Q: I have a rupture of the inner meniscus in my knee. Are there any restrictions or suggestions?  The doctor said all postures like child natural seat,  tortoise where I am bending the knee really strong are forbidden…but I have no pain when doing them.

from Brahmi, Senior-Level TriYoga Teacher and Director TY Boston 

Usually with a torn meniscus pain is the guiding factor. But if there is no pain, here are the guidelines I would offer (which reduce pain):

The general guideline is to lift the hips higher, to reduce the amount of weight and flexion in the knee joint, and use modifications to reduce or eliminate weight bearing in knee flexion. It is not that these movements are “forbidden”, it’s just that these movements are somewhat painful or totally inaccessible due to pain.

In child, put a small pillow between the hips, calves and back of thighs. This reduces the flexion and the amount of weight on the knee, or keep the hips lifted. Some students who keep their hips high in the air and their hands are on blocks. Can also have a folded blanket, small pillows or foam under the knee.

For Natural Seat sit on blocks or leave it out. There is always the option in flows to go from Child to Cat Tuck to Cat instead of Natural Seat.  Another option is to come to kneeling (may require padding under knees). Same goes for Toe Stretch. If there is pain putting pressure on the knee, a small pillow can be placed on the shin just behind the knee and there is no weight on the knee at all.

Tortoise may be totally inaccessible but the solution is the same – lift the hips until it is comfortable. If 2 blocks does not work, then leave out.

In Basics, Leg lifts, Bridge Rolls (with a lot of attention to alignment of feet and knees), and Half Locusts are very good. If the knees hurt in Bridge Rolls then feet can be on blocks.

The most beneficial asanas for strengthening the quads which support the knees: Wall Chair, Warriors, and Extended Squat. For Warrior the foot and knee MUST be in alignment. Out of alignment one centimeter can bring bone onto bone – very painful. For the transition from Side Warrior, have a block on the outside of the knee and press hand into the block and strongly engage the core for that transition. It keeps the pressure off the knee.

Swan can sometimes be very painful. For flows keep the foot close to hips. For Asana put a bolster under hips, and do not bring the foot out very far. For some the foot is almost under the hips and the hips are high.

If Swan is an issue, Cradle can also be an issue. If there is pain in the knee the remedy is to have the knee further away from chest. There are always three options: Foot to earth, Foot to 1 or 2 blocks, or knee to chest with strap or hands around knee. Also, in Swan, Cradle and Tortoise flexing the ankle and pressing out through heel can relieve tension in knee.

The quarter turn from Squat Tortoise to Pyramid may also require extra attention or modification: weight bearing with the knee at an angle is not a good idea for any knee, so best to take it in steps.  First 1/4 turn to Half Tortoise, then Squat Tortoise with knee directly over heel and knee cap tracking over toes, then Pyramid with attention to alignment of the knee.

Tortoise Toe Stretch 2 can be helpful if sitting on blocks and very small movements : at first the knee may only lift an inch ~  but still get a toe stretch 😉

In Level 3, jumping from Tortoise to Forearm Stand may put pressure on the knee, so may be best to stay with Level 2 variation of walking one foot then the other.

I have had 3 knee surgeries and have very advanced arthritis in my right knee. I am now able to do Child, Natural Seat, and Tortoise (sometimes need a pillow for that – knee can get stiff). It took me years to gain these back. But I think it is a hopeful message.