Fixed firm and knee pain

Yoga Discussion General Yoga
#1

I am new to the practice of yoga and am in the midst of a 30 day Bikram challenge. Let me say I am loving it. I have a history of knee and hip pain on the right side and suffer some sciatica issues there also. I have had two arthroscopic procedures for meniscus tears. I have the strangest response to my practices and I am associating it with fixed firm as that is where I feel the most resistance in the knee. I am certainly not going deep into the pose and am actually using a foam block to feel some connection between sit bones and the ground below. It seems that after practice my knee will feel really structurally solid which I am very thankful for. Then a few hours later it’s that dull aching pain that sometimes turns from dull to nuclear.

Any ideas?

#2

Please use your common sense. If you are experiencing this in the middle of a “challenge” what do you think your knees will feel like when you complete the “challenge”? Yoga should never be felt in the joints, and your personal medical history is very clear on the subject of knees. Just stop and find a practice that is more suitable for your knees. Not everything that you love is necessarily good for you.

#3

Nuclear? That word only describes families when it’s a happy thing. Please stop harming yourself, and wonder why you love something that gives you so much pain.

#4

Hello Eric,

I think in responding to questions such as this, it is important to separate the feedback relative to the style of practice from the feedback to the particular musculo-skeletal question you pose.

I’m including a link to a photo of the pose you reference which you state as “fixed firm”. Many will have to view this since it is only referenced this way in the practice you mention. Otherwise it is oft referred to as Supta Virasana. However this post isn’t about what the pose is called :slight_smile:

The posture is designed to open the three hip flexors - psoas, iliacus, and rectus femoris. The last of these three is unique in that it crosses two joints; the pelvis (Pelvifemoral) and the knee (Femorotibial). When these muscles are not already open AND the student uses the body weight to recline, the demand placed on the muscles is very interesting. The psoas and the iliacus are deep and very, very powerful. They’ll not go. The rectus will must assuredly yank on the patellar tendon at the knee and can cause pain.

Further, as you can see by this poor chap doing the posture, when those muscles are at their limit AND that limit prevents the pelvis from tipping posteriorly, then the pose goes into the lumbar spine.

In my view this is a pose that many students dive into too deeply and far too quickly. When that happens it is possible to stretch tendons at the origin and insertion of the muscles (one of which is the knee) AND do harm to the lower spine and sacroliliac joint.

When muscles reach their limit but the student keeps going, the tendons must act since they are the secondary support structure. So they stretch, and they are not designed to stretch. Tendons that are stretched often feel good in the moment but are excruciatingly painful within three days. Whether this is your experience or not I cannot say.

When this is added to the pre-existing conditions of knee issues and sciatica, the pose and pain make for a combination that is “ill-advised”, when safety of the student is a paramount concern. That may not be the paradigm of this student or this practice.

gordon

#5

As a Bikram enthusiast I can tell you that Bikram teachers are taught to be very tolerant of students going easy on or avoiding postures altogether if they find it especially painful. By the same token Bikram teachers can sometime push you to do an uncomfortable posture unless you push back. Fixed firm is extremely challenging to the knees and with the health issues you describe you might consider avoiding it altogether or going very slow on this one. Also the pranyama (I’m sure I’m spelling it wrong) breathing at the end of the Bikram sequence can also be very painful for the knees. A certified Bikram teacher will generally instruct a student to sit cross-legged in that posture if they find it painful for the knees.

One last suggestion - Be aware that there is a bit of a schism between Bikram and other forms of Yoga that is based on his, to put it delicately, strong personality and litigious nature. Any advice you receive from people who practice other traditions within the Yoga community is undoubtably heartfelt and, for the most part, learned. It is always possible that some emotion is involved when responding to a question about a Bikram practice. By the same token if you ask many Bikram teachers about other forms of Yoga you may find they are not lacking in opinions, not all of them charitable. If you love it, in my view, it is probably doing something for you. Just go easy on fixed firm.
And finally, as I have noted in other posts, my view is not “the view” but rather just an opinion.

#6

Well, I wasn’t reacting particularly to the word “Bikram yoga”. My reply would have been the same if Eric’s post had said “tennis” or “marathon running”. In fact, I admire people who can do a fast-paced practice in a hot environment. It doesn’t suit me personally, though. The words that concern me most are “new to yoga”, “30 day challenge” and “arthroscopic procedures” and “aching pain”. Let me explain:

People who are new to yoga usually do not have sufficient discernment to tell what is and what is not good for their bodies. Also, they often do not know the proper alignment for their limbs and joints. Flowing into and out of poses rapidly increases the risks of misalignment. Add prior injury and surgery into the cocktail and the risks go up farther. Eric is speaking about pain in an injured joint, not about sore muscles!

In fact, I’m not even sure that “fixed firm” is the issue here; there could be other poses equally responsible. Combined with daily repetitions over a month, the risks are compounded. Strain is cumulative! All in all, Eric may be headed for injury. That would be a great pity. To my mind, yoga is first and foremost about avoiding harm (ahimsa). That’s what I was trying to convey.

So, stop doing harm. At the very least, leave out the suspect pose (fixed firm). Talk to the teacher. Completely stop the challenge if there is still pain after the next session. It’s such a pity to waste valuable practice time on surgery and post-operative recovery.

#7

I would like to post more thoroughly but can only stand the iPhone keyboard so long. Let me say that my instructor for this class does not, in the least, push us to do poses beyond our ability or comfort. That being said I am very athletic for a 51 yo guy and my nature…err, competitiveness…sometimes gets me in trouble. I am an active cyclist and really have to fight to keep from being an over acheiver. In some ways the Bikram practice may play to my weaknesses. I appreciate the thoughtful responses. I am sure that the yoga practice, of varied styles, will be a part of my life going forward. I will post more information as I get back to a more comfortable keyboard

#8

Hi Willem - Your concern is very compassionate and your advice very thoughtful. In reviewing my post I can how I should have been more concerned about the description ericspin gave about the history and condition of his /her knees.

I am really fascinated by the Bikram phenomenon and its interesting paradoxes. I am very tuned in to the fact that people do often have strong opinions about it but I didn’t mean to imply that I was responding to your post in my post or that I was arguing with you in any way. I have simply practiced enough Bikram to know what ericspin might expect from a Bikram teacher.

#9

Thank you for your reply. I appreciate the discussions on the forum, because that is what I learn from most. I always try to err on the side of safety, both for my students and for myself. I’m a pitta predominant person, and I have had my share of small injuries, some due to my own desire for achievement, others due to lack of discernment, and some caused by teachers. I have found out that alignment with the greater principles of yoga (such as non-harming and contentment) help to stay away from trouble.

I know (too) little about Bikram yoga. What can one expect from a Bikram teacher in the case of Eric?

#10

Interestingly, today I will be attending a two hour workshop that will focus on the 12 sitting postures of Bikram. I intend to discuss my thoughts on this with the instructor prior to the workshop and then use the two hours to focus on alternative methods for the postures that are causing this pain. As mentioned in my earlier post, I bring a competitive nature to all of this which is certainly not benefitting me. I was reading some of your posts to my wife last night and was struck with the idea that, maybe this is why I have been guided to the yoga practice at this point in my life. To confront and challenge this part of me that craves the competition in everything. To confront my A+++ personality traits. I know when I am on my bike I am never satisfied unless I ride further and faster than before. I know that I struggle with always wanting to be the best student. Possibly this is my opportunity to do something different.

Thanks for your responses. It feels strange to be the new kid in class at my age. I will post my experience of this workshop this evening.

#11

Willem,

Many Bikram teachers (at least they have done this with me) will suggest beginning fixed firm from a wider knee stance and simply easing into it.

Ericspin since it sounds like you are not dealing with any motivational problem in terms of going on a regular basis IMO you really shouldn’t push through the discomfort on this one. You have plenty of time. I have been practicing Bikram along with other forms of yoga for several years and at 47 I am now able to comfortably get my butt on the ground in fixed firm and lean back just a little and am thrilled with that.

Also when I have knee pain it is always on one side. My regular (non-Bikram) teacher has been very helpful in teaching how asymmetrical we humans can be and how to make minor adjustments that introduce balance to symmetrical poses. In general this kind of advice is not given by Bikram instructors who usually, by training, stick closely to a “dialog” or script, often with large classes and who are taught not to make adjustments by touch. An alignment intensive tradition such as our friend InnerAthelete appears to teach or perhaps an Iyengar or Anusara class might do wonders in helping you create a balanced way to approach the pose.

Or not.

#12

I would like to share this, from an alignment-based tradition. What happens to the meniscus and the ligaments when you force yourself or are not in proper alignment is explained here.

#13

Very interesting discussion, and lots of great advice everyone!

Eric, I am a bicycle commuter and find that cycling makes my hip flexors and IT band very tight, which often affects my knees. I love practicing Supta Virasana/“Fixed Firm” to stretch my IT bands/quads/hips, but sometimes I’m so tight from cycling that it’s too intense and somewhat painful. I find that it helps to practice Eka Pada Rajakapotasana (Pigeon Pose) with the back leg bent and holding the ankle to stretch the quad, specifically the rectus femoris. Plus you get the added benefit of stretching the piriformis, which can help with sciatica. I hope that is helpful!

#14

I just tried pigeon with one leg bent and it works well. Have your tried bhekasana (frog pose)? Then you can do both legs at the same time.