Yoga for healthy knees

Knee pain and knee injury are unfortunately common. The knee joint is a hinge joint. This means that the knee can open and close, just like a door. Anatomically speaking, it mainly allows for flexion and extension, with very little rotation. Its ligaments allow for and restrict movement. When the ligaments around the knee are in a relaxed position, they allow movement. When they are tight, they restrict movement. When the knee is extended (straight), the ligaments are tight and restrict movement. When the knee is bent, there is more movement possibility.

This is why in standing poses there is a strong emphasis on lifting the knee cap, not as a cosmetic ideal, but to keep the knee structure strong and allow the surrounding muscles to stretch.AND, we need to practice discernment of this principle when healing from an injury or working with very tight surrounding muscles. ie: bend the knee lightly and work gradually over time toward a straight knee.

Yoga can be a great tool for knee health and injury recovery.

In this detailed blog, find tips and modifications on how to help knee pain and prevent knee injury.

In Supta Kapotasana Hands hold under the knee
The Top foot is flexed

1. Increase hip-joint mobility

The knees are often forced to compensate for the lack of mobility or stability in the surrounding joints, especially the hip joint. In poses that require internal or external hip rotation, the knees are at great risk if the hip mobility is not sufficient and the practitioner does not recognize it.

Therefore, keeping our knees safe starts with safely increasing the mobility in our hip joint. Focusing primarily on stretching the muscles that resist external rotation, such as the glutes and the 6 deep lateral rotators. A great pose for safely increasing external rotation in the hip joint is Supta Kapotasana (aka thread the needle or reclined Pigeon Pose). As you don’t use your body weight, this pose is low risk. Notice the hold inside the knee and the foot in flexion.

2. Use your feet

We can stabilize (thus protect) the knee joint by using the whole of our feet. Lifting the toes and spreading them back down. Also, try ‘flointing’ the foot of the leg which is in external hip rotation. The “floint” is a stretched (extended) foot, leading with the ball instead of the toe. This decreases the chance of an inappropriate rotational strain on the knee joint.

Practice it in wide-legged standing poses, and in hip-opening poses (such as Ardha Kapotasana aka 1/2 Pigeon Pose) where the externally rotated knee is more bent (more closed) and there is little space between the calve and thigh. Examples below

“Flointing” the foot

3. Elevate your pelvis and your knees to prevent knee rotation

The knee and hip joints are intimately related in function. Lifting the pelvis in relation to the knees can increase our range of mobility, therefore preventing knee pain and reducing the risk of injury. For example, placing a blanket or bolster under the front buttock in Kapotasana (Pigeon Pose) greatly reduces the risk of straining that knee into an inappropriate rotation.

Supporting the knees can also help us keep our knees safe. An example is placing blocks (or blankets) under the bent knee in Janu Sirsasana. Keeping the knee where we brought it by engaging in a safe external hip rotation prevents us from pressing our knee downward as we extend our upper body forward.

Elevating the pelvis in seated hip-openers facilitates the rotation of the hip joint. Supporting the knees with rolled blankets or blocks assures that the knee is resting and not dangling (and therefore experience rotational force).

Janu Sirsana with knee support
Kapotasana with pelvis support
Baddha konasana with forward extension

4. Don’t hyper-extend your knees

Hyper-extension of the knee, especially when weight-bearing, can cause strain to the joint, as it puts unhealthy tension on ligaments (the anterior cruciate ligament -ACL, posterior cruciate ligament – PCL, and popliteal ligaments -along the back of the knee). Over time, hyper-extension of the knees can lead to swelling, pain, and a limited range of motion. If you are prone to hyperextension, work more on your stance. The knee is highly influenced by the alignment of the feet. When the ligaments on both sides of the knees are equally strong, the kneecap slides without restraint and the cartilage below the patella doesn’t wear down.

Practice Tadasana everywhere
Use support to practice one leg balance

Balancing poses with straight standing legs, train the muscles in the feet, ensuring a healthy arch and optimal weight distribution.

5. Don’t flex your knees to their maximum

When there are knee issues, avoid flexing the knee to its maximum. In seated postures such as Vajrasana, Virasana, or Adho Mukha Virasana (child’s pose), support the pelvis, so the knee does not have to bend fully. You can also use a rolled blanket as a wedge between the calves and thighs or right in the back of the knee to further protect the knees. If none of these modifications work for you, use chairs or other furniture to sit on and lower your forehead.

Vajrasana and Adho Mukha Virasana variations

6. Keep your kneecaps off the floor

If you experience pain in kneeling poses such as Bharmanasana (tabletop), try elevating the shins, so there is no pressure on the kneecaps.

Bharmanasana w/ knees lifted

7. Easy does it

A common mistake that can lead to injury in wide-legged standing poses such as Virhabadrasana poses (Warrior Poses) is to “push into the knee” to flex the hip. Instead, find your appropriate stance, flex your hips and release your pelvis down, bending the knees without pushing into them.

And, for knee issues, don’t aim to come into a wide warrior stance, keep your feet closer to insure knee alignment. The front knee is stacked above or behind the ankle and the kneecap points toward the second toe. keep the arch of the foot active by lifting the toes and spreading them back down. You can also support “floint” and/or support the foot:

Virabhadrasana w/foot support- straighten your left elbow, Laetitia!

8. Don’t squat too low

People with knee issues or pain should be very careful with lowering the hips below the knees.  Therefore, postures such as the Malasana (deep squat) and Kakasana (Crow Pose) should be avoided.

9. Use a block between your shins to keep your knees aligned

Place a block just below your knees, hugging a block between your shins in standing postures such as Tadasana (mountain pose) Uttanasana, and Utkatasana (Chair Pose). . This modification helps to maintain a safe alignment in which the knees are aligned with the middle toes.

On the way to Uttanasana – release your neck, Laetitia!
Utkatasana

These are just some of the ways we can use our body, modify and use props to support healthy knees until we are 103!

If you are dealing with knee problems, Contact me for a private Yoga therapy session.