Total Knee replacement modifications

Yoga Discussion General Yoga
#1

Greeting all! I need to ask for some assistance for one of my students.

She is brand new to my class, but has practiced yoga off and on. Age is probably late 50’s. Overweight. Wonderful flexibility especially in hips and hamstrings. Tight in Quads and calf muscles. She had a total knee replacement a little over 1 year ago and can do fairly well bending it, but cannot kneel or put any pressure on it. I can think fast on my feet and came up with a few but am at a loss for an easy to get into resting pose. (Balasana is too uncomfortable for her) There are just so many poses where you are either kneeling or bending the knee quite a bit, so any guidance here would be appreciate. My class is a slower paced vinyasa flow that begins with 1 or 2 yin poses. We do a lot with lunges, especially crescent lunge and there is just no way she can do them. I suggested a thick blanket or pillow to put under her knee as a cushion, but she declined saying she can’t even put that amount of pressure on it.

She does well with standing poses and I paid particular attention to her alignment above and below the knee, stressing not to allow the knee to come to the inside of the front foot in poses such as Virbhadrasana I II.

She really enjoy the class and bought a package of classes. I guess I could suggest that she go to the gentle class, but she came with her friend and they’d like to stay together. I do realize what I need to help her as far as strengthening, lengthening and balancing. But some ideas for modifications on poses such as Balasana and lunges, etc I do need help with.

Thanks everyone!

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#2

For me it is important to direct a student to that place where they are best served. And there have certainly been times where I have advised students to see a senior teacher (as I was, at those times, honest with myself about my ability to help their particular situation fully). So I think the question that bears reflection is " Is this a therapeutic issue and does my class, its nature, and my skill set coalesce to help this student with this thing?"

It is perfectly fine to tell the student that they’d be better served with something else AND they can then freely choose to remain but I think they need to make such a choice without any contribution from us to their self-deceptions or ignorance.

It would be important for me to know that she has clearance from her health care provider for full activity and also to determine whether she has issues with internal and external rotation of the hips. If, as you say, she has “wonderful flexibility in her hips” then it is possible that baddha konasana, sukhasana, or janu padasthilasana might be “resting” seated poses.

For this student, in vira I/II ,parsvakonasana, and vanarasana (what you refer to as lunge) it may be best to have the bent knee over the back of the heel instead of over the ankle bone. Additionally, all four poses can be done with the front hamstring on the seat of a chair. This will reduce the strain for the student AND eliminate the need for the back knee to be on the floor for support and stability. Balasana likely should not be done by this student IF a folded blanket under the knees AND one between the hamstring and calves does not eliminate the knee pain.

#3

Thanks IA.

I’ve never had a problem with referring students to a more appropriate class. I’ll evaluate this more after next weeks class. She does have clearance by her Doctor.

For this student, in vira I/II ,parsvakonasana, and vanarasana (what you refer to as lunge) it may be best to have the bent knee over the back of the heel instead of over the ankle bone.

Thank you. It is how I instructed her.

Additionally, all four poses can be done with the front hamstring on the seat of a chair. This will reduce the strain for the student AND eliminate the need for the back knee to be on the floor for support and stability. Balasana likely should not be done by this student IF a folded blanket under the knees AND one between the hamstring and calves does not eliminate the knee pain.

I suggested the chair, but she declined because it would, in her words, mess up the flow of the class. I placed the chair nearby just in case. Balasana is a no-no for her. Baddha Konasana, Sukhasana, etc are all options for resting pose but by the time she got into them, we would be moving on to something else. It would be a more clumsy transition if you understand my meaning. (going from Down Dog to Baddha K then back to DD)
But honestly, I don’t think there are any other options.

I will encourage her to use the chair and to try Baddha K and Sukhasana as resting poses. I’ll re-eval her depending on decision.

Thanks much IA! Advise and wisdom is appreciated.

#4

Exactly. The pace of the class directly prohibits therapeutic applications.