Yoga & Knee Pain
by Nicole Haas, PT, DPT, OCS and 2016 Colorado School of Yoga Alum
Do you ever wonder why your knee “talks” to you during or after yoga practice, even though you may pay particular attention to alignment and the cues your teacher gives while holding a pose? Do you try to keep your knee stacked over your ankle versus too far forward when you’re lunging in Crescent? And do you try to press your knee outward toward your little toe in Warrior 2? And do you use a blanket or a block to take the pressure off your knees when you kneel or sit? And does your knee still complain regardless of all your attempts and intention to align it correctly?
It’s possible you are doing everything right… while in the poses. And it’s very possible your knees are getting aggravated during the transitions between poses as you move. As in life, we can all have a tendency to rush the transitions to reach the calmness, stillness, and support of a well-aligned pose. A place where we feel stable. And when we transition slowly, it seems to take more effort and create more discomfort. Transitions can be hard…especially when you’re paying attention to them.
As a yoga teacher- and especially as a physical therapist of 18 years who did her doctorate research on knee pain- I cannot help but focus on the transitions and movement patterns between the poses, and to wonder how much attention and effort we are giving our knees as we flow. According to research on knee pain (the kind of pain on the front of your knee or related to your knee cap), it is the lack of control of the knee and hip muscle engagement during squatting and lunging type of movements that correlates with pain. And the reason I think it’s so important to focus on the alignment and control of the knee during the transitions.
How, then, can you keep your knees happy during the transitions? You can start by keeping these important things (from a biomechanical perspective) in mind as you move and flow between the poses…
Don’t allow your knee to collapse inward as you move into or out of a lunge.
Try to focus on keeping your knee lined up with your 2nd toe when looking down at it. You shouldn’t see your pinky toe peeking out from the side of your knee- that indicates your knee is diving inward in relation to your foot. Cue your outer hips and gluteus muscles to help you, to help guide your knee outward. Interesting to note, weakness in the gluteus muscles is strongly correlated with knee pain as well, and is the muscle group that prevents the knee from collapsing inward during a lunge or squat type movement.
Don't use momentum to get to the next position.
Why miss the opportunity to engage your muscles properly and work toward finding the ease of your flow and transition? Momentum can create susceptibility to the knee as it waffles back and forth, in and out over the top of your foot as you lunge and squat. You might also miss your knee’s “feedback” to you as you move in a way that aggravates it. Slowing down allows the mind-body connection to engage and pattern properly, and from the knee’s perspective, to keep it aligned and free from irritation.
Transition with intention.
Be mindful of the pose you are moving from and towards. Activate your muscles before you move to gain their support during the transition. For example, from downward dog as you lift one leg up and then step through to your thumb, engage your hip muscles and draw you knee outward as you ground through your feet to rise.
And what if your knee is already painful and gets more aggravated with yoga?
1. When squatting or lunging, avoid bending your knee deeper than 60 degrees (0 degrees = straight leg, 90 degrees= knee bent at right angle). This causes greater compression of the knee cap mechanically. For example, in standing poses, remain a bit higher in the pose to unload the knee, and focus on engaging all the hip and core musculature for support.
2. In kneeling poses, keep the pressure off of the knee cap to avoid further irritating it’s sensitive tissues. It’s common to use a blanket or double one’s mat to pad the ground for knee contact, but it’s best to pad the area of your lower leg below the knee cap so that the knee is free from pressure.
3. Avoid prolonged positioning in full knee bend, or use a blanket between your heels and your hips to keep the knees more open/ less bent while in the pose.