Your brain and nervous system are hardwired at a primal level to be constantly on the lookout for anything that is perceived to be threatening. That threat may come in the form of an injury, what you read online about the human body, or in the words that your yoga teachers use. Read on to find out more about the nocebo effect related to yoga.
Most of us are familiar with the placebo effect: the phenomenon that if we have a positive expectation of an event, we are more likely to experience a positive outcome. If you have high blood pressure and are given a tablet every day that you believe to be the most effective medication for reducing blood pressure the likelihood is that your blood pressure will lower, even if the tablet is in fact an M&M.
Did you know that the opposite is also true? The nocebo effect is the phenomenon whereby a negative expectation of an otherwise harmless event can lead to a negative outcome (Planès et al 2016). So, if you were given an M&M each day but were told that it was cyanide you would end up with symptoms of being poisoned.
Fear-based language is everywhere, particularly in the medical world. Think about the term ‘chronic pain’. The term chronic essentially means permanent even though no experience is ever permanent. Even someone who experiences persistent pain doesn’t experience the pain at every moment. Another term is ‘treatment-resistant depression’ referring to depression that has not responded to three treatments. How would you feel if you had depression and were then told that you were treatment-resistant?
This language can also appear frequently in a yoga class setting: ‘Keep your knee above your ankle in Warrior Pose to protect your knee’, ‘Keep your knee in line with your ankle to protect your knee’, ‘Place your foot above or below your knee in Tree pose but not against it’, ‘Micro-bend your standing leg to protect your knee’ and ‘Flex your foot in Pigeon to protect your knee’ to name just a few.
These statements are not only fear-based but are generally false and can’t be backed up with sound anatomical logic. We are often taught that our knees are simply hinge joints that move in one plane. No wonder so many of us don’t want our students to put lateral force on the knee joint. In fact, our knee joints are much more complex than this and move in six different ways. They can flex/extend/hyperextend, rotate medially/laterally a small amount when flexed, move side to side when extended (roughly 6°), glide forward and back and glide side to side. These incredible movements allow us to perform the huge variety of activities that we do every day!
The way that your leg bones are naturally positioned/shaped might mean that you are slightly knock-kneed or bow-legged (valgus vs varum) which in turn means that knees will naturally gravitate inwards or outwards in some asanas such as Warrior 2. Also, the collateral ligaments that prevent medial and lateral dislocation of the knee joint are typically lax when the knee is flexed and allow some side-to-side movement. We naturally take our knee beyond our ankle every time we get out of bed or climb a flight of stairs.
Our bodies are anti-fragile which means that our tissues strengthen when stressed appropriately. But if you believe that your knees are fragile, and this message gets reinforced time and time again, you are more likely to experience pain and dysfunction in your knees.
Let’s change the narrative that has been created around the knee joint (and other parts of the body such as the lower back and shoulder.) Look after your knees, move them well and move them often. Listen to your body and respond if there is feedback. But please don’t image that your knees are fragile.
Reference:
Planès, S., Villier, C. and Mallaret, M. (2016) ‘The nocebo effect of drugs. Pharmacology research & perspectives 4, 2.
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