A Yoga Sequence for Knee Health

Please remember that this post only provides general guidance around knee health. If you have had a knee injury or recent knee surgery there are many factors that need to be considered before engaging in any rehabilitative exercise regime and its best to consult your doctor, health-care team or physio before starting yoga. 

It may seem a rather obtuse or clinical title for a yoga sequence – certainly not as sexy as A Yoga Sequence for Better Sleep for example (although that is coming soon!) – but building greater knee strength is a subject matter close to my heart, and has been a massive part of my yoga regime for years.

In fact the whole reason I came to yoga was because I had dislocated my knee several times and I faced the hearbreaking realisation that a dance career was just not going to be for me. Yoga early on presented an alternative. I loved the movement, the mindful connection to breath. The grace. It’s not a coincidence that many yogis and yoga teachers are ex-dancers.

Whilst yoga is often touted for its ability to enhance flexibility and range-of-motion, what I often find gets missed is yoga’s fantastic strengthening and stabilising qualities. To be sure it doesn’t have the grunt appeal or forehead-mopping benefits of lifting heavy weights or working with a resistance band but I believe yoga has a LOT to offer those of us with sore, sensitive or unstable knees.  As always it’s all about what you practice.

 

5 Reasons Why Yoga is Great for Knees:

  1. Its low impact i.e. in most forms and styles of yoga we don’t jump or bounce therefore reducing the amount of load, force and therefore stress on the joint.
  2. We use a lot of Closed Kinetic Chain (CKC) style movements and postures which are generally safer for knees that feel weak or unstable and are easier to control and therefore maintain good form whilst doing. CKC movements involve having the foot fixed on a solid surface e.g. the floor, as you do the movement or posture.
  3. We move slowly and mindfully which gives us a chance to focus on good tracking alignment of the knee (misalignment of the knee is a big factor in weak, unstable or injured knees). By taking our time as we consciously move in and out of positions we can retrain our habits and postural tendencies.
  4. Yoga recognises the holistic nature of the body and that knee problems often have their source in musculo-skeletal imbalances further up or down the body. Remember that the site of the injury is often not the source of the problem. When I have clients come to me with knee injuries, I always look at what’s happening in the position and alignment of their feet, hips and spines.
  5. In yoga we build isometric and eccentric strength which are fantastic for building strength and stability in our joints.
    • In isometric work we are holding the muscles and joints in a loaded static position – think of what happens to the muscles of your legs as you hold a Warrior 2 position for example.
    • In eccentric strength work, we gradually lengthen the muscles as we load them, for example, when we hinge forwards from standing into a forward bend the hamstrings are eccentrically lengthening.

 

Designing a Well-Balanced Yoga Practice for Knee Health

With the above in mind, the following sequence is designed to not only work all of the muscles that surround and stabilise the knee but also some muscle groups that seem relatively distant and unconnected. We will also work on stretching out some muscles that when tight can often cause knee tracking issues. Here’s a nifty table that outlines some of the major muscles and connective tissues you need to address for optimal knee health.

Strenghten Stretch
Quadriceps (muscles on the front of the thigh) Iliotibial Band or ITB (a tract of connective tissue running down the side of the upper leg)
Hamstrings (muscles at the back of the thigh) Outer quadriceps (when tight can pull the knee-cap outwards)
Glutes (your bottom!) Tensor Fasciae Latae or TFL (a muscle on the outer side of the hip)
Adductors (the inner leg muscles) Adductors (the inner leg muscles)
Vastus Medialis Obliqus VMO (a small tear-shaped muscle in the inner knee)

 

A couple of tips for practice:

As always the devil is in the details. I often say to my students – you spend the first 6 months in yoga just learning the basics, where do your hands and feet go, the general shape of a pose, remembering to breathe. You spend the rest of your life learning all the little details that make this practice so rich and exciting!

With that in mind there are a few small alignment tips that I think make all the difference when you are working on knee health.

 

  • Root down through the heel bone. When you press your heel firmly into the floor you will feel the muscles and connective tissue around your sitbone engage helping to strengthen the glutes and stabilise the hips. Strengthening the glutes plays a HUGE role in knee health.
  • Check your foot to knee-cap positioning again and again. The knees are the prisoners of whatever is happening in the feet and the hips! If the feet are turned out but the knees are pointing forwards (or even inwards) then your knees end up taking the strain of this misalignment. Happy knees are ones which track in the same direction as the centre of the ankle/2nd or 3rd
  • Engage the VMO. Getting the VMO (that tiny little tear-shaped muscle at the inner knee) to switch on can be tricky. If you’ve injured your knee it is likely that this muscle won’t be firing properly. Rooting through the heel bone can help to switch this muscle on but I also like to bring my fingertips to the area to help give me tactile feedback so that I know when it’s engaging.
  • Do not lock the knee. There is a tendancy for many students to “lock” the knee cap backwards in standing poses, particularly balance poses. Unfortunately this can often lead to torsion, instability and potential wear and tear of the knee joint. Instead we want to keep what I refer to as a slight micro-bend of the knee joint (the leg will still look straight) whilst engaging ALL of the musculature evenly around the knee (front-to-back and side-to-side).

The following practice gives some ideas for the sorts of poses that I regularly use with clients when working improve knee health. All of the poses/movements are designed to be repeated several times through until you feel a comfortable level of fatigue in the muscles without losing good form and technique. The exception to this is the two standing balances – Standing Quad Stretch Pose and Tree Pose which should be held for 30 seconds on each side, and the supine stretches at the end of the sequence which you can hold for up 1 minute on each side. Enjoy and feel free to leave any questions or comments below! 🙂

 

5 Yoga Exercises To Realign The Spine

From a physical perspective, one of the main benefits of a yoga practice is to cultivate and maintain spinal flexibility and strength. There’s a saying ‘You’re only as young as your spine is flexible’. Having a stiff, tense and weak back not only makes us feel old, but it has a negative knock-on effect on the mobility throughout the entire rest of your body. This is why I often focus in my private sessions on helping clients to improve their spinal health and to realign the spine if their posture is poor.

The spine has five ranges of motion – flexion (forward-bends), extension (back-bends), lateral flexion (side-bends), rotation (twists) and axial extension (lengthening/traction). A nice way to sequence a yoga session is to see if you can incorporate all five of these movement patterns into the practice. If you’re short on time, or it’s first thing in the morning and you just need to gently bring some energy into your body, try the following five yoga exercises. Hold each pose for 5-8 breaths (each side if there are two sides) and you’ll be good to go!

Remember if you have any back injuries or current back pain these poses may or may not be appropriate and you might want to check with your healthcare provider beforehand.

 

Supine twist (rotation)

Come to lying on your back. Pick your hips up and shift them slightly to the left so they are slightly skewed. Bring your knees into your chest and take them over to rest to the right side.

Put a rolled up towel between the thighs if the thighs and knees don’t touch each other.. Rest your right hand on your left outer thigh and allow the left arm and shoulder to stretch out to the left, releasing the left shoulder blade down towards the floor. Take 5 deep breaths before switching sides.

 

Bridge roll ups (extension)

Come to lie on your back. Bend the knees, heels under knees and placing feet hip-width apart with the toes pointing forwards. Bring the arms alongside the hips, palms facing down.

On an inhale start to peel the hips, lower, middle and upper back away from the floor. On an exhale lower the arms, upper, mid, lower spine and hips towards the floor. Try to articulate the spine one vertebrae at at time, synchronising the movements with the breath.

Repeat 5-8 times before releasing stretching the legs out and taking a few moments to pause and feel the effects.

 

 

Cat-cow (flexion and extension)

Coming onto hands and knees, place your knees hip-width apart under your hips and your hands shoulder-width apart.

On an inhale drop the belly slightly towards the floor and arch the chest forwards (creating a little backbend in your upper back). This is cow pose.
On an exhale press down through the hands and round the back towards the ceiling, lifting the belly and front ribs up into the back body, tucking the chin to the chest and looking towards the belly button. This is cat pose (imagine an angry cat!). Repeat this back and forth motion for 5-10 rounds, synchronising the movement to the breath.

 

Downdog against a chair (flexion and axial extension)

Hold onto to a ledge, table or back of chair. Hands shoulder-width apart, palms facing downwards or even inwards if possible so that you can draw the shoulders away from the ears.

Walk your feet back, bend your knees and align your heels under your hips as you stick your bottom backwards. Work on maximising the length in your spine. Gently lower the chest down so that eventually the spine is parallel to the floor (or just above) and the ears and upper arms line up with each other. Feel for a long line of energy from the tailbone all the way through to the crown of the head. Relax and soften the upper trapezius muscles right around the ears. Hold for 5 breaths. Make sure your breath remains fluid and easy without strain or tension. Repeat twice.

This would be a good pose to repeat throughout the day!

 

Mountain Stretch and Standing side bend (axial extension and lateral flexion)

Standing in mountain pose, feet hip-width apart and parallel. Hands resting by your sides. On an inhale reach your arms up overhead, interlace the fingers and flip the palms. Hold for a couple of deep breaths. On the inhale think about stretching up through the spine, pressing outwards and up through the palms. As you exhale think about drawing the lower belly back towards the spine and softening the inner shoulders slightly down away from the ears.

Then place one hand on your hip, inhale to reach your other arm up towards the ceiling, lengthening the side of your waist. Exhale as you begin to lean over to the side stretching into the sides of your body. Inhale to come back up and switch arms, exhale to lean over to the other side. Repeat 3-5 times each side, returning to mountain pose with your arms by your sides to finish.