The human knee is a deceptively simple hinge joint that flexes and extends the leg. But look closer, and you might call the knee a crazy and improbable Rube Goldberg mechanism, where the femur (thigh bone) balances the weight of the upper body atop the tibia (the larger of the two shin bones). The kneecap or patella, smaller than a mango seed, slides up and down the front of the joint without any bony attachment to the shin or thigh. This entire gizmo is knitted together with ligaments and tendons, and cushioned by fluid and cartilage. Maybe you’re thinking “Wow, a lot of things could go wrong here.” You’re right: Knee injuries are the most common reason for visiting an orthopedic surgeon.
Are some yoga poses good or bad for tricky knees? It depends on the nature of the injury and where you are in the healing stage. Standing poses, for example, are excellent for strengthening and stabilizing the supportive structure around the knees … yet can put knees at risk if improperly aligned. Trikonasana is only one “tricky asana” where knees are concerned. Others include Utkatasana (Chair Pose), Virasana (Hero’s Pose), Parsvottanasana (Pyramid Pose), lunges, and many hip openers. But the truth is, nearly any pose can be injurious if done carelessly. Whether you’ve experienced a meniscus tear, patellar bursitis, ACL strain, or other injury, a few simple asana guidelines can help:
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1. Slow down. Pay attention. Breathe. Humans are a visually oriented species, and all too often, we approach asana by “how it should look,” twisting knees out of alignment to strike a pose. Instead, practice from the inside out—how does it feel? Hone your internal awareness, learning to discern between deep stretch and pain, nerve signals and muscle signals, etc.
2. Align. In yoga, knee injuries are often a result of hip tightness or misalignments of the foot or ankle. Though the knee is primarily a hinge joint, some of us have a fair amount of rotation at the knee due to bone shape or “lax” ligaments. This means we have to be extra careful not to overcompensate for tight hips by rotating or “torquing” the knees. Nowhere is this more important than in Padmasana (Lotus Pose), but the principles that teacher Susi Hately demonstrates in this video apply to other asanas as well.
3. Substitute or modify. During class, trade tricky asanas for poses that are kinder to the knees. (You did inform your instructor about your injury before class, didn’t you?) Learn how to use props—rolled-up socks behind the knees in Virasana, for example, or folded blankets to align the hips appropriately before attempting seated poses.
4. To prevent injuries, balance strengthening and stretching. Most yogis savor the stretch, but a well-rounded asana practice also includes strengthening poses. A commonly underdeveloped muscle is the vastus medialis, the part of the quadriceps that lifts the kneecap. Swami Rama taught an exercise called Dancing Knees, simple joint movements good for warming up or strengthening, similar to those demonstrated in this video.
5. Don’t hyperextend. When you hear a teacher say “lock the knees” (ouch!), understand this to mean “firm your knees.” It might feel as though your knees are ever-so-slightly flexed, but the supporting muscles are strong, and the kneecaps are lifted rather than pushed back.
Finally, whether you are healing an acute injury or accommodating a chronic condition, practice ahimsa, the principle of non-harming, both on and off the mat. Think of your injury as an opportunity to explore more of yoga’s rich philosophy and practices.
What are some of the things you’ve learned for protecting knee injuries during asana?