Editor's note: This article contains general recommendations for yoga practitioners and teachers. It is not a replacement for the personal advice of a health professional. Yoga teachers should remain within their scope of practice: This means not attempting to diagnose, treat, or offer medical advice to students.
Cringing at the thought of lotus, lunges, pigeon, or other poses that place pressure on or near the kneecap or require the knee to twist? “If you have prior injuries or a history of pain, swelling, clicking, or instability, your knees may be vulnerable to the stress placed upon them in some yoga poses,” says physical therapist Bill Reif, the author of The Back Pain Secret: The Real Cause of Women's Back Pain and How to Treat It.
While every yoga pose may not be appropriate for people with sensitive knees, paying attention to alignment, modifying traditional poses, and accenting the poses that do the most good may allow you to avoid knee aggravation. Furthermore, you may even benefit your knees by cultivating strength and flexibility in the places that need it most.
The following sequence, designed with Reif’s help, strengthens the quadriceps, hip muscles, and core, and mobilizes the hamstrings and IT band. It focuses on alignment and modifications that can make a wide range of classes more accessible for those with knee pain. This sequence may also be particularly helpful for those whose knees veer inward, causing hip, knee, or foot pain.
Approaching the Practice
While doing the following yoga practice, or any yoga practice, it is wise to keep in mind any personalized alignment or movement recommendations you've received from your doctor or physical therapist. Some general knee alignment hints and modifications (discussed in more depth here and here) that may also be helpful are:
1. Don’t hyperextend your knees.
2. Aim the center points of your knees toward the centers of your feet.
Naturally, none of the suggested poses should lead to an increase in knee discomfort. While the rare pop or click is likely not a cause for concern, poses shouldn’t provoke knee clicking that is repeated or painful (which, according to Reif, could be a sign that knee tracking is off and/or that the cartilage is being damaged). As you experiment with the following practice, if your knee discomfort worsens or persists, consult with your physician.
For the following practice, you will want an extra yoga mat (or a blanket) and two blocks. To practice pose #11 as instructed, you will need a wall (or other support, such as the back of a chair). Those who cannot tolerate any pressure on their knees may want to use a chair for all of the standing poses.
Throughout your practice, breathe deeply and comfortably, in and out through your nose, and, since core work seems to be helpful for reducing knee pain—as discussed in #2—draw your belly in and up toward your lowest front ribs on every exhale.
1. Supine Bird Dog
This version of a familiar pose takes all pressure off the knees. “It doesn’t strengthen the same muscles as the usual bird dog,” says Reif, “but it supports the back by strengthening [the] core.” This pose can also trigger imagination: If other poses usually practiced on your knees are uncomfortable for you, perhaps you could invent supine versions of them, too.
Lie down on your back and arrange yourself as if you’re doing bird dog on the ceiling: Bend your knees over your hips, shins parallel to the floor. Stretch your arms up toward the ceiling and extend your wrists. Inhale.
On your exhale, draw your belly in, and—without moving your left leg and right arm—reach your right leg forward and your left arm back behind you. On your inhale, return to center. On your exhale, change sides. Repeat the entire sequence 10 to 20 times, or until you feel warm and present to the sensations in your body.
2. Side Bridge
Side bridges, along with bird dog and twisting curl-ups, were used in a study that showed that core strengthening is effective for reducing knee pain. You will need a yoga mat (or a blanket) for this practice.
Roll onto your right side, placing your right elbow under your right shoulder, with your right forearm out in front of you. Arrange your shoulders, hips, and knees along the midline of the mat. Have your knees comfortably bent and a blanket (or yoga mat) underneath your shins. Place your left hand on your left hip.
On an inhale, draw your belly in and up and lift your hips up, aiming to create a continuous line from your right shoulder to your right knee. (If at first your hips don’t lift or don’t lift much, don’t worry: Trying to lift your hips up will also build strength.) Repeat 10 to 20 times, then lie down, turn onto your left side, and repeat an equal number of times.
Like any kneeling pose or poses practiced from hands and knees, lunges (which strengthen the hips and quadriceps of the front leg while stretching the psoas and quadriceps of the back leg) can be made more accessible by placing padding such as a folded blanket or yoga mat underneath the shin(s).
Reif prefers that the padding be under the shin rather than under the kneecap in order to “take pressure off the patella, allowing it to glide properly within the femoral groove, which is important for proper tracking.” He also recommends padding your shins even if you’re not feeling strain during a pose, as pressure on the kneecap can exacerbate knee issues over time.
Roll to your side, then press yourself up into a hands and knees position with a folded blanket (or folded yoga mat) under your shins, supporting them from your ankles (or feet) to the very bottom of your knees.
Step your right foot forward, placing your heel under your right knee (placing blocks under your hands, as pictured, may help you to make this transition more smoothly). Stay where you are, or walk your hands up your front thigh to bring you upright, then place your hands on your waist. Make sure your right toes are pointing forward and your right knee is tracking toward the center of your right foot. (You should be able to see your big toe.)
On your next inhale, back up out of the pose slightly, straightening your front knee somewhat.
On your exhale, draw your belly in and bend your front knee a little deeper, but make sure you feel no strain. (Feel free to bend your knee less than the 90 degrees often given as a target.) As you bend and straighten your front knee, breathing all the while, make sure your knee continues to track toward the center of your front foot.
After several repetitions, find a sustainable depth in your lunge, and remain there for several breaths, raising your arms overhead if you like.
Then bring your hands down to either side of your front foot, and switch sides.
To take pressure off both the back and front knee in a lunge (or other bent-knee standing poses, like the warriors you’ll do later), and to accommodate decreased ranges of knee movement or stability challenges, use a chair to support the thigh of your bent leg.
Sit tall on the edge of the left side of a chair seat. Step your left foot back a comfortable distance, curling your left toes under. Stay here for several breaths, holding on to the chair seat for stability, or reaching overhead or as high as is comfortable. Then lower your arms if you lifted them, scoot to the other side of the chair seat, and repeat the pose on the other side.
4. Downward Facing Dog
In addition to providing a hamstring stretch, downward facing dog affords a clear view of your feet and knees, potentially helping you refine knee and toe tracking.
From your lunge position, come to hands and knees, then move your knees back two or three inches. Curl your toes under and lift your hips to come into downward facing dog. Inspect your feet and your knees. Ensure that your feet are hip-distance apart with your middle toes pointing forward. Check that your knees are aiming toward the center of your feet.
Walk your dog, exhaling to bend one knee, inhaling to straighten it, then changing sides. Explore this movement for several breaths, keeping your knees tracking toward the centers of your feet.
5. Half Forward Fold
Pressing the hands into the shins in this hamstring-lengthening pose is often discouraged since it can tip the shins back, encouraging the knees to hyperextend. Placing the hands on blocks underneath the shoulders is one tried-and-true way to avoid this, but here is another strategy you could explore to prevent hyperextension:
From downward dog, walk your feet forward to the front of your mat. Position your feet roughly hip-distance apart and line up the outside edges of your feet with the long sides of the mat.
Place your hands on your shins bringing your torso parallel to the earth, or as high as needed in order to move your spine into a neutral position (where there’s a gentle inward curve of the lower back). If your back is rounding and/or the stretch at the back of your legs is extreme, bend your knees, making sure your knees track toward the centers of your feet. If your legs are straight, press your shins forward into your hands until your shins are vertical (or close) and your quadriceps engage. Stay here for several breaths, then walk your hands up your thighs, keeping your spine long on your way up to mountain pose.
6. Chair Pose
According to Reif, chair pose not only builds strength in muscles that help with knee tracking (the quadriceps), it can also help students learn how to squat by hip-hinging (which will reduce strain on the knees). To effectively explore the hip-hinge in chair pose, resist the temptation to move into this pose by first moving your knees forward. Instead, Reif advises moving your hips back first, keeping the weight balanced over the middle of your feet as you hinge your spine forward.
He also emphasizes that going deep isn’t necessary: “Since more bend can mean more strain, those with knee pain may want to significantly lessen the depth of any squat and lunge.” (You can also practice this pose from a chair, sitting tall on its edge, carefully aligning your feet and knees, then lifting your hips up for a breath or two at a time.)
From standing with your feet hip-distance apart, toes forward, and arms alongside you with palms facing in, move your hips back and down, bending your knees slightly and sloping your spine forward. Make sure you tip your tailbone back enough that your lower back curves in slightly. Reach your arms up as high as you comfortably can.
Explore how deeply you can bend your knees without feeling any discomfort. Make sure to aim them toward the centers of your feet, and do not bend them past your toes. Stay here for several breaths, drawing your belly in and up on each exhalation, then stand upright in mountain pose.
7. Warrior I Variation
Warrior I, among its other benefits, challenges the quadriceps and hip muscles of the front leg. Practicing it with a shorter-than-usual stance enables the front knee to bend less, which is important for people with knee sensitivities. “Less bend means less stress on the joint,” Reif reminds. He also adds that a shorter stance “provides greater control and more stability for those who need it.”
Standing in mountain pose with your feet hip-distance apart, root your right foot down and step your left foot back about two or three feet. Turn your left leg out just enough that your left knee and left big toe point toward the front left corner of your mat. Lift your left inner arch and inner ankle.
Bend your front knee, being careful not to let it go much past your heel. (If you can comfortably bend your knee more, step your back foot farther back so that your front knee can stay over your front heel.) Lift your arms overhead, reaching through your fingertips. Stay here for several breaths, then repeat the next three poses on this side before moving on to the second side.
8. Warrior II Variation
Warrior II strengthens the quadriceps of the front leg and the external rotators and abductors of the front hip, but the traditional “tightrope” (heel-to-arch) alignment of this pose can cause the front knee to drift in the direction the pelvis is facing. Practicing this pose with a warrior I stance instead necessitates less of a front-knee bend and promotes healthier knee tracking.
Keeping your legs steady and your right knee pointing toward the middle of your right foot, turn your chest to face the left, reaching your arms out wide in a T shape. (Adjust the angle of your back foot for comfort; feel free to turn it out more, bringing the outer edge of your back foot closer to parallel with the end of the mat.)
Stay here for several deep breaths, then repeat the next two poses before returning to warrior I.
9. Reverse Warrior Variation
Reverse warrior strengthens the quadriceps and hip muscles of the front leg, but because placing a hand on the outside of the back knee could exacerbate knee problems, keep your hand light, or try this version:
From warrior II, bring your left hand to the left side of your waist. Turn your right palm up and lift your right arm overhead as you side bend to the left as far as feels good.
Stay here for several breaths, using your inhales to create an expansion of the left side of your waist as well as your right, and drawing your belly in and up on your exhalations. After several breaths here, come back to an upright position to set up for triangle on the same side.
10. Triangle Variation
Triangle, which strengthens the front hip and stretches the hamstrings of the front leg, is a pose in which the front knee can easily hyperextend in those who have more ligamentous laxity. Putting the bottom hand on a block or chair seat is one way to avoid the pressure on the front shin that can cause hyperextension; here is another method:
(Note: Maintaining the same footing here as in the modified version of warrior I can also help with stability and knee tracking. If you still feel unstable in this pose, practice it with your back foot adjacent to a wall.)
Straighten your front leg, and, keeping your left hand on the left side of your waist, reach your straight right arm and your torso toward the front of the mat.
Bring your right hand to your right shin. Keep it light; instead of pressing down with your hand, press your right shin up into your hand until the quadriceps of your right leg engage. Reach your top arm straight up if you like.
After several breaths here, root down through both feet and return to upright. Turn to face the front of the mat, ground your right foot, and step back up to the top of your mat. Repeat poses seven to ten with the left foot forward.
11. Dancer Pose Variation With a Wall
Any standing balance pose places much of the body’s weight on the standing leg, and wobbliness can disrupt knee tracking. To mitigate this while balancing in dancer, a pose which can help build core and hip strength, keep the toes of the lifted leg down and/or touch a wall (or other support, like the back of a chair).
Additionally, for some people, the traditional form of dancer pose, in which you grab your lifted ankle with your hand, can exacerbate knee problems. Reif explains, “Those with limited knee flexion may have difficulty reaching the ankle and to do so, they may torque the knee, pulling the ankle inward or outward from a direct line with the thigh.”
And while the pose is often modified by using a strap, Reif points out that a strap can actually give you more leverage, allowing you to pull your knee off course. Hence this variation, which while less risky, is challenging in its own way, as it may be harder to balance without holding the ankle.
• Stand an arm’s length from the wall in mountain pose, with your feet hip-distance apart and parallel. Bring your left hand to the wall at shoulder height. Straighten your right arm alongside you, touching the outside of your right thigh with your right hand. Inhale here.
• On an exhale, step your right foot a few inches behind you, right knee slightly bent, right toes curled in under you. Do not externally rotate your right leg; keep your right toes and right knee pointing forward. Come into a slight backbend, lifting your chest forward and up. Bend your left elbow as your chest approaches the wall. On an inhale, step your right foot alongside your left and return to mountain pose. Change sides on your exhale.
• Repeat this movement several times, lifting your back foot if possible. Then hold the pose on one side for a few deep breaths before switching sides.
12. Quadriceps Strengthening With Yoga Mat or Blanket
According to Reif, placing a prop under the knees can create a “target or goal” that helps us perceive the contraction of the quadriceps. In this movement, a rolled-up blanket or yoga mat not only provides this feedback to the backs of the knees, it minimizes hyperextension.
From standing, come down to the mat by lowering one knee then the other into a kneeling position, supporting the shins with padding, or by stepping back into a lunge, lowering one shin down onto padding and then the other. Sit back and swing your legs out in front of you.
Slide a rolled-up blanket (or yoga mat) under your knees as you arrange your legs for staff pose: feet hip-distance apart, heels down, toes and knees pointing straight up. Place your hands alongside your hips, or walk them back as necessary in order to curve your lower back in and lift your heart up.
On an exhale, draw your belly in and press your right knee down into the roll, keeping your spine long and your right heel down. On your inhale, relax.
On your exhale, keep your left heel down and press your left knee down into the roll. Alternate until you have repeated the movement 10 to 20 times on each side.
13. Sage’s Twist
This twist stretches the area around the IT band, which may be tight for some people with knee pain.
Remove the padding from under your knees. Straighten your left leg (heel down, knees and toes pointing straight up) and bend your right knee up toward the ceiling, placing your right foot on the mat inside or outside your left thigh. Bring your right hand to the mat a few inches behind your hips (or as far back as necessary to lengthen your spine).
On an inhale, reach your left arm up toward the ceiling. On an exhale, twist to your right, hugging your right knee with your left arm or bringing your left arm to the outside of your right knee with your forearm up and palm facing right. Stay here for several breaths, pressing your leg into your arm and your arm back against your leg. Then unwind and practice the next pose before repeating both on the second side.
14. Head to Knee Pose
This pose stretches the hamstrings, which are tight for many with knee pain, and requires careful attention to the actions of the feet and legs.
With your left leg still straight out in front of you, open your right knee to the right and place your right foot on the inside of your left thigh. If your right knee is lifting, and you feel discomfort in your knee or hip, place support (a blanket, block, or a rolled-up yoga mat) under your right thigh.
Bring your left hand outside your left hip (or slightly back behind you if your hamstrings feel tight), and place your right hand on the outside of your left thigh. Point your left toes toward the ceiling, working to make your left foot look like it’s pressing into a wall (or use an actual wall). If you feel a stretch here, stay upright (or lean back) for several breaths.
For a deeper stretch, if accessible, slope your spine forward over your left leg as you slide your right hand toward your left shin or ankle (as pictured above). Press down with your left hand to help you project your heart forward, and pause at the first place you feel a stretch. Spend several breaths at that place before returning to an upright seat and repeating pose #13 and this one on the second side.
15. Bridge Pose With Two Blocks
Using blocks in bridge pose not only promotes healthy knee tracking, says Reif, it also provides feedback that helps us both perceive and create greater muscular contraction. “Just make sure you are squeezing the block with your thigh muscles and not your bony knee joints,” he adds.
From your seated position, bend your knees toward the ceiling and bring your feet to the floor. Place a block on its flattest setting between your feet and a block on its narrow or medium height between your thighs. (Note that the blocks are there, in part, to help keep your knees and toes in line with each other and hip-distance apart; if you need to adjust them based on your proportions, please do.)
Lower onto your back, your heels underneath your knees and your arms alongside you. Tip your pelvis forward enough that your lower back curves in gently, and keep this lumbar curve as you proceed.
Press down with your feet, squeeze the bases of your big toes and your inner thighs into the blocks, and lift your hips up as high as is comfortable. Walk your shoulders closer to each other and interlace your hands under your hips if that feels good in your shoulders. Or you can keep your arms alongside you or grab the outside edges of your yoga mat. Stay here for several breaths.
Lower down slowly, without letting your feet lift, continuing to press your feet and thighs into the blocks. Repeat two to three more times.
16. Supine Figure Four Pose
Pigeon pose and standing figure four pose may strain sensitive knees. According to Reif, the dorsiflexion of the top foot instructed in the pose below may prevent the stress on the outside of the knee that “sickling” your foot could cause. Stick to this supine version to stretch the gluteus medius, maximus, and minimus and piriformis of the top leg while providing a light challenge to the same muscles on the other side.
Remove the blocks from between your knees and feet, and return to your pre-bridge position: feet hip-distance apart below your sitting bones, knees over heels. Bring your hands to your hips, root down with your left foot, and cross your right ankle over your left thigh. Draw your right toes back toward your right shin.
Notice if your hips have skewed: Did your right hip drop, or your left hip hike closer to your shoulders? Lengthen the left side of your waist. Drop the left side of your pelvis and lighten the right side of your pelvis. (This will require effort from the muscles around the left hip.)
Keeping this pelvic alignment (which will probably cause your right knee to move closer to your chest initially), bring your right hand to your right thigh and gently press your right leg forward.
Stay here for several breaths.
If you need a deeper stretch, keep your right hand on your right leg as you bring your left hand behind your left thigh, and draw your legs closer to your shoulders, lifting your left foot up off the floor. Keep your left hip heavy and the left side of your waist long. Stay here for several breaths.
17. Savasana With Knee Support
According to Reif, support under the knees can relax the hamstrings (and create slack for the sciatic nerve), which may be refreshing after a practice that has placed high demands on the legs.
Place your rolled-up blanket or yoga mat underneath your knees before you sprawl out into your savasana. Spend several minutes here, allowing your legs to surrender their weight into the support beneath them.
Photography: Andrea Killam