The knee joint is a brilliant collaboration of bone, cartilage, and ligaments. It’s the largest joint in the human body and is considered to be the most complex—allowing human beings to crawl on the ground, kneel, sit, walk, run, and stand upright.
Despite the genius of design, however, the knee is the recipient of most orthopedic surgeries. It is estimated that by 2030, total knee replacement surgeries will grow 673% to 3.5 million per year. In addition, knee pain is the number two cause of chronic pain; more than one-third of Americans report being affected by knee pain. The causes of knee pain can range from osteoarthritis to dislocation from sports injuries, and more and more doctors are recommending yoga as part of the pain management and healing process. On the other hand, there is the risk that if we don’t properly take care of our knees while doing yoga, we can exacerbate pre-existing knee conditions—or even suffer new knee injuries.
The following suggestions and modifications to common yoga poses can help you protect your knees, whether you currently have knee pain or just want to make sure you never do.
If you do already experience knee pain, take a moment to consider which style and pace of yoga will be most suitable for your knees. You should also consider the educational background and training of your yoga instructor, seeking someone with a yoga therapy background or orthopedic or physical therapy experience. Slower-paced classes with longer holds are going to allow for more attention to critical alignment of the joints. Classes that include jumping and variations of padmasana (lotus) in every session may not be the best choice if you’re dealing with injury—or at least you may need to modify how you transition in these classes, even sitting out some poses to make the class suitable for you. Finally, as with any other exercise regimen, before undertaking a yoga practice you should get a doctor’s recommendation on range of motion and position restrictions and guidelines (especially when returning to yoga after surgery).
Regardless of the state of our knees, every yoga practitioner should know what a stretch feels like when it’s safe for the knee. While everyone may have a slightly different experience of a stretch, a good rule of thumb is that sensation in the muscle above the knee joint is fine, whereas a sensation of pulling at the sides of the knee or under the patella (kneecap) is reason to back away from a movement. A classic example in which sensation in the knee can warn you to back off is lotus pose. In order for a leg to safely go into lotus position, the knee must be fully flexed. Often, the leg that’s first folded in can be in full flexion and move safely into position, but the second leg cannot. In this case, forcing the second leg into the pose—especially when there is pulling at the sides of the knee or under the patella—may risk a tear in the medial meniscus (one of the crescent-shaped cartilaginous discs of the knee).
Regardless of the state of our knees, every yoga practitioner should know what a stretch feels like when it’s safe for the knee.
In addition to those general considerations, here are some ways to modify specific asanas in order to make them easier on the knees. These can be great options for yogis with knee pain, but even if you don’t have knee pain, you may wish to make the extra effort to keep your knees healthy during practice.
Support your seat in (hero pose). Sitting on a bolster, a folded blanket, or a block placed between your feet can take compression off the knee joints. You may need to experiment with the height and width of your props in order to find the degree of knee flexion that’s best for you.
Sit on blocks in (garland pose/squat). While new yogis with knee pain (or anyone for whom it may be contraindicated) should not lower the hips below the knees when they squat, sticking instead with utkatasana (chair pose), a person with no knee pain can move into a supported malasana (squat) position by sitting on two blocks at their lowest level (stacked on top of each other), thereby reducing the pressure on the knees in this pose.
Turn your pigeon on its back Hip stretches are generally good to do prior to attempting any poses that are challenging for your knees (especially those involving kneeling or squatting). But if you have knee pain when the shin is internally rotated in poses like baddha konasana (bound angle/butterfly) or sukhasana (easy cross-legged seated posture), weight-bearing hip stretches like eka pada rajakapotasana (pigeon) may put too much stress on knee joints. A better option is a supine hip opener such as figure 4 stretch—sometimes called “supine thread the needle.”
Boost your child’s pose. Using a bolster—or even stacking two under the abdomen from the pubic bone up to the head—can turn balasana (child’s pose) from a knee struggle back into a peaceful pose. In this version your head can be turned to one side (be sure to change sides as you practice), and arms can hug the top of the bolster.
Levitate your kneecaps when on all fours. For many, putting pressure on the patella is painful in table or cat/cow. For a more knee-friendly variation, place a folded blanket (about an inch thick) under the shins, with the kneecaps barely off the blanket.
Hug a block between shins in chair pose. Place the block just below your knees at its narrowest width (or middle width if you have a larger frame and/or take a wider stance). This variation can help ensure safe alignment, with knees tracking in line with the middle toes.
Maintain a tiny knee bend in standing poses.Triangle, pyramid pose, and most one-legged balance poses (such as tree pose) are excellent postures for building the strength and stability of the legs. However, they are often practiced unsafely with hyperextended knees, which props bones on bones and doesn’t help the muscles to stabilize. Hyperextension of the knee can stress the ligaments of the knee, including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and popliteal ligaments (along the back of the knee), resulting in swelling, pain, and a limited range of motion. I often have students “pulse” the standing-leg knee in one-legged balance poses (gently bending and straightening the knee) a couple of times to cue the muscles to engage and help the bones to align, and then I ask them to stabilize by maintaining a slight bend in the knee joint.
Sit higher in poses such as bound angle and (head-to-knee pose). Sit up on props, such as a folded blanket or low bolster, to angle the pelvis forward in seated postures, allowing the knees to drop below the pelvic rim. If the knees remain above the pelvic rim, one can support the thighs by placing blocks or folded blankets underneath them, putting less stress on the medial meniscus.
Over the years, I have heard many students with knee pain sing the praises of yoga and yoga therapy. However, the value of the practices is accessed only when yoga is practiced in smart and specific ways that can keep the knee joints stable over a lifetime. We tend to take the hardworking knee for granted until it complains to us with pain, but using some of these techniques can send the pain packing—or bar the door before it ever enters our lives.
As one of my students joked, rather painfully: “Yoga practices for healthy knees can really give us a better ‘under standing’ of our asana practice.”