Yoga can actually be a very useful tool in the rehabilitation process after knee replacement surgery. Carried out mindfully and with awareness of your limitations at any given point throughout the recovery period, yoga can help to minimise or even eliminate bad postural habits that you may have had prior to surgery and which may have even been a contributing factor to your knee problems.
The range of motion in your knee will depend on various factors including; the range of motion you lost prior to surgery, how long ago the surgery was carried out, and if you’ve been following an exercise plan post operation recommended to you by your physiotherapist. The basic indicator of how easily you can get up and down from the floor is a good place to start with when considering what yoga poses you can and cannot do.
Post-op alignment in yoga is very important to prevent recurrence of any knee issues. Avoid torque forces through the knee joint which will affect the cement in the joint (the meniscus). Its really important that you keep your toes and knees tracking in the same direction in poses such as Warrior 1 and Goddess. Also stacking the joints from the base up in standing poses will not only help prevent future knee issues, but will also give you more stability in your standing poses. Remember that you can always pull up and back from poses such as Warrior 2 until you feel that you have the strength to go deeper, never passing the knee beyond the ankle.
Contrary to what you may think though, kneeling is problematic but not necessarily injurious to the new knee. Using props such as blankets or cushions under your knee when doing poses performed on all fours may help ease any discomfort. Be conscious of when the right time to perform poses in which you’re on your knees is, such as camel, remembering that often the pose can be taken standing up or cross legged as a variation if you find that you’re putting too much weight on your knees for comfort.
One of the key factors in using yoga as part of the therapeutic process after a knee replacement is that you’re not just bringing awareness to the knee itself. Strengthening all the muscles that cross the knee will greatly help towards a successful recovery. This means working with the whole area from the hips down to the feet to make them stronger in their supporting role. Strengthening your quadriceps and hamstrings will be highly beneficial, as these are often weakened in surgery. And if you have tight hips or hamstrings make sure that you modify the pose to allow these areas to properly open and stabilize,preventing strain on or incorrect movement in the knees.
Standing poses if carried out mindfully can help to strengthen the quadriceps and hamstrings, but make sure you take them slowly and pay special attention to alignment. If taken in small steps these standing poses will help maximise a full range of motion in the knee. Any poses that require deep flexion of the knees can be propped or you can use a chair or wall to help take some of the weight out of the pose, or of course avoided altogether. Also poses that strengthen the hips and ankles will help to further stabilise the knee joint.
Questions to consider with your yoga teacher or therapist before starting to practice yoga again after knee replacement surgery.
1. How long ago was the surgery?
2. Are you still in pain?
3. Are you still in physical therapy?
4. Do you have any hip or back pain (either before or after the knee replacement)?
5. How much mobility do you currently have? Can you get up and down from the floor?
6. Do you have arthritis in any other joints?
Poses for strengthening the supporting muscles:
Warrior 1 and 2 – strengthen and stretches the leg muscles and hip flexors, in particular building strength in the quadriceps,and helps build awerness in proper tracking of the knee. Your knee should be aiming towards being in line with your second and third toe of the bent knee leg.
Bridge pose – work with your hamstrings. Stretch your hip flexors and engage the hip extensor. Make sure that your knees are tracking in the same direction as your feet, which are in turn in line with your hips.
Tadasana on block with leg lifts out to side and back to centre – building strength in your abductors (outer hip) and adductors (inner thigh).
Locust variations – stabilises the sacrum. Stretches and strengthens the hip abductors and tones the quadriceps.
Extended hand to big toe with a chair – you dont have to come into the full expression of this pose. Bring a chair to one side to lightly place your fingers on and then use a belt around the toes of the foot that you’re going to extend up.try to keep stability in the pelvis keeping your hip bones in line.
Poses with counter indications :
Pigeon pose – take a figure of 4 on your back instead to take the weight off your knees.
Eagle pose – place a block by the side of your standingleg and dont wrap your leg. Probably best to avoid all together if too close to surgery.
Low Squat – try a higher Goddess pose instead or place a block or two under your sit bones to help take some of the weight of the pose. Make sure that your knees are tracking in line with your feet.
Hero pose. Sit on a block or bolster or avoid this pose all together.
Childs- place a cushion or blanket under your knees to cushion them and also between your calves and thighs to help take the pressure off your knees.