Healthy Hips and Knees
Bring your lower body into balance with safe sequencing and sensible alignment.
by Marla Apt
If you’ve ever experienced knee or hip pain, you know how tenuous simple activities such as walking down the stairs or squatting can feel—let alone attempting the vast range of positions and movements in a typical yoga class. Losing the spring in your step while babying a bum knee or hip can be humbling, and fear of further injury may lead you to completely immobilize yourself, which can actually exacerbate the condition. Luckily, yoga offers many tools to create space and relieve pain in the knees and hips.
Save for acute injuries, knee and hip pain are most commonly caused by wear and tear, which can be further irritated by the subtlest asymmetry. Imbalances in the hips can disturb the alignment of the knees, and vice versa. The range of motion in the hip (a ball and socket joint) is more varied than in the knee (a hinge joint). While the knee is mostly designed for flexion and extension, the hip can also be abducted, adducted, and rotated externally and internally. Limited mobility or hypermobility in any of the movements of the hip can contort and damage the knee. For example, if your upper leg doesn’t easily externally rotate from the hip, you may compensate by turning the lower leg instead, which torques the knee and overstretches connective tissue around the joint. Through yoga we can stretch and strengthen the muscles around the hips and thighs in order to address the full range of motion in the hips, and in effect, protect the knees.
Safe Sequencing for Hips and Knees
Knee problems tend to present us with more immediate feedback than hip problems, where it may take years of joint deterioration before the pain begins to express itself. When the knee is painful or swollen, it is best to start your yoga practice with non-weight-bearing asanas. Choose poses that extend the knee and align the upper and lower leg over the knee joint, such as supta padangusthasana I (reclining big toe pose I) and upavishta konasana (seated angle pose) in the sequence below.
In weight-bearing asanas, whether the knee is bent or straight, it’s important to ensure that the knee is tracking properly. We’ll examine this closely in parshvakonasana (side angle pose), where proper external rotation of the hip allows you to safely bend the knee, and in utthita hasta padangusthasana (extended hand to big toe pose), where lining up the ankle, knee, and hip in the standing leg serves to stabilize the hip.
In bent-knee poses, make sure that the inner portion of the knee isn’t stretching or contracting more than the outer portion. If knee flexion is limited when bending beyond 90 degrees, as in virasana (hero pose), place props such as a rolled cloth or a folded blanket behind the knees to create space in the joint. Once you work on knee flexion, the knee should again be extended in straight-legged asanas.
Let’s examine these principles in more detail. Hold each pose in the sequence below for one to two minutes on each side.
Supta Padangusthasana I (Reclining Big Toe Pose I)
While this pose requires hip flexion, it doesn’t involve rotation, abduction, or adduction of the hip, so the inner and outer edges of the knee can be stretched evenly. Lie down on your back, extend your legs, and press the thighs down toward the floor. Even though your back is in a neutral position and the lumbar spine doesn’t touch the floor, the lower back should feel long. Keep your toes and knees pointing straight up toward the ceiling. Extend from your calves to your heels and broaden the soles of your feet.
Bend your right knee in toward your chest and place a belt around the ball of the right foot. Press your right hip into the floor as you raise your right leg up, perpendicular to the floor. If you can’t straighten the leg, or if your right buttock lifts off the floor, take your foot further away from your head. Pull on the belt to draw the balls of the toes down toward the floor, and extend from the back of your right knee up through your right heel. Keep the bottom of your right foot parallel to the ceiling and the toes and knee of your left leg pointing straight up.
Now move the belt back to the heel of your right foot and press the inner edge of your right heel into the belt reaching the ball of the foot toward the ceiling. Press the front of your right thigh to the back of the leg to fully straighten the leg. As you push your heel up into the belt, pull on the belt to draw the right thigh down into the hip socket. Keep the outer edge of your right hip grounded as you press the left thighbone down toward the floor. Extend from the left calf to the left heel. Make sure that the right knee is facing straight ahead as you reach up through the ball of the right big toe.
Bend the right knee toward your chest and then extend the leg on the floor before doing the pose on the left side. You can repeat this pose several times on each side to relieve pain in the knees.
Upavishta Konasana (Seated Angle Pose)
Sit on the floor with your legs extended in front of you in dandasana (staff pose), then hold your inner knees with your hands to spread your legs wide apart. With your hands besides your hips, lift your torso upright. Keep your knees and toes facing straight up toward the ceiling. If you find that your legs turn out or your lower back sinks, place a couple of folded blankets under your buttocks until you can maintain a natural concavity in the low back, and lengthen the front of the spine from the bottom of the pelvis to the top of the throat.
Press the fronts of the thighs into the backs of the thighs, and the entire backs of your legs into the floor. (If you’re sitting on blankets, reach the backs of your legs downward.) Keeping your heels on the floor, lengthen your calf muscles away from your knees toward your heels. After sitting in this position for a couple of minutes, you may be able to spread your legs wider apart: press your fingertips into the floor directly behind your hips, raise your buttocks a few inches off the floor, and push your pelvis forward so that your feet slide a little further away from each other, then lower your buttocks back down. With your legs wider apart, you may feel a stretch along the inner thighs and the inner edges of the knees. Make sure that your feet and toes are still facing straight up. Raise the sides of your waist and ribs away from the pelvis and open your chest.
To come out of the pose, hold the inner edges of your knees with your hands and pull on the legs to bend the knees; then bring your legs back together.
Parshvakonasana (Side Angle Pose)
In parshvakonasana, the bent knee should track directly in line with the middle toe of the foot. Oftentimes, because of tight adductor muscles and/or limited external rotation in the hip, the knee falls in, putting extra strain on the inner knee. Turning the thigh out properly from its source, the hip, enables you to safely and evenly bend the leg. In the process, tight inner thighs are stretched while the outer hip region is strengthened, helping to stabilize the hip joint.
From tadasana, spread your legs and arms wide apart and align your feet under your hands. Place a block behind the right foot. Turn your right foot out 90 degrees and the left foot slightly in. Turn the entire right thigh out so that the centerline of the leg, from the hip through the center of the knee and the center of the ankle line up with the middle toe of your right foot. Press the outer edge of your left heel into the floor and straighten the leg. Keep revolving the right leg as you bend the knee to a 90-degree angle, without letting the knee bend beyond the ankle. Keep the center of the right hip, knee, and ankle in line with each other.
Keep pressing your outer left heel down as you exhale and extend your torso to the right, to place your right hand on the block at the outside edge of the right foot. Bring the outer right hip forward toward the inner thigh and press your right knee back against your right upper arm. Bend your left elbow and place your hand on your left hip. Continue to root down into the left outer heel so that your weight is evenly distributed between the two legs. Roll the left shoulder back and revolve your chest and front of your pelvis toward the ceiling. To come out of the pose, press down through the left heel as you pull up through the left arm and straighten the right leg. Repeat on the other side.
Utthita Hasta Padangusthasana (Extended Hand to Big Toe Pose)
Find a wall, a shelf, or a ledge that is approximately hip height and stand facing it about one leg’s distance away in tadasana (mountain pose). Place your hands on your hips and put your right heel on the ledge directly in front of you. Straighten your right leg, and make sure that your left foot is still facing straight forward. If you can’t straighten your legs or keep your left foot facing forward, try a lower support. Press the inner edge of your left heel into the floor and press the front of your left thigh back toward the back of the leg, keeping the kneecap facing straight ahead. It should feel like the left hip is directly over your left ankle, so that the leg is perpendicular to the floor. Press your right thigh downward. As you stretch both legs, press back from the tops of the thighs (close to the hips) rather than from the knees. Keep the fronts of the thighs and knees firm, and engage the quadriceps, pulling away from the kneecaps.
Don’t sink into your outer left hip by allowing it to jut out to the left; instead, keep your weight balanced over your left inner heel and move the outer thigh toward the inner thigh. Without disturbing your left leg and hip, move the outer edge of your right hip down toward the floor and lift up out of the right side of the waist.
Exhale, bend the right knee and place the foot back on the floor into tadasana. Repeat on the other side.
In the second variation of this pose, you’ll extend the leg laterally to the side. Turn 90 degrees to the left so that your feet are parallel to the wall or the ledge. Place your right foot on your support with the toes and knee facing straight up. Keep your left leg straight and pressing back from the top of the thigh. Straighten the right leg and roll the outer right hip and buttock down toward the floor. As you rotate the right leg outward to keep the knee facing upward and the hip descending, make sure that you aren’t sinking into the outer left hip. As in the previous variation, press the inner left heel into the floor and move the outer left hip and thigh toward the inner leg.
Breathe smoothly and lift your waist and chest away from the pelvis. Release the pose and stand for a moment in tadasana before repeating on the other side.
Virasana (Hero Pose)
Virasana can address asymmetries and stiffness in the hips, knees, and ankles, while providing deep relaxation to fatigued leg muscles. Although the classical pose can prove challenging for those with joint problems, this propped variation is accessible and therapeutic. You will need four blankets and one block.
Roll two blankets together lengthwise to make a thick roll. Roll another blanket alone to make a roll half the thickness of the first one. With your knees together and your feet apart behind you, place the bottoms of your knees and the tops of your shins on the thin roll, and your ankles on the thick roll. Lift your buttocks and place the fourth blanket, folded flat, into the backs of the knees. Your feet should be pointing straight back with the toes on the floor. Place the block horizontally underneath your buttocks and on top of the ankle roll as you sit on it in between your heels. The buttocks should be able to settle downward; if you feel like you have to hold your pelvis up slightly out of the pose, add more support to your seat. As the tops of the thighs and inner groins descend, lift your torso and chest up away from your pelvis. You may feel a stretch along the fronts of your legs, but there should be no pain in the knees.
In coming out of the pose, the goal is to straighten the legs without twisting the knees. First lift your buttocks and remove the block. Place your hands on the floor in front of your knees, tuck your toes on the floor behind your blankets, and push up into adho mukha shvanasana (downward-facing dog pose). Firming the thighs and knees, press the fronts of your thighs toward the backs of your legs as you fully extend the backs of your knees. Lift your hamstrings toward your buttocks as you lower your calves and heels toward the floor.