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Yoga Modifications for Knee Injuries to Make Your Poses Feel Better.

body insights Feb 22, 2020

When people talk to me about knee pain during yoga, they often describe two things. Either there’s pain while putting pressure on the knee such as in a table top position or child’s pose; or there’s pain while bending the knee such as in a lunge, squat or seated pose. 

While it’s impossible to determine the precise alterations each person needs to make for their own circumstances, there are lots of yoga modifications for knee injuries that can often positively influence knee pain during and after yoga. Such modifications include--but are not limited to--learning how to modify your knee bends, using support and being able to control your knee tracking. 

An effective modification is one that both protects us from making unsafe movements and rehabs our ability to generate safe joint actions. This means we aren’t just looking to avoid doing certain things, we are also looking for rehabilitation work to rebuild the structures of our body to their fullest capacity. A structure cannot be pain-free if it is avoided. The only way to address our pain effectively is to build up our knee’s capacity to do movements it is designed to do. 

Most yoga teachers are good at helping students avoid unsafe movements. Some yoga teachers are good at helping students find rehabilitation work, although this is more a specialty of physical therapists or other movement modalities such as Functional Range Conditioning. So as we move forward into the land of modifications, we must understand and respect the scope of practice of our yoga teachers and seek out any additional resources we need to understand the movement requirements of our own unique bodies. 

At the end of the day, it’s up to each of us individually to march on through the frustrating moments and continue to engage in trial and error. Every solution that has ever been found has happened this way. There is a solution for our knees. We haven’t stumbled upon it yet. Today is a new day. 

Here’s how you can use these common yoga knee modifications to both stay safe and rehab your knee effectively over time. 

Modify Your Bends

There are lots of factors that may contribute to pain while bending the knees. 

Generally speaking, the knee likes to bend with even pressure on the inside and outside of the joint, without rotation in the lower leg (which is possible when the knees are bent), and tracking in its neutral direction which is probably over the second toe (unless you know something different about your skeleton’s anatomical neutral). 

If there are variations here--let’s say the ankles or hips are limited and it causes us to put pressure on the knees unevenly left to right, or the knee is tracking over the big toe instead of the second toe, or we have too much rotation in the lower leg--this can create issues for our ligaments, tendons, cartilage (in the knee called meniscus) and/or muscles. 

Our pain may originate from one intense traumatic event, like pivoting too quickly and injuring a ligament as the lower leg over-rotates. It may also be from repetitive stress--repeating suboptimal movement patterns over a long period of time that wears down on the ligaments, cartilage and connective tissues. 

In general, if you find that you have intense pain while bending the knees, my first tactic would be to modify the bending. If your front knee hurts in a lunge, try these knee bending modifications and see what information you can gather:  

  • Practice in your controllable range of motion for time-under-tension: Only bend your knees within your controllable range and as much as it is pain-free to do so. A controllable range means you can go slowly without relying on momentum to create a movement. Time-under-tension means to spend time in positions so that a) the tissues have time to adapt, and b) the brain can hit “save” on the movement pattern for next time.

  • Floss your knees: Practice straightening and bending your knees to capacity. Stop if pain is triggered, reverse out and try again. You can practice this on your back where the knees don’t have to support your body weight. You can practice this in a standing position where the knees are loaded with the weight above them. You can add additional weights like a loaded backpack or a kettlebell to load your knees even more. This is the progression one might use to rehabilitate the knees’ ability to do their job well. 

  • Practice with straight legs: Any lunge can be practiced with straight legs. Use this as an opportunity to stay active in your legs and to learn how to actively use your feet, ankles, knees and hips. 

  • Practice your lunges sitting on a chair: Maybe your knee hurts because there’s too much load and it’s being asked to do too much. You can reduce the load by snuggling a chair or stool under the pelvis for support and see if the knee is still in pain with a reduced load. 

 These modifications are designed to both rehab the knee and inform you of the boundaries between a safe and unsafe range of movement at this moment in time. 

Pay Attention to Knee Tracking 

Knee tracking refers to what direction the knee is pointing as it bends and straightens. It’s important to develop our knee tracking in order to address the strength and stability of the joint. 

For most people, anatomical neutral is when the knee tracks over the second toe. As the knee connects the ankle and the hip, the knee needs to be able to control this tracking when the legs are in different positions. 

Start noticing what direction your needs are tracking during yoga practice. My guess is that there are slight or large variations throughout every chain of movement. There are for me. What if you spent your practices focusing on training your ability to deliberately track your knee over its second toe in every pose and throughout every chain of movement? 

When the knee tracks over the second toe, both the shin bone and the thigh bone are neutral in relationship to each other. This can help rehab the knee from pain that may originate from over-rotation.

Use Support 

Finally, if your knee pain is such that you can’t bear weight on your knees, like in table top or child’s pose, there are several options. 

As someone with sensitive knees, I prefer to practice with my mat on top of a carpeted surface. This works wonders for my knees. Other solutions might be a folded blanket under the knees, knee cushions or even knee pads if you felt so inclined. 

Continue to pay attention to your knee tracking to ensure that center knee is aligned with center ankle and second toe. 

See if this helps. 

Takeaways

In order for our knees to be pain-free, they need to be capable of performing their joint actions with control. If I had to sum up my number one yoga modification for knee injuries, the takeaway would be this: Avoid movements that cause immediate pain and train your knee to perform its joint actions with control. 

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