Yoga as Therapeutic Exercise: A Practical Guide for Manual Therapists

6

Chapter

The basic exercises

9. Basic exercises for the knees 9. Basic exercises for the knees


10. Basic exercises for the knees 9. Basic exercises for the knees


11. Basic exercises for the knees

The knee is probably the most complicated joint of

the body. Among the synovial joints, those joints

that are enclosed in a capsule, producing a lubricant

fluid, it is the largest joint. Like the hip the knee

also has to cope with weight-bearing from above

and absorption of forces from below. The menisci

increase the surface for these functions, improv-

ing stability. The ligaments and muscles are impor-

tant for stability. The exercises should improve not

only muscle power but also coordination and the

balanced cooperation between the different groups

of muscles. Alignment of the kneecaps and feet, of

the knee joints and ankle joints, is essential for each

exercise: good function is equally as important. For

the best nutrition of the cartilages and menisci the

full range of movement is essential (Roth 2009).

We have already mentioned stability. The primary

movements are flexion and extension: the secondary

movements are small ranges of internal and external

rotation, abduction and adduction. There is a minor

play of translation as well. Knee stability is increased

by a small external rotation of the tibia when stretch-

ing the knee. A slight outwards movement of the tib-

ial tuberosity can be seen and felt, or the lower leg can

be kept stable and the thigh slightly turned inwards.

Both movements lock the fully stretched knee.

There are exercises for improving both stability

and movement. The effects are achieved not only

through the actions themselves, but rather in the

quality of the movements, which should be smooth.

Finetuning, easing away slightly from the limit of

movement, helps to stay within the physiological

range and use the muscles in a balanced, coordi-

nated way. For the fully stretched knee this means

minimal flexion combined with extension. While

bending the knees a minimal stretching action can

be combined, like resisting the action of bending.

These actions are particularly relevant for standing.

In summary it is a balanced activity of the flexor and

extensor muscles.

Knee problems are frequently related to the feet,

ankles, and hips. Therefore posture and movement

patterns need to be considered in a wider sense.

Particular care in alignment is necessary if the mus-

cles are hypertonic to protect instable knee joints.

Furthermore the primary cause of knee problems

may be in the hips, feet, and ankles, and the

whole posture. A change in muscular forces due to

wrong alignment and movement patterns contrib-

utes to degeneration and inflammatory processes

of the structures of the knees. Muscular forces

also change the shape of the bones (Raman 2008).

From all this we understand the importance of exer-

cising and particularly learning or relearning healthy

positioning and movement. Also knee surgery is

now the therapy of choice in serious cases of degen-

eration. As we have mentioned for hip replacement,

these patients seem to recover well if they have

exercised before the operation. It is strongly recom-

mended to continue improving posture and move-

ment patterns both before and after the operation.

Exercise 9.1: Rhythmic knee movement

Aims: mobilizing the knee joints, improving the

movement of fluid.

1. Sit on a table.


2. Rhythmically oscillate the lower legs forwards
   and backwards for 1–3 minutes.


3. Relax the lower legs for a few breaths.


4. Rhythmically circumduct the lower legs for 1–3
   minutes, so that the legs can dangle; change the
   direction in between.


5. Relax the lower legs for a few breaths.

Exercise 9.2: Finetuning the knee

extension

Aims: full extension of knee joint, balance of flexor

and extensor muscles.

1. Sit on the floor with straight legs, with the feet
   in dorsiflexion.


2. Use a back support if you need it, or put your
   hands behind your pelvis on the floor.


3. Hyperextend both knees, and alternate with a
   trace of flexion, 3–5 times.


4. Hold for 3–5 breaths the connection of knee
   extension with a trace of flexion, keeping the
   foot in dorsiflexion and the toes stretched.


5. Relax both legs and arms; stay calm for a few
   breaths.