Knee pain and the Ashtanga yoga primary series - Practice with insight and avoid injury
Knee pain and the Ashtanga yoga primary series - Practice with insight and avoid injury
Perhaps you recently started practising Ashtanga?
Maybe you’ve been practising for a while?
The practice makes you feel great. You’re sleeping better, you have more mental focus and physical strength. It’s become central to your well-being.
But ….. you’ve developed a niggling pain in your knee and it just won’t go away.
Does this sound familiar?
I want to begin this post with the caveat that I am not a physio-therapist.
However, I have been teaching Ashtanga Yoga for more than a decade during which time I’ve seen my fair share of Ashtanga students presenting with knee pain. I’ve also suffered from it myself.
This post is going to provide you with some ways you can modify your practice to support your healing. If your pain is ongoing I would also recommend you see a physiotherapist who will be able to diagnose injuries and/ or muscle imbalances and provide an appropriate program for your healing. You can then share this information with your teacher who will work with you and any advice you’ve received to help you get the most from your practice.
Why is knee pain so common in Ashtanga yoga?
Many of us spend the majority of our time sitting in chairs, and pre-yoga may even have found it very uncomfortable to sit on the floor once we passed primary school age. Over time this prolonged sitting can leave us with weak and/or tight muscles around our hip joint. These muscles include our hip flexors (the ones that connect our spine to our leg), our gluteus medias whose job is to stabilise the pelvis and the other external rotator muscles including the gluteus maximus and the smaller external rotators and adductors.
For our hip to function optimally we need our muscles to be both strong and flexible. It’s important to remember that it’s not just about stretching or “opening our hips”, our muscles can be both short (tight) and weak, or long and weak.
Personally, I’ve found it helpful to my practice and for healing my knee pain, to follow a short daily exercise plan involving leg and glute strengthening exercises like squats and leg raises.
When we begin the seated section of the Ashtanga primary series we’re asking our hip joint to externally rotate multiple times. If we don’t have the necessary functionality of movement this can result in stress to the knee joint which is at its most vulnerable when it’s flexed (bent) and the hip is externally rotated. Because our knee joint is a hinge joint it functions optimally when it is bending and straightening. Injury can occur when twisting or side stretching the knee.
Two common ways we can injure our knee when practising Ashtanga Yoga primary series
Twisting the knee joint in half lotus asanas like Ardha baddha padma passcimattanasana and Marichasana B and D
This can happen when the thigh bone and the shin bone move in opposite directions. Particularly when externally rotating the hip joint in any half lotus (padmasana) shapes. This twisting can cause a tear in one of the menisci. The menisci are C-shaped cartilage that acts as a shock absorber between the thigh and shin bone (there are two in each knee). Pressure on the meniscus may be felt as a pinching inside your knee joint. A tear could feel like instability, locking of your knee, swelling and or pain, but equally, you might not feel much pain at all.
Side stretching of the knee - Tiryang mukha eka pada pascimattanasana or Janu sirsasana A
Tiryang mukha eka pada pascimattanasana, like Virasana (hero) stretches the medial collateral ligaments which can also tear if put under too much pressure. You may also feel pain in the outside of your knee in asanas like Janu sirsasana A if the muscles and ligaments on the outside of your knee are being overstretched.
The Solution - Prevention is Always better than cure
These tears can take a long time to heal due to the limited blood supply the menisci and the collateral ligaments receive and can in some cases require surgery. If you think you have a tear in your meniscus or your collateral ligaments it’s a good idea to seek professional advice.
Entering or preparing for half and full padmasana (lotus)
These asanas require extreme external rotation of your hip joint so it’s important to approach them with patience and care and back off if you feel any pain.
Try following these four steps to enter half Padmasana
Flex your toes towards your head and push away through your heel
Try to spread your toes
Focus on the external rotation in your hip joint
Avoid pulling your foot towards you - make as much movement as you can in your hip and gently receive your foot
7 tips for managing knee pain in your Ashtanga yoga practice
First and foremost, let your teacher know you’re feeling pain. They will be able to help you modify your practice to better support you.
Say no to adjustments that risk increasing your pain or injuring you further
If you feel pain in your knee in Tiryang mukha eka pada pascimattanasana. Try popping a block or a thick book under the buttock off your straight leg
If you feel pinching on the outside of your knee in Janu sirsasana A try moving the foot of the bent knee closer to the foot of the straight leg or popping a block under the knee if it’s off the floor
If you feel pinching inside your knee in half lotus or Janu sirsasana roll up a thick tea towel and put it behind your knee joint. See if it helps and back-off if it doesn’t.
Modify Marichasana B & C by tucking your leg underneath your bent knee avoiding half lotus. Here you can also try a different external rotator stretch such as a figure of 4-shape.
Finally and most importantly back off if you feel pain or pinching in your knee joint. Prevention is always better than cure.
