Kneecap-Area Injury from Lotus Pose

[bhikkhu]

Hello everyone,

First off: I realize that all I can get from Internet advice is an educated guess on the issue, but that is my only option as I have pretty much no access to medical professionals of any kind.

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A few weeks ago I started practicing the half lotus (after a year of working with Kit's material including the lotus video and many others) since things were coming along especially in the hips. From the start there was light pain in the knee cap area during the pose. I figured it wasn't a big concern since it was not on the meniscus side, so I started trying it for a few minutes at time.

One morning, soon after I held it for about 15 minutes on each side, and after coming out I noticed that my knees had become quite sore. The pain subsided quickly after getting up, but it would come back whenever I tried to bend the knees a lot, including in the usual burmese pose I always used to do with no issues.

It has gotten slightly better, but it's been about 3 weeks. The pain is now limited to the left leg only, which has always been my tightest, especially since I've always sat right-first in Burmese pose.

Any strong bending at the knees where hip abduction is involved seems to be a problem (Cobbler's Pose, Janu Sirsasana Burmese Pose), and deep squats too. Apart from this there is no pain. Pigeon Pose is fine.

Interestingly, I can do the lying quad stretch (or hero pose) where the knee is bent almost maximally without discomfort. Here of course there is no external rotation nor abduction at the hip. Also, my cossack squat on the left leg has always been more unstable, and less deep than on the right, sometimes with a little bit of pain too. Right now I wouldn't even try a cossack.

So I was just wondering if all this rings any bells to anyone here. My guess so far had been tightness in the quads, but the seemingly crucial role of the hip confuses me. Should I continue to stretch the quads (or something else) or rather refrain from it? Other things that might aid both recovery and prevention?
 

Any insights appreciated.

 

[Jim Pickles]

I dont know, but I suspect that the underlying cause may be lack of rotation at the hips - the thigh bone cant rotate enough on the pelvis (due to tightness in many areas, including the inner thigh muscles, possibly mainly the adductor magnus which has a branch attaching near the knee joint, and probably pulls on a lot of connective tissue there). One relatively safe way to increase this range is to sit with one heel into the groin, the other leg out to the side at a comfortable angle, and lean forward, going in the direction over the bent-in foot as much as possible, while keeping the back as straight as possible (so the pelvis rotates forward). As for the knee injury, I suggest let it recover fully (which may mean not doing this exercise) before trying anything that challenges it. My own view, which I tell the students, is that it is not worth trying the lotus or related positions if it stresses your knees. Your knees are more important to you than being able to do the lotus/half lotus.

Kit's videos on freeing up the hips would be valuable, while making sure you stay within your limitations so as not to stress the knee again.

[bhikkhu]

Hello Jim,

Thanks for your reply. Your suggestion of the hip muscles does make more sense (for what that's worth) than my newbie quad hypothesis: flexing the knees when the legs are abducted/rotated wouldn't somehow require more quad flexibility, am I right? The amount of knee flexion for half lotus is certainly a lot less than what I can normally do when stretching quads.

Also, the exercise you mention is indeed one of the best ways to induce pain in the affected knee. It seems to involve the same position as the Burmese Pose, which I have always sat in with right foot first everytime, for many hours a day. Perhaps (?) this created an imbalance between the two hip muscles you mention, and is the reason the left knee to some extent always has, and still is the one giving trouble.

Despite all this I had felt my adductors were coming along pretty well. In the wall tailor pose exercise I was able, with feet raised on a rolled towel, to bring the knees to the floor and then bend forward, at least 30 degrees I think.

At that point I was able to past the tests in Kit's Lotus video (barely, which is why I went for Half Lotus). I then thought that the way forward from there was increasing lateral rotator (piriformis?) and not so much adductor flexibility. I've read a few times that the former, not the latter, is usually the limitation for lotus. And yet I see that tailor pose often gets recommended as prep exercise. Why could that be?

I'll certainly not push too hard for lotus, especially after this. It would just be practical if I could do it comfortably since I sit for a great chunk of every day, plus there could be times where I'd have to do so without a cushion. Perhaps it's unrealistic that it'd be that much more comfortable of a posture, but I'd like to give it a try. Having these muscles as loose as possible is helpful anyway.

[Jim Pickles]

In the upper inner thigh area there are so many different muscles going in many different ways, that I think it is often difficult to tie tightness down to a single cause. And it may have multiple causes, including connective tissue tightness. The best I can suggest is do a wide range of exercises while staying in your pain-free range, and gradually allow yourself to loosen. Piriformis (and related muscle) tightness may indeed be a contributor, but I cant see how that would lead - directly at least - to knee issues. I also suggest if you are not doing it already, you also try the Pancake, which is another good inner thigh/knee/hip loosener.

[bhikkhu]

On 11/4/2021 at 12:08 PM, Jim Pickles said:

In the upper inner thigh area there are so many different muscles going in many different ways, that I think it is often difficult to tie tightness down to a single cause. And it may have multiple causes, including connective tissue tightness. The best I can suggest is do a wide range of exercises while staying in your pain-free range, and gradually allow yourself to loosen. Piriformis (and related muscle) tightness may indeed be a contributor, but I cant see how that would lead - directly at least - to knee issues. I also suggest if you are not doing it already, you also try the Pancake, which is another good inner thigh/knee/hip loosener.

Indeed I can see that there are too many muscles and factors here to pin it down to a single one.
I just didn't think about the inner thigh muscles at all initially. I don't think I would have come to suspect them by myself.

I'll make sure to stick to that pain-free range, as you suggest. I'd been somewhat failing to do that until now, trying to figure out what's going on.

[Jim Pickles]

Also theres a lot of fascia connecting things together in ways that don't follow the lines of the muscles (so its difficult to identify what's going on). I find once the fascia has got irritated in one area, if it gets pulled on by fascia in another area, then the irritated area will hurt again, but you will get the wrong idea of what's going on because the move that triggers it may come from a different area. Hence using a wide range of exercises, staying in the pain-free range, to let it settle down.