Like all aches and pains, knee pain in yoga can be multi-faceted and complex, sometimes caused by a variety of factors and stressors on the body.
Because of the physical nature of yoga asana, many yogis can experience problems with their knees over the course of their yogic lifetime. Though you may have to look at changing your practice in the short term, it doesn’t mean you’ll have to stop completely.
We’ll go over:
Anatomy of the knee
Much like the whole of our body, the knee is a remarkable product of human engineering, crafted to bear an incredible amount of stress while enabling fluid movement and stability.
The knee joint is an amazing structure that consists of bones, ligaments, tendons, and cartilage. At its core are three main bones: the femur (thigh bone), tibia (shinbone), and patella (kneecap).
These bones are connected by ligaments that provide stability to the joint. Ligaments like the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) prevent excessive movement and rotation.
These ligaments form a network of support that keeps the joint aligned during various activities.
Tendons also play a crucial role in knee function, providing stability in the joint. They connect muscles to bones and allow for coordinated movements during yoga practice.
For instance, the quadriceps tendon connects the quadriceps muscle to the patella while the patellar tendon connects the patella to the tibia.
There are also various types of cartilage in your knee that act as shock absorbers between bones and provide smooth movement in the joint, whilst its hinge structure facilitates flexion and extension while also permitting limited rotation to accommodate various movements.Let’s take a look at how the knee is working in Warrior 2, for example:
Front Knee:
- Quadriceps: The quadriceps at the front of the thigh are actively engaged to maintain the bent position of the front knee. They work to extend the knee joint
- Patella (kneecap): The patella acts as a protective bony structure and enhances the mechanical efficiency of the quadriceps muscles by providing a fulcrum for their action, aiding in knee extension.
- Ligaments: Ligaments, particularly the ACL and the MCL, play a crucial role in stabilizing the knee during the flexed position. They prevent excessive side-to-side or forward/backward movement of the knee joint.
Back Knee:
- Extension and Stability: The knee of the extended back leg helps support the body’s weight. Engaging the muscles surrounding the knee joint, like the hamstrings and calf muscles, provides support and stability to the extended leg.
- Ligaments: The ligaments in the back knee, such as the PCL and LCL, help maintain stability by preventing excessive movement during the extended position.
knee pain in yoga: 4 causes
When it comes to practicing yoga safely and effectively, knee health plays a vital role. The knees are intricate joints responsible for bearing the majority of our body weight during daily activities.
As we delve into various yoga poses that require bending, twisting, and balancing on one leg, the knees can undergo significant stress and strain. Failing to address knee pain can lead to chronic discomfort, reduced mobility, and even long-term damage.
Let’s dive into some of the key causes of knee pain in yoga.
1. Overuse
With so many repetitive poses in yoga, especially if you’re practicing a style like Ashtanga, we may experience strain around the knee joint and the surrounding muscles.
Certain poses emphasize specific muscle groups around the knee joint. Continuous engagement of these muscles without counterbalancing or incorporating poses targeting opposing muscle groups might create a muscular imbalance.
This imbalance could lead to overworking certain muscles, potentially causing strain or discomfort.
The repetitive stress on the knees can lead to inflammation, tendonitis, or even cartilage damage over time.
2. Alignment
When it comes to alignment, you need to remember that everyone’s body is different.
Just because a particular knee alignment feels good in one person’s body, or maybe you’ve been told by your instructor that it should feel good in your body, it doesn’t mean it’ll work for you.
Even more so; just because a man in 1950s India said ‘this’ is how a body should be aligned, it doesn’t mean that you should compromise your own body’s signals for the sake of the ‘right’ alignment of the pose.
Though there used to be, and definitely still is, a common belief that knees shouldn’t go further than your toes in certain positions, this is something that is becoming increasingly challenged.
Ultimately, this belief underestimates how strong our knees actually are.
Rigidly adhering to the ‘knees behind toes’ rule can limit a person’s range of motion, restrict the engagement of certain muscle groups, and, importantly, misjudge the knees’ capacity to adapt and handle varied movement patterns.
It can inadvertently lead people to believe that their knees are inherently fragile or incapable of performing certain movements, potentially limiting their progress and ability to explore their body’s full range of motion.
For these reasons, Kneesovertoesguy is one the most popular Instagram accounts to bust these myths – demonstrating the full capability of our body!
That being said, if you know that aligning your knees further than your toes irritates your knees or gives you pain, then stick to what feels right!
While the ‘knees-over-toes’ concept has gained traction, it’s important to note that not all knee pain, particularly patellofemoral pain (at the front of the knee), is universally alleviated by emphasizing deeper knee flexion in exercises like squats and lunges.
There’s a misconception that strengthening the Vastus Medialis muscle solely through deeper knee flexion exercises resolves all knee-related issues.
Each individual’s experience with knee pain is unique, and what works for one person may not necessarily benefit another. Consulting with a healthcare professional or a qualified fitness instructor to tailor exercises to your specific condition is crucial.
3. Other parts of the body
Knee pain in yoga isn’t always directly related to issues within the knee joint itself. Sometimes, discomfort in the knees can stem from problems in the joints adjacent to them – the hips and ankles.
For example, in tight or weak hips, limited hip mobility can shift the workload to the knees, especially in poses that require hip rotation or flexion. This transfer of stress to the knee joint can result in discomfort or pain.
Tight hips can also affect the positioning of the thighs and pelvis, altering the angle and stability of the knees. If the hips lack flexibility, it can strain the knees by forcing them into positions they aren’t suited for.
The same goes for weak or unstable ankles which may struggle to support the body’s weight, especially in standing poses. This instability can cause the knees to bear more weight than necessary, potentially leading to overuse and discomfort.
Instability or misalignment in the ankles can disrupt the kinetic chain, impacting the alignment of the knees, too.
4. Pre-existing conditions
While yoga can be a fantastic tool for healing and strengthening the body, it’s important to acknowledge pre-existing conditions or previous injuries that might affect your knees.
Conditions like arthritis can cause chronic inflammation and degeneration of joint tissues, making them more susceptible to pain during physical activity.
Past knee injuries, such as ligament tears or meniscus damage, may require extra caution and modifications to prevent further harm.
If you have any pre-existing conditions or past knee injuries that could impact your yoga practice, it’s crucial to consult with a healthcare professional before diving into intense poses.
Remember that practicing yoga with sensitivity toward your body’s limitations is a sign of true strength and self-care.
Knee pain in yoga: Tips & modifications
1. Listen to your body’s cues
Your own body’s intelligence will be more valuable here than any instructor or anatomy book. Here, focus on mindful movement and balanced muscle engagement.
This involves focusing on factors like maintaining a stable base, distributing weight evenly, engaging core muscles, and ensuring the knees track in line with the toes, rather than fixating solely on the knee-to-toe relationship.
Similarly to this, don’t let your ego dictate your practice.
Yoga is a wonderful practice that allows us to explore our physical and mental boundaries. However, in the pursuit of achieving those challenging poses, we often push our bodies beyond their limits.
I’m definitely guilty of this, ignoring my body’s pain cues in a desperate attempt to achieve a pose I’d be working so long to get!
If you start experiencing persistent pain in your knees, it’s crucial to take a step back and assess whether you’re placing too much strain on them.
Apply the practice of ahimsa to yourself, too, not just others!
2. Teacher’s adjustments
If you don’t want an adjustment from a teacher, tell them. This tip comes from personal experience!
Hopefully, with the ever-increasing knowledge of trauma-informed teaching, your teacher may have a system in place that acknowledges whether you would like manual adjustments or not – like consent cards.
If not, and you’re worried about how an adjustment might impact your knee pain in yoga, refuse the assistance.
The same goes for verbal cues, if your teacher is telling you to do something and it doesn’t feel right in your body – ignore them or politely decline!
I have been too often pressured into ‘full expressions’ of a pose that doesn’t feel right for me and paid the consequences later on.
As a student of Iyengar, I’ve had a teacher come over to me in bhekasana and push the tops of my toes all the way down to the floor – ouch! I had knee problems for months after this and was left wishing that I had asserted myself and told her not to adjust me.
3. Use props
There can seem to be a bit of stigma around the use of props, with somehow the idea that they make you a less ‘advanced’ student.
I tell my class that they actually make you a more advanced student, as you’re making an effort to practice mindfully and listen to your own body.
Advanced yoga isn’t solely about achieving the most complex poses; it’s about adapting the practice to suit your body’s unique requirements.
Employing props to modify poses according to your body’s needs demonstrates an advanced level of adaptability and self-awareness. Acknowledging the need for props embodies humility and self-acceptance.
Advanced practitioners understand that humility lies in recognizing limitations and seeking support where necessary – not to mention that props optimize alignment!
Here’s some ways I love to use props to support the knees in my classes:
- Yoga Blocks:
- Supported Forward Fold: Place a block under each hand in uttanasana to reduce the distance between the floor and hands. This eases the strain on the legs while maintaining the stretch in the hamstrings.
- Supported Bridge Pose: Slide a block under the sacrum in setu bandhasana to lift the hips slightly. This can decrease the angle of knee flexion, providing relief.
- Yoga Bolsters or Cushions:
- Supported Reclined Bound Angle Pose: Place a bolster or cushion under the length of the spine in supta baddha konasana. This supports the back and encourages relaxation without stressing the knees.
- Sitting Poses: Use a bolster, block, or cushion under the hips in seated poses like virasana or vajrasana. Elevating the hips reduces pressure on the knees.
- Blankets or Towels:
- Knee Support: Fold a blanket and place it under the knees in poses like balasana or anjaneyasana to cushion and support the knee joint.
- Chair or Wall Support:
- Chair Yoga: Utilize a chair for support in standing poses like vrksasana. This reduces the weight on the knees while allowing for balance and stability.
- Wall Support: Use a wall for stability in standing poses. The wall can offer support, allowing you to focus on proper alignment without straining the knees.
- Straps:
- Gentle Leg Stretches: Use a strap to gently stretch the hamstrings or quadriceps. This indirectly eases tension on the knee joints by improving the flexibility of the surrounding muscles.
4. Skip the pose
If the pose really causes you pain, even with the use of props and modifications, skip it!
The beauty of yoga lies in its adaptability. Skipping a specific pose doesn’t mean you’re unable to practice yoga, it just means finding alternatives that suit your body better.
I personally would never mind a student doing an alternative pose, as would many yoga teachers I know.
You could try and find a similar pose by:
- Considering the primary focus or benefits of the pose causing discomfort. Is it about stretching a particular muscle group, balance, or strength building? Understanding this essence helps in selecting a similar pose.
- Looking for poses that offer similar benefits or engage similar muscle groups but with different joint alignments or less stress on the knees.
For example, instead of utthita parsvakonasana (extended side angle), practice trikonasana (triangle pose) with props.
Both poses emphasize stretching the side body and engaging the legs and core. However, triangle pose usually involves less knee flexion compared to extended side angle, which might be more comfortable for some experiencing knee discomfort.
