Knee alignment

Yoga Discussion Structural Yoga Therapy
#1

I took your workshop at the Yoga House in Pasadena a few months ago, which I enjoyed immensely. I am writing to you about a knee problem that you talked about during the workshop. One of my students said she has been having knee problems. When I looked at the alignment of her knee, I noticed that, in order for it to be pointing forward, her foot had to be turned out. I have only seen this once before, and that was in your workshop. A girl called Susan complained to you about her feet/knees, and we all gathered around and you pointed out the alignment problem. You had a name for it, which I have forgotten. Anyway, I told my student about what you had said to Susan. I advised her to try practicing with her knee straight and her foot turned out, which seems much more logical to me than getting the foot straight and twisting the knee. She was very relieved to make this discovery, as she has been having pain in her knees, in bridge/wheel, etc., and I now understand why.

So, I just wanted to ask you if you had any more advice I should pass on to her, regarding her approach to the postures. I don’t see any problems that could arise from turning her feet out, when they would normally be parallel, but I just wanted to be thorough about it. Are there other implications that I should be thinking about? For other postures? Thank you for taking the time to read this. I look forward to your response.
Regards, FC

#2

This condition is called tibial torsion. It is described in my book on page 101. There are no poses in which this turn out would be a problem. She needs to be reminded that she should not align her feet. It just is a situation where the teacher needs to know of the situation and not try to align her feet parallel as that will stress or injure her medial knees.

#3

(continuation of discussion on tibial torsion from new “questioner”)

Hi Mukunda, about tibial torsion; I experience this myself, and I’m about to take a Yoga course from an Iyengar instructor. Based on the one class I took from her already, I believe she would have me use/strengthen abductors to pull the knees away from each other and eventually align them over parallel feet with toes a little turned in (a position I currently feel ridiculous in, knees turn in even more). I think she subscribes to a tapas approach and would require the feet to be in classical alignment (but I might be wrong). I think she is a wonderful teacher, but I don’t want to injure myself, as I already suffer from pain in my right hip, neck and shoulders, and migraines. I want to take her class primarily to learn more self-discipline and inner/outer strength and for more knowledge of asanas and alignment and corrections to pass on to my students. I come from the Integral Yoga tradition, and I’m getting confused about being too soft on myself and my students, particularly in dealing with pain. But that’s another long question. Do you have any thoughts or advice for me? I’m open, but feeling a bit confused in trying to understand some apparent contradictions between different schools of yoga-not knowing which philosophy applies where, and studying more to try and figure it out. Thanks so much. -K

#4

True tibial torsion cannot be corrected. It is a bony misalignment, sounds like you have it. Though to be sure I need to see you or a photo or your tadasana. It is a skeletal condition that few yoga teachers know of and without knowledge trying to change it results in more stress to ankles, knees and/or hips. My feeling is that pain is never a good place to work in. Only rarely does a good practitioner work a student through pain, and then it is only emotional pain not physical. Physical pain must be understood before it is worked on. Without clear understanding of anatomy and especially kinesiology, teachers can cause more problems. Hence my motto “If it isn’t broke don’t fix it.” This especially applies to those teachers that attempt to align misaligned students who are not in any pain or discomfort. Such attempts “to correct” alignment cause pain. All bodies are fine. Pain and discomfort are cited in Yoga Sutras II, 46, as a sign of something is not right. Asana is to always be comfortable and steady, then from there we can proceed to following sutras that point out how to perfect the pose. One should not use contemporary misconceptions of alignment as a guideline. Instead refer to the timeless teachings of Patanjali. He knows where we need to go with Asana practice.

#5

I am also finding “tibial rotation” in several of my students, and trying to find a way out of the Iyengar method, of which I have most of my training don’t want to force a students knee in the “correct alignment” but have had trouble knowing what to do. I will use the example in this question for triangle pose, moving to the right first, one of my students for instance has a problem with her right knee, it wants to rotate in medially, the outer spiral of the leg causes her pain, so she feels she needs to turn her foot in slightly. The Iyengar training in me wants to tell her to put her foot parallel to her make and outer spiral her leg…but I don’t feel this is right for her? thanks for the time once again! Namaste R

#6

the condition is tibial torsion. It is described in my book on page 101. It refers to a bony misalignment that when the knees are aligned the feet point outward. It is not a problem with positioning, or muscular weakness. It cannot be corrected. So procedure that I recommend is to have then stand with feet turned out and not aligned. In the example you cited students leg wants to medially rotate, instead have her turn her foot out so that alignment is given to her knees and not to her ankles. This should keep her more comfortable. A very controversial topic – when alignment causes problems. The reason not all bodies are aligned, some have curvatures and they need personalized attention, not conforming to standardized alignment ideas. One needs to study more about anatomy and especially kinesiology.

        There are no poses in which this turn out would be a problem.  She needs to be reminded that she should not align her feet.  It just is a situation where the teacher needs to know of the situation and not try to align her feet parallel as that will stress or injure her medial knees.