“. . . according to the Yoga Sutra (3.1), the term [Bandha] refers to the ‘binding’ of consciousness to a particular object or locus (desha), which is the very essence of concentration.”
Georg Feuerstein



Wednesday, March 2, 2011

Strong Thigh Muscles Benefit People with Knee Osteoarthritis (and a Tip for Engaging the TFL)

A series of recent articles from opinion leaders in the academic medical community have demonstrated the benefits of quad strength for persons with arthritis of the knee joint. One of these studies, which used MRI to directly assess knee cartilage, is particularly important because it sheds new light on an older study—that did not use MRI—that suggested stronger quads were associated with a slightly greater risk of arthritis progression in persons with malaligned knees. Here’s a quote from the Mayo Clinic article, which was published in the December 2008 issue of Arthritis & Rheumatism:

“In summary, in men and women with symptomatic knee OA [osteoarthritis], we found no association between quadriceps strength and cartilage loss at the tibiofemoral joint, including in malaligned knees. However, greater quadriceps strength, which may prevent lateral offset and tilt of the patella, protected against cartilage loss at the lateral compartment of the patellofemoral joint, a frequent site of symptom generation in knee OA. Subjects with greater quadriceps strength were also more likely to have less knee pain and better physical function. Our results suggest that strong quadriceps muscles have an overall beneficial effect on knee OA.”1 For Science Daily’s composite of this article, click here.
Also, see Mayo Clinic researcher Dr. Amin’s comments at The American College of Rheumatology Annual Meeting on Nov. 15, 2006:

“A stronger quadriceps muscle helps keep the patella from moving laterally and tracking abnormally with movement... Our study results emphasize that it’s important to encourage people with knee osteoarthritis to maintain strong quadriceps muscles as recommended by their physician.”

These quotes are linked to the Science Daily summaries of the research. This is an excellent online publication you can use to stay current on scientific developments. They have a lot of integrity in their reporting and also provide full citations and links to the articles they summarize, as I do here for Dr. Amin’s study.

So, current evidence demonstrates that quad strength is not associated with increased cartilage wear—even in malaligned knees. In fact, it appears to protect against it for part of the patellofemoral joint (where the kneecap articulates with the femur). This is one reason I recommend using up-to-date articles from reliable sources like those referenced here to expand your knowledge base. Sound theory informs good practice and teaching.

The flip side is that unsound theory misinforms practice and teaching. For example, if you were to subscribe to the falsehood that people with strong quads and misaligned kneecaps experience rapid progression of the disease—as some are now advocating for yoga—you might discourage your students from using these muscles in their poses. Then you would deny those same students the benefits of strengthening the quads, especially those with arthritis. You might also lose out on aligning the kneecap and reciprocal inhibition of the hamstrings. I’ll go over the importance of integrity in reporting on matters of health and a number of other key points about the knee in a five-part exclusive I’m preparing for the respected Yoga and Health Magazine. Stay tuned . . .

On to the Tip . . .

We’ve gone over the benefits of engaging the quads in a number of posts. These include reciprocal inhibition of the hamstrings, which helps to release the muscles and protect against symptoms of overstretching. Contracting the quads also strengthens them, with the benefits outlined above. Finally, these muscles and their synergists align the bones of the leg and maintain congruency of the knee joint, thus protecting the cartilage. The tensor fascia lata is one of the synergists that can be used to help stabilize the knee.


First, the Anatomy...

The tensor fascia lata can be used as a synergist of the quads for knee extension. This muscle originates from the outer surface of the front of the iliac crest and the anterior superior iliac spine. It inserts onto the fascia lata (iliotibial band). This fibrous band of tissue runs down the lateral thigh and attaches at the upper outer surface of the tibia onto Gerdy’s tubercle (a small protrusion of bone). The TFL acts to flex, abduct, and internally rotate the hip. When you engage it, this also tenses the fascia lata, hence it’s name—TFL. This tensing action is then transmitted to the insertion of the fascia lata on the tibia, aiding to stabilize and refine knee extension.

Here's the Cue...

quadriceps and tensor fascia lata in downward dog
Using the quadriceps and TFL in Dog Pose.
Warm up first with four or five Sun Salutations to acclimate the stretch receptors of the hamstrings and other muscles that lengthen in Down Dog. Use the tips we have provided in the previous posts to lower the heels and spread the weight evenly across the soles of the feet. Then, keeping your feet fixed on the mat, gently attempt to drag them apart (as shown here). This attempt at abducting the feet engages the TFL and brings added stability to the knee joint. Feel how this also brings kneecaps that are turning outward back to facing directly forward—the optimal position in the pose. This is because engaging the TFL acts to internally rotate the hip joint. Lastly, feel how this cue also refines the hip flexion that is part of the form of Dog Pose. You may recognize this tip from our previous post on nutation. This is yet another example of the "portability" of these techniques that illustrates the interconnectedness of yoga poses.

Thanks for stopping by. Check back for the next post on the big toes and standing forward bends. Also, be sure to visit us on Facebook for your free poster and e-Book!

Namasté,

Ray and Chris

1Shreyasee Amin, Kristin Baker, Jingbo Niu, Margaret Clancy, Joyce Goggins, et al. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis and Rheumatism. Available at: http://goo.gl/o8jEe. Published 30 December 2008.

7 comments:

  1. Thank you SO much for posting the information on the recent knee studies. I've always suspected that strengthening the knee joint could help alleviate some of the symptoms of OA in the knee. Your reminder about "checking in" on current research is crucial! Thanks. Love all of your posts!

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  2. love the links, love the bringing fwd previous tips into today's info, love the bolded info breaks, and how could one not love the info itself ;-)

    i assume we'll get the word when the 5 part series starts in yoga & health mag? ;-)

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  3. Hello Adan,

    Many thanks~yes, definitely I will advise on the series. It is coming out soon!

    Best,

    Ray

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  4. Hello Anon,
    You're welcome! You are correct with instincts on OA. Yes, it is very important to stay abreast of the current research from the medical field. Yoga is now in the mainstream and I can say that it makes one confident, both as a practitioner and a teacher to know that what we are practicing both supports and is supported by science. I find it really great when I see science supporting instincts and intuition such as yours relating to arthritis and the knee--and there is much more to come!

    All the Best and thank you for your comment~Ray

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  5. I wonder if there is a study which focuses upon neurological strength instead? I would think that if a person had optimal neurologic strength in their vastus medialis and lateralis then there would be a very high instance of no OA in such studies. These two muscles have more proprioceptive capabilities that the other muscles of the thigh and the vastus medialis has a strong synergy with the tibialis posterior, another major knee stabilizer. Just a thought.

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  6. Thanks, you are all so great to pass on info and help us all. I love this and I use this for edifying and stimulating my own practice.

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  7. I recently came across your blog and have been reading along.I'm impressed. You're truly well informed and very intelligent. You wrote something that people could understand and made the subject intriguing for everyone. I'm saving this for future use.

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