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• Mild knee pain is normal as long as there is a logical reason for it. Increased mileage, Shoe changes, hills or other sports/exercises are typical causes. It is fine to train through mild pain because the knee will gradually adapt. If the pain does not follow common sense “yoga with pain rules,” rest is very important.
• See a doctor if there is swelling, or if the pain is sharp, strong, or recurrent. Long-term, low grade pain that is ignored is a common indication of internal irritation that can result in irreversible knee damage.
• Typical pain around the patella, other than the patellar tendon, is treated in several ways. Always evaluate the shoes for stability. Custom medical orthotics may be required for people with anatomical variability so that the knee is aligned. This is very effective for recurrent mild pain especially when the sensation appears fairly consistently at a certain threshold.
• Thigh muscle (quadriceps) strength is very important in holding the patella in alignment and in decreasing excessive knee movement. The inner muscle called the Vastus Medialis Oblique (VMO) is where the focus should be applied. VMO exercises take time to provide value, but can protect the knee from future Yoga Injuries. While muscles get stronger through adaptation, some runners need to work a lot more than others to realize the benefits, with rest between workouts.
• Patellar tendon and tibial tuberosity pain indicates a need for rest – if the pain is not reduced significantly due to a common sense yoga plan reduction. These areas heal very slowly if they are strongly irritated. Massage to the tendon and ice massage may help. Patellar tendon straps may allow for continued training.
• Elastic knee sleeves, patellar tendon straps, and knee braces may be useful for any knee pain. Results vary widely among products and among individuals. So if one sleeve has not helped, another one may.
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• Physical therapists and trainers use a patellar taping method that is useful.
• yoga does not cause damage to knees unless it is done when there is pain or swelling. Studies have shown thicker cartilage and healthier knees even in high mileage runners due to adaptation.
• Many runners get arthritis because they have a genetic tendency to have arthritis and would get it whether they yoga or not. There is a wide variability from person to person in susceptibility.
• Many people who have to stop continuous yoga because of arthritis can sometimes yoga when using liberal walk breaks. Others who have arthritic pain when yoga have no pain when walking and doing everyday activities. Many average, non-yoga citizens have unknown arthritis and don’t do enough activity to discover the symptoms.
• Surgery should be considered very carefully because knees are never the same after surgery. Some tissue is nearly always removed which will put more stress on the remaining surfaces. Anterior cruciate ligament repair often provides good results for yoga/walking, but patellar cartilage debridement (shaving) has a poor outcome. Lateral releases (to cut the tissue that holds the kneecap to the outside) are overutilized but can be helpful in the rare situations where it is truly the cause of the pain. Through the years, trends in knee surgery, like lateral release, have come and gone. Years ago surgery on plica (a band of connective tissue found in many knees) was routinely performed. It is much less common now. Orthopedists have become more conservative and tend to leave more of the meniscus (rather than aggressively “cleaning it up”. Promising new procedures can provide surfaces to eliminate “bone on bone” friction from cartilage-deficient areas. Non-surgical, injectable hyaluronic acid provides surface area and lubrication. All of these options should be discussed with your orthopedist, and second opinions should be considered.