Asana after ACL surgery?

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Yoga gets a bad rap as being bad for your body, and especially your knees. So when I told my PT that I wanted to return to practicing yoga a mere four weeks after surgery, her eyebrows shot up and her eyes got all googly. (I’m pretty sure this meant she didn’t think it was a good idea.) She admitted quite honestly that she didn’t know much about yoga poses and couldn’t advise me one way or the other.

I don’t have a hard time believing that people can get injured in a yoga class or that yoga poses – done improperly or without consideration of the body’s limitations – could be counter-indicated for a recovering ACL. There are so many benefits of yoga for someone recovering from ACL surgery, though, that I think it’s worth figuring out how to do it safely.

First, let’s think about the benefits. Of the 38 listed in this Yoga Journal article, here are the ones that seem to specifically apply to knees:

1. Flexibility + Strength. Strong muscles can protect ACL patients from conditions like arthritis, which we are more susceptible to developing after injury and surgery. When we build strength through yoga, we are balancing it with flexibility. Flexibility aids with whole body alignment which reduces strain on the knees.

2. Joint love. Each time we practice yoga, we take our joints through their full range of motion. This can help prevent degenerative arthritis or mitigate disability by “squeezing and soaking” our joints with synovial fluid. ACLs are nourished, in part, by the synovial fluid inside our knee joint; it receives fresh nutrients when the knee joint is “massaged” with motion.

3. Brain waves. An important component of yoga is focusing on the present. Studies have shown that regular yoga practice improves coordination and reaction time, meaning there might be a reduced likelihood of re-injury in the future.

4. Calm nerves. Stressed out about your injury? About your limited abilities after surgery? The pace of your recovery? Yoga encourages you to relax and slow your breath, shifting the balance from the sympathetic nervous system (the fight-or-flight response) to the parasympathetic nervous system. The latter is calming and restorative.

5. Space place. Regularly practicing yoga increase proprioception (the ability to feel what your body is doing and where it is in space) and improves balance. People who have torn their ACL usually have poor proprioception and must work hard to regain this.

6. Immune boon. I wrote previously about how we are more susceptible to getting sick after ACL surgery. Asana and pranayama probably improve immune function, but, so far, meditation has the strongest scientific support in this area.

7. Pain drain. According to several studies, asana, meditation, or a combination of the two, reduced pain in people, meaning you may not need as much medication.

If there are so many awesome benefits of yoga for our healing knees, the next question is how to do it safely. A caveat before I continue – I am not a PT, a doctor, or even a trained yoga instructor. What I’m writing here is only what I have learned from others. Do not rely on this advice alone. Work with your team of healers and an experienced alignment-based yoga instructor to verify that yoga appropriate for you before undertaking any practice after injuring your ACL. In addition, every body is different. What works for me may not be right for you. Stay present and check in with yourself as you’re going.

With that out of the way, let’s take a look at how the knee works. I found this great graphic online that helps. Study it.

KneeAnatomy

The major takeaway is that the knee is a hinge joint and naturally has a limited range of motion. Any movement that works against the natural range of motion is bad for the knee and should be avoided.

Improperly performed tree pose is one example. The photos below depict alignment that puts the knee in danger because the knee does not bend in the direction that force is being applied.

BadTree1BadTree3BadTree4

When the pose is done correctly though, it shouldn’t bend the knee in a direction it isn’t intended to go. The first picture shows the “full” pose. The second two are common modifications for those whose hips are not open enough for them to place their foot on the thigh. See the difference?

TreePoseInnerThighTreePoseCalfTreePoseKickstand

The fact that so many teachers don’t warn people that putting your foot directly on your knee is dangerous, tells me how important it is to understand anatomy so you can protect yourself.

Second, it’s important to make sure you understand proper alignment for the various poses that engage the knees. Gaiam has done a great job of summarizing some key points in this area on their blog. It’s well worth studying. Also, if you have access to instructors certified in Iyengar, Purna, or other alignment-based yoga, it is a great idea to take a private lesson to get tips specifically for you.

Finally, there are some yoga poses that obviously engage the knees, which may need to be modified or avoided until you are fully recovered. These can be divided into two categories – the poses that apply direct pressure which may cause pain or discomfort and the poses that can aggravate simply through wide range of motion. Examples of poses in the first category include marjarisasana (table/cat), bitilasana (cow), balasana (child’s), and uttana shishosana  (extended puppy). Examples of poses in the second category include padmasana (lotus) baddha konasana (bound angle) and balasana (child’s). Again, an alignment based yoga instructor should be able to help you with modifications.

Instead of being ruled by fear of the unknown like my physical therapist, I hope you will approach yoga after ACL surgery with knowledge and the assistance of an excellent instructor. I truly believe a healthy yoga practice can help the knee embody fluidity, ease of movement, strength and openness.

Photo: RelaxingMusic

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