115 degrees) just sitting upright, and the angle of rotation is somewhat different, making it more challenging .When we combine the Padmasana action with a forward bend, as we do in Ardha Baddha Padmottanasana, the total external rotation required at the hip joint jumps to about 145 degrees.

The above picture show the safe knee placement. Most of the people , the thighbone stops rotating partway into the pose due to tight muscles or ligaments( shown in the below picture). In some cases, it could be due to bone-to -bone limitations deep in the hip.When the femur stops rotating, the only way to get the foot up higher is to bend the knee sideways. Knees are not designed to do this-they are only designed to flex and extend.