Keywords: Knee contractures (April 2004)

ORIGINAL QUESTION:

I'm currently working with a disabled child 9 years old who has "knee contractures" that reduce extension by about ten degrees. The physical therapist that works with him say's they are workable and it is possible to reverse them. I worked with her and saw her method and it made me want to get another opinion. My student was in severe pain. I believe the knees have contracted because his legs rarely if ever reach full extension, he does not walk and spends most time in wheel chair or laying on back with knees pulled up part way, even during sleep. We are addressing the sleep position now.

Any advice or experience?

Blessings,

Jeff Moore

ANSWERS:

From Dr. J. Addarich, DC AYTT 10/03

Dear Jeff,

Contractures are tough to work with. It really depends on how long the contractures have been present. Once tissue shortens and contractures develop, to my understanding, they are irreversible. (Maybe at such a young age if the tissue is repeatedly torn with aggressive stretching and then treated with Ultrasound to aid in reducing the inflammatory response, new tissue can form, or maybe even surgery could help, by replacing the ligaments or even a joint replacement...not my expertise, but questions to ask the clients parents?)

You can help keep the joint from deteriorating too quickly by passive mobilization, which is what the PT does. It can be very painful for the client of this work. If the child doesn't practice daily stretching, be it active on the child’s part via Yoga, or passively with you or a PT stretching the joint for him, then the outcome won't be favorable.

Yoga and PT are both great because the goal is to keep the joint around which the tissues have contracted from deteriorating too quickly. A joint will begin to show signs of deterioration within 24 hrs of being immobilized, that's why motion is so important.

I hope this helps you.

~~~Peace, Dr J

From Le'ema Graham:

Dear Jeff:

I'm thinking three things: sacrum, sacroiliac, and psoas....restorative poses w/bolsters for lengthening through gentle forward and backward bends...also the use of Essential Oils for pain which you can contact me personally for more information as to which ones to use...call me toll free @ 888-442-4497...I would love to help...I work w/yoga for special needs, kids and teens...

Namaste,

Le'ema

AYT 2000

From Aumkara Newhouse:

Hi Jeff,

In addition to sleep habits, wheel chair, etc. what other environmental effects are there? Possibly the fight or flight response could be an issue shortening the hamstring adding to the challenge. Music could be an issue,what does the child listen to?

Blessings in AUM,

Aumkara

From Tara Brown:

Hi Jeff-

I am five weeks post surgery for an ACL (anterior cruiciate ligament) in my right knee. The thing that has helped my extension the most (and can be painful) is simply sleeping on my back in Savasana. Quad contractions pressing the knee down helps. And laying prone over a bed with weights on the ankles also works.

I'd ask him to lie on Savasana at home.

Best regards,

Tara Brown

From Pam Blasco,

Hi Jeff,

I am very interested in what your experience and findings will be. We have two boys (men) who have special needs. I have been asked to teach special needs adults yoga this fall. This is a very exciting prospect, as it is close to my heart, and I feel a tremendous sense of fulfillment working with this population. Divine Mother is working overtime bringing this to me. My experience is more with mentally challenged people with some physical limitations (gross and fine motor). I will be following the e-mails. I find breath work is always a great place to begin.

I completed YTT in 1999, and return for w/s twice a year. I teach in three studios, one that I have with a partner, and another belongs to my daughter.

Joy to you,

Pam

From Claudio – Yoga teacher in Ananda Assisi (Italy)

Dear Jeff,

Swami Kriyananda in presenting Paschimotanasana, in his book "The art and Science of Raja Yoga", addresses the issue of chronic tightness behind the knees.

He says that it is "the result of a mental shrinking away from expected dangers and difficulties" (hard to imagine for a so young boy! Nevertheless, it can be an old habit).

"The stretch behind the knees helps to release certain deep-seated psychological tensions. .....Releasing the tension behind the knees can help, indirectly, to overcome a sense of insecurity."

Please read the whole paragraph if you can, because it will give you directions on how to approach this disability with yoga posture.

In His joy

Claudio

From Gerry Swan AYTT 8/02

Jeff - Congratulations for searching for a less painful way to help your student. Is knee contracture a problem with the knee itself, or does the knee remain bent because of chronically shortened leg muscles?

A movement that has helped me to relax constricted leg muscles is to lie on my stomach. Inhale, exhale, relax. On an inhale bend my left knee so that the heel of my foot is as close to my bottom as possible. Then slowly, in rhythm with an exhale allow the lower leg to move towards the floor. Relax totally. Bend the same knee on an inhale, but this time bring the leg to a 90 degree angle to the floor (not so close to bottom). Then slowly in time with the exhale allow the lower leg to move towards the floor. Relax totally.

Finally, bend the knee on an inhale, bringing the lower leg to a 45 degree angle to the floor. On the exhale, allow the lower leg to move with the breath towards the floor. Relax totally. Repeat with the right leg. The pattern of these three movements including the total relaxation seems to allow the muscles to extend. Simple and effective. I hope this works for your student.

In a case where the knee is restricted and the leg cannot move to a totally extended position on the floor, perhaps a pillow(s) could be used so the leg muscles are supported and can fully relax.

These movements were taught to me by Stuart Moody - thanks Stuart! Best of luck to you Jeff, and your student.

from Elisa AYTT 2003

Hi Jeff

My advice has nothing to do with yoga but, I was a volunteer for one year in Betty Wright warm pool and we helped children and adults with this kind of problem, too.

Warm water really helps to relax deeply and then to go further with the stretch.

It works. I saw some amazing things during this time and you can join some yoga stretching posture and warm water

If you need more information, I can give you the number of this pool.

joy and sun

elisa DIVOUX ( justeuneladybird@hotmail.com )

From David Ramsden:

I found some information on the Internet at:

http://www.thera-bandacademy.com/IV__Resource_Library/iv-a-2-a.html

I am not sure if it is helpful (they're selling a product), but it does talk about methods of stretching.

David Ramsden

Portland