作者彙整:

我們這群瑜伽愛好者，在一起練習時，大家都體會到瑜伽和健康的重要性，因此相約八月的第一個星期六，要在一起聚會討論這方面的議題．時間是十一點半至兩點，地點上次都提過．，因此，我先訂定下一次研討會的主題 ，根據大家受傷機率最高的部位－－膝蓋來做討論，講義是在yoga journal期刊上的專欄，其中有一篇特別探討Lotus posture，他寫很仔細，又有圖片，網址如右：http://www.yogajournal.com/teacher/978_1.cfm (好像會跳掉,沒關係,我附原文如下,這是教學用,不會侵犯著作權,大家有空可以多去這個網站汲取新知)

探討盤腿為什麼容易受傷，還好要如何調整盤腿的角度才不會受傷，其實人體各個部位的關節，在三十多歲以後就漸漸地老化，但你可能不自知，因為你尚未有感覺，只是覺得腿勁沒有以前來得好，這也是我深深覺得暖身的重要，尤其，有些骨科醫生甚至要求病人在尚未有嚴重症狀時，爬山及上下樓時要戴護膝，為的就是減緩對膝蓋的壓迫．

如果，順利的地話，我會邀請醫師或復健師過來講課，畢竟他們對這一方面比較專業，大家可以先看看講義，再把它印下來即可，若萬一他們時間沒法配合，我就先去上課，問清楚相關細節，再整理中文講義,當天由我主講給大家聽，希望大家的膝蓋，會愈來會愈強壯．

回歸醫學，才是我的夢想．

judy

ps:大家一起想想還有那些動作是和膝蓋有關的，可以回應，以便資料整理 ps:大家若有膝蓋方面的問題可以回應上來，我會一併整理請教專家，若你也想參加，也可以回應上來，因為場地不大，所以有名額的限制，費用定在五百元以下，若醫生肯來，最好，因為要付專家費．若不肯來，則費用訂２５０元，場地費１５０元，現場講義一份１００元．

注意，要來的同修，請務必寫”我要參加此一研討會”才會先幫你保留名額，因為我們會保障先前一起研習的同學的名額，所以名額不多，先報名先參加，僅對外開放２５個名額．

時間：8月5日(六)11:30~14:00
地點:梵瑜伽(捷運板南江子翠站四號出口即可看到,雙十路上,可看右側網站有介紹)
內容:討論膝關節,以下面文章為主
人數:有限制,因場地不太大.

膝關節是由股、脛、臏骨等構成上下槓桿長，構造複雜，是容易發生損傷的關節。膝關節的主要功能為屈伸運動，在半屈或屈90度時有輕微的旋轉運動。它周圍的肌肉和肌腱，內、外側副韌帶，前、後十字韌帶以及外側半月半，共同維持膝關節的穩定性。

雖然股骨和腓骨上的強壯肌肉能幫助支撐身體進行多樣的運動，但保持左右平穩必須要靠兩條韌帶。當膝關節旋轉超過韌帶限度時，軟組織會首先受損傷，整個關節是由髕骨後滑囊中分泌的滑液來潤滑的。大腿肌肉、小腿肌肉及與之相連的肌肉負責關節的活動，膝關節承受運動負荷產生的壓力的能力取決於這些肌肉的力量。

　　田徑運動中經常性的跳躍運動會導致膝蓋囊炎(和瑜伽某些串連動作是一樣的,也是大師兄所提到的問題.)。這是一種肌腱炎，液體分泌過多會造成滑囊炎；關節的滑動和不平穩常常導致膝關節習慣性脫位，單純的膝部外傷或日積月累的許多小傷會慢慢的釀成骨關節炎、慢性疼痛和關節僵硬；相反，肌肉和關節長期不運動也會患關節炎。以上是一般性關節炎的受傷的原因。

學生的訓練強度應由小到大，遵守循序漸進的原則。運動量大，強度小，轉為量小強度大，此時，如果忽視訓練中的循序漸進的原則出現訓練強度忽大忽小，或長期保持較高強度，則會引起機體過度疲勞現象。有時因為氣溫的回升，運動員興奮性較高，往往掩飾了機體的這種不適應的現象，因而在大強度中，容易出現膝關節的損傷。 

結論和建議

結論

• 4.1.1通過自己的調查、訪問找出膝關節損傷的主要原因在與專項動作技術不合理和準備活動不充分，以及過度的訓練，訓練安排不當。
• 4.1.2膝關節的確是經常易發生損傷的關節。在訓練中我們要特別注意膝關節，防止膝關節損傷。

建議

• 4.2.1訓練前必須作好準備活動，特別是下肢的活動，使膝關節運動靈活協調。
• 4.2.2加強肌肉力量練習，特別是股四頭肌以及小腿三頭肌與膀肌的力量訓練，使之強健有力。
• 4.2.3做好運動場地的義務監督，避免場地因素損傷。盡可能不在崎嶇不平的跑道上練習，尤其是進行短期的練習。
• 4.2.4當持久訓練出現反應遲鈍時，應終止基本部分練習。

  左圖是右膝伸直,中間有髕骨patella,很多時候是patella角度跑掉,造成knee pain.右圖是彎曲,可以清楚看到patella 和股骨femur的角度.

   

  左圖是右腳的解剖圖,右圖是膝關節的俯視圖.

Protect the Knees in Lotus and Related Postures

By learning basic anatomical principles, you can teach your students how to safely open their hips without injuring their knees.

By Roger Cole

	Figure 1 Safe Knee Placement View in Detail
	Figure 2 Unsafe Knee Placement View in Detail

Lotus Pose (Padmasana) is a supreme position for meditation, and Lotus variations of other asanas can be profound. However, forcing the legs into Lotus is one of the most dangerous things you can do in yoga. Each year, many yogis seriously injure their knees this way. Often the culprit is not the student but an overenthusiastic teacher physically pushing a student into the pose.

Fortunately, there are techniques that make Padmasana much safer to learn. Even if you don’t teach full Lotus, you can use the same techniques to protect students in related postures, such as Ardha Baddha Padmottanasana (Half-Bound Half-Lotus Forward Bend), Baddha Konasana (Bound Angle Pose), and Janu Sirsasana (Head-to-Knee Pose). These poses can do wonders for the hip joints and the muscles around them. Unfortunately, many students feel a painful pinching sensation in the inner knee in all of them. To understand why, and how to prevent it, consider the underlying anatomy.

The problem starts at the hip joint, where Lotus and its relatives require an astounding degree of mobility. When you move from a neutral, seated posture, such as Dandasana (Staff Pose), to Baddha Konasana, the ball-shaped head of the thighbone must rotate outward in the hip socket about 100 degrees. Bending the knee and placing the foot in preparation for Janu Sirsasana requires somewhat less external rotation, but as a student bends forward in the pose, the tilt of the pelvis relative to the femur brings the total rotation to about 115 degrees. Padmasana requires the same amount of external rotation (115 degrees) just sitting upright, and the angle of rotation is somewhat different, making it more challenging for many students. When we combine the Padmasana action with a forward bend, as we do in Ardha Baddha Padmottanasana, the total external rotation required at the hip joint jumps to about 145 degrees. To put this in perspective, imagine that if you could turn your thighs out 145 degrees while standing, your kneecaps and feet would end up pointing behind you!

If a student can achieve all of this outward rotation at the hip in Lotus, they can then safely lift the foot up and across onto the opposite thigh without bending the knee sideways (see Figure 1). Some people with naturally mobile hips can do this easily, but for most people, the thighbone stops rotating partway into the pose. This limitation may be due to tight muscles or tight ligaments or, in some cases, to bone-to-bone limitations deep in the hip. When the femur stops rotating, the only way to get the foot up higher is to bend the knee sideways. Knees are not designed to do this-they are only designed to flex and extend.

If an overzealous student continues to pull the foot up after his thigh stops externally rotating, or if a student or teacher forces the knee downward, the thighbone and shinbone will act like long levers that apply great force to the knee. Like a pair of long-handled bolt cutters, they will pinch the inner cartilage of the knee between the inner ends of the femur and tibia. In anatomical terms, the medial meniscus will be squeezed between the medial femoral condyle and the medial tibial condyle. In layman’s terms, the inner ends of the thigh and shin will squeeze the inner cartilage of the knee (See Figure 2). With even moderate force, this action can seriously damage the meniscus. Such injuries can be very painful, debilitating, and slow to heal.

Poses like Baddha Konasana and Janu Sirsasana can cause similar pinching. In these postures, we do not usually pull up on the foot, so the problem comes mainly from the lack of outward rotation of the thigh relative to the pelvis. Let’s first look at Baddha Konasana.

Remember, to stay upright and stable while placing the feet in Baddha Konasana, the heads of the femurs will turn strongly outward-about 100 degrees-in the hip sockets. Because this requires so much flexibility of the entire hip region, many students instead allow the top rim of the pelvis to tilt backward while placing the feet in Baddha Konasana. They move the thighs and pelvis as a single unit. This requires little rotation of the heads of the femurs in the hip sockets, and it demands little flexibility. It also defeats the aim of mobilizing the hip joints and causes the entire spine to slump.

As a teacher, you may find yourself instructing the slumping student to tilt the top rim of the pelvis forward in order to bring them upright. If their hips are loose enough, this instruction won’t create a problem; the pelvis will tilt forward, the thighs will remain externally rotated, and the spine will come upright. But if the hips are too tight, the femurs and pelvis will roll forward as a single unit. While the thighbones rotate forward, the shins will not, resulting in the aforementioned pinching in the inner knees. This explains why some students do not feel any knee pain in Baddha Konasana until they attempt to tilt the pelvis completely upright.

Some students complain of knee pain only when they bend forward in poses that require external rotation. That’s because a forward bend like Janu Sirsasana demands even more external rotation at the hip joint. Again, in the tight student, the pelvis and femur roll forward as a single unit, pinching the inner knee. Of course, in either Baddha Konasana or Janu Sirsasana, pushing the knee(s) downward makes the problem worse, because tight muscles make the femur rotate forward as it is pressed.

Now back to Lotus Pose. Forcing the knees into Padmasana by lifting up on the ankles can also injure the outside of the knee. When a student lifts the shinbone without adequately rotating the thigh, it not only closes the inner knee, it opens the outer knee, overstretching the lateral collateral ligament. If a student then forcibly turns the feet so the soles point upward (which people often do to get the feet higher up on the thighs), they can worsen the strain. This action of turning the soles actually pulls the anklebone away from the knee, creating a chain reaction all the way up to the lateral collateral ligament.

What’s the solution? First, use common sense. Never force a student into Lotus or related poses, and discourage students from forcing themselves. Teach students not to push into pain, especially knee pain. Do not adjust the pose by pulling on the foot or ankle, nor by pushing down on the knee. Instead, either teacher or student should apply firm outward rotating action to the thigh, turning the femur around its long axis, using the hands or a strap. (For full instructions on how to do this adjustment, see the sidebar.)

If your student already has knee pain but can do basic standing poses comfortably, teach these poses first, with careful alignment. This can bring her a long way toward recovery. When you reintroduce problem seated poses such as Baddha Konasana and Janu Sirsasana, use the hands or a strap to apply the same outward rotating action described above for Lotus.

For students who are ready to learn Lotus, introduce it gradually, working from poses that require less external rotation at the hip (such as sitting in Ardha Baddha Padmottanasana without bending forward) to those that require more (such as full Padmasana). Wait until last to introduce poses that require the most external rotation (forward-bending variations of full Padmasana). As students are learning these poses, teach them to rotate their thighs outward either with a hands-on adjustment or a self-adjustment. Instruct them to monitor and avoid pinching sensations in the inner knees.

Encourage your students to go slowly, be patient, and persist. In time, they may be able to sit comfortably and meditate deeply in Padmasana. If not, remind them that true meditation lies not in some specific posture but in the spirit of their practice. Help them find a posture that suits them, then guide them to settle in and experience the stillness that is yoga.

Adjustments instructions

Adjustment Instructions

It’s always a good idea to ask a student for permission before you do an adjustment. You can perform this one with or without a strap. (See Figure 1 to view strap placement.)

To begin, kneel behind and to one side of the student. To do the adjustment manually, grip the upper one-third of the thigh with both hands and turn it firmly outward. To use a strap, encircle the upper one-third of the thigh with it once or twice. Pass the free end through the buckle the first time around. When you’ve finished setting up the strap, make sure that the loose end is to the outside of the thigh, so that pulling outward on the strap will externally rotate the thigh.

Use one hand to pull firmly outward and slightly downward, being careful not to force the knee downward. Place the other hand on the back of the pelvic rim and use it to prevent the pelvis from tilting backward. While adjusting, ask the student for feedback and heed what he says. Watch his facial expression and look for signs of relief, not discomfort. When done correctly on a healthy student, the rotating action can be quite strong without causing injury.

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