At some point, most of us will experience knee pain. The knee joint is essential in propulsion and weight bearing and experiences a lot of wear and tear over a lifetime. My knees first started getting angry at me from over twisting the joint in ashtanga yoga, then got angry when I started wearing a heel lift (that was a mistake!), and again flared up when I did too much jumping at a dynamic yoga retreat. Oops. Our knees – sweet little modified hinge joints that they are – are subject to forces both from our hips and from our feet. When things go astray in the ankle/calf or the hip, the knee can suffer.
In addition to an acute impact injury, knee pain can be caused by a wide range of factors:
- wear and tear over time and wearing down of connective tissue (arthritis, inflammation)
- bursitis (inflammation of bursa through friction or pressure)
- meniscus injury (small cartilaginous discs in the knee that are injured often through twisting at the joint)
- ligament tear (you have 4 major knee ligaments, including the ACL, which may be torn or severed through impact and abrupt twisting)
- patella pain (the knee cap is pulled “off-track” from it’s happy place)
- tendonitis (the quadriceps tendon that holds and slides the patella against the front of the joint is inflamed and irritated)
- hypermobility, where the connective tissue around the knee is too loose and permits structures to move inappropriately
- IT band tightness (the connective tissue band that runs along the outside of the thigh to the shin becomes overly tight, causing pain or rubbing the femur bone)
To manage your knee pain, you must first go see your doctor or your physiotherapist to understand why your knee hurts. Clearly, yoga will not be helpful for your if you have an undiagnosed ACL tear. Also, someone who is hypermobile will need different physical medicine than someone who is chronically tight. However, if you are a relatively healthy practitioner looking to maximize the good effects of your yoga practice for your knee, then here are five tips for practice to protect this essential joint.
1. Don’t do crazy poses
Yoga has lots of nutsy hip opening poses like lotus or hero’s pose, where you bend the knee and then rotate your hip. While hip opening is one of yoga’s benefits, sometimes practitioners will over-enthusiastically transmit that hip twisting into the knee. That’s a no-no. The knee – although it’s a modified hinge joint and can twist – generally likes to be treated like a pure hinge joint. When you’re practicing positions like hero’s pose, pigeon pose, or lotus pose, make sure to treat the knee like a pure hinge joint. Pretend you can’t twist it. That will help you keep the forces aligned through the joint effectively.
2. Stabilize
The muscles surrounding the knee stabilize the knee. Strengthening your hamstrings and quadriceps can help your knee to function better. Poses like purvottanasana (stretch of the east), bridge, and locust can help strengthen the hamstrings and glutes, while poses like chair, utthita hasta padantusasana A (without holding the leg up) and standing warriors can help strengthen the quadriceps. (A caveat here: strength training exercises such as squats and bridging may be more effective for you than yoga. I love yoga, but it’s not a universal panacea.)
3. Mobilize
Overly tight quadriceps, hamstrings, and IT bands can also cause problem. Issues can also arise from tight calves and tight hips (the tension transmits through the connective tissue and affects your knee). Yoga is an excellent practice for supporting mobility. Try these:
Glute/hamstring opening:
- forward folds
- reclined hip stretches (see, yoga for back pain)
Outer hip stretches (IT band, piriformis):
- figure four/thread the needle
- cow face pose
- pigeon – very carefully
- my favorite: reclined hip stretch where you take the foot across the midline of the body – yikes.
Inner thigh/groin stretch
- happy baby
- lizard pose
- wide legged forward fold
- cobbler’s pose
- janu sirsasana
Hip flexor/quadricep stretches
- high lunge
- low lunge
- saddle
- thigh stretch
4. Avoid unsupported hyperextension
If you are hypermobile (can extend your joints beyond straight), it’s very easy to “sit” in your joints without engaging your muscles. Rather than fully extend your joints, keep a slight bend so that you must engage the muscles around the joint rather than rely on ligamentous stability. Watch in in poses such as the following straight legged poses:
- triangle
- pyramid
- standing forward folds
- warrior 3 (standing leg)
5. Avoid pain, unless directed
There are different kinds of pain. The discomfort that you encounter when you stretch your overly-tight IT band is intense and teeth-gnashy. This, however, is good pain and is useful for your functionality. However, the sharp pain that you encounter in your inner knee when you squish your meniscus is bad pain. If you are encountering pain and you don’t know what it is, then you need to go see your physiotherapist or doctor and find out what is going on. Once you are empowered with this information, you can more effectively use your yoga practice as a tool for improving your strength and flexibility. Until then, listen to what your knee is saying and avoid movements that create or increase discomfort or pain levels.
We love our knees, and want to be practicing with them for a long time!
Happy practicing!
