Precise cues about foot placement are really common in yoga, from “Step your feet hip distance apart” to “Turn your back foot in 45°” and “Have the outer edges of your feet parallel with mat” to name just a few.

I used to be incredibly precise with my teaching cues in the past. In Mountain Pose, to find a stance with the feet ‘hip-distance wide’ I’d ask students to line the mid-point of their ankles directly below the bony parts at the front of their pelvis (Anterior Superior Iliac Spines or ASIS). I’d then ask them to line the base of their second toes up with the mid-point of their ankles to get their feet parallel. In hindsight that might have worked well for a couple of students in a busy class, but it won’t have worked so well for all the other students, based on their own unique anatomy.

The orientation of the quadriceps muscle force is expressed in terms of the Q-angle and was first described by Brattström (1964). The Q-angle approximates the resultant force orientation of the four muscles of the quadriceps group acting on the patella (kneecap). The Q-angle is defined as the angle between a line connecting the center of the patella and the patellar tendon attachment site on the tibial tubercle and a second line connecting the center of the patella and the ASIS when the knee is fully extended.

There are not any universally accepted normal or abnormal values of the Q-angle, which may be due in part to the absence of a standardized measurement position. A study by Emami et al (2007) established 13.5° ± 4.5° as the mean Q-angle for healthy subjects between the ages of 18 and 35 years, regardless of gender. They found that the mean Q-angle for women is 4.6° higher than that for men.

Tetsworth and Paley (1994) state that alignment in the lower limb is determined by the line extending from the center of the hip joint to the center of the ankle joint. This can be referred to this as the mechanical axis or weight-bearing line of the limb and is best judged by radiography. In genu varum (bow leg), this line passes medial to the knee and increases the force across the medial compartment. In genu valgum (knock knee), the load-bearing axis passes lateral to the knee and increases the force across the lateral compartment (Levangie and Norkin 2005). Both genu valgum and genu varum are commonly reported knee joint variations and are more frequent in women (Kendall et al 2005). 

Genu varum develops as a normal variation in many toddlers, straightening at around 2 years of age and reversing into genu valgum at approximately 3 years of age. This is then typically followed by gradual reduction of genu valgum to the normal adult level of 5° to 7° by 6 to 7 years of age (Lee et al 2009). Genu valgus may also be seen in early adolescence when it is thought to be a result of rapid growth. 

Relating this to yoga, it is important to note that the common principle of keeping the knee in line with the center of the ankle in such poses as Chair Pose (Utkatasana) becomes arbitrary. This principle will work well for some students who lie in the middle of the knee alignment spectrum but will not work so well for all the students who lie off-center on the spectrum. I might phrase this by saying to my students “In this pose we generally keep the knees tracking in line with the ankles, but this won’t work for everyone’s’ anatomy. Let’s focus more on how our knees feel in this pose, making adaptions when we need to.”

When it comes to standing in Mountain Pose, I now always go back to ‘the why informs the how.’ When I become clear about why I am teaching this pose in a class I can become clear on *how* to teach it. I often suggest that my students explore finding a standing position that allows them to feel tall, engaged, connected to their breath, centered et cetera. One teacher told me that she asks her students to jump and see how the position they land in feels for them. I love that! Alignment can be useful as a template or framework, but we must be open to deviating from it to make yoga inclusive to each unique body. It is much more effective to focus on what a position feels like and not what it looks like.

Do you see precision showing up in the way that you cue asanas and how could you tweak that to make your teaching more inclusive?

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References:

Brattström, H. (1964) ‘Shape of the intercondylar groove normally and in recurrent dislocation of the patella.’ Acta Orthop Scand 68, 1–44.

Emami, M., Ghahramani, M., Abdinejad, F. and Namazi, H. (2007) ‘Q-angle: An Invaluable Parameter for Evaluation of Anterior Knee Pain.’ Archives of Iranian Medicine 10, 1, 24–26.

Kendall, F., McCreary, E., Province, P., Rodgers, M. and Romanin, W. (2005) Muscle Testing and Function with Posture and Pain. 5th edition. Philadelphia: Lippincott Williams & Wilkins.

Lee, M., Perez-Rossello, J. and Weissman, B. (2009) ‘Pediatric Developmental and Chronic Traumatic Conditions, the Osteochondroses, and Childhood Osteoporosis.’ In B. Weissman (ed) Imaging of Arthritis and Metabolic Bone Disease. Philadelphia: Saunders Elsevier.

Levangie, P. and Norkin, C. (2005) Joint structure and function: A comprehensive analysis. 4th ed.Philadelphia: The F.A. Davis Company.

Tetsworth, K. and Paley, D. (1994) ‘Malalignment and degenerative arthropathy.’ Orthop Clin North Am. 25, 367-377.