Friday Q A Alignment of the Knees

Q:  Here is a question for you.  I was practicing Utkatasana Tuesday and as I sat down into the pose I got a twinge in my inner left knee.  (Slightly forward of the seam line, between the upper and lower leg bones.) I straightened up and repeated the pose squeezing a block between my knees. The little pain was gone. How did squeezing a block between my knees change the alignment of the knee?

A:  Utkatasana, mistakenly called “Chair Pose” by some, comes from the Sanskrit root word utkata, which Richard Rosen defines as “exceeding the usual measure, immense, gigantic; richly endowed with, abounding in; drunk, mad, furious; excessive, much; superior, high, proud, haughty; uneven; difficult” (from his book Original Yoga ).  If you have spent any time in this pose, you can certainly get behind the difficult part, but we try to avoid it feeling uneven. (We like to call it "Powerful pose.")

Whenever you have pain in a joint in a yoga pose, look not only to that joint, but also one or two joints above or below that one as you look for an explanation of your pain. Not being able to see our questioner in person, it is hard to say why the pain showed up in the first variation, but any time you are standing and bearing weight on your legs, and you bend the knee joint, there is the potential to compress the joint in an uneven fashion that could result in pain. As I have discussed elsewhere regarding arthritic joints and creating space in the joint, creating a feeling of lift of the femur bone (the upper leg bone) away from the lower leg bones is always a good starting place to see if you can eliminate the pain.

In this situation, placing a block between the thighs and squeezing has many effects, any one of which could have alleviated the knee pain. Squeezing the blocks may change the way the feet are aligned, as they may come closer together, and the weight might shift more towards the inner foot. So, if the feet were the underlying cause of the knee pain, the block squeeze could re-balance the feet.  When looking at the knees, if someone is a bit knock-kneed, with the knees dropping toward one another, the block could move the knees outwards slightly and make more space in the outer knee joint and bring the inner knee joint closer together. If the knees are a bit bow legged, the block squeeze could bring the knees closer together, opening the inner knee joint and narrowing the outer knee joint.  Again, these shifts could alleviate pain in the pose.

If the inner thigh muscles are weak, the squeeze of the block is going to contract them more actively using the five adductor muscles, and this could bring the vertical alignment of the thigh bones back towards even if one is bowing or sagging in or out through the femur bones. And if the outer buttock and hip muscles are really tight and pull legs apart or tend to roll the femurs out a bit into external rotation at the hip joint, the squeeze of the block could help internally rotate the thigh bones to help them adduct a bit closer together, resulting in better alignment at the knee joint. Finally, the block also can activate the quadriceps muscle that tends to be weakest, the vastus medialis (which I believe is discussed in one of my earlier posts on knees). This can help balance out the stronger vastus lateralis, which would tend to pull the femur to the side and roll it out a bit at the knee.

And although this list of possible effects of blocks between the knees is not exhaustive, as you can see there are many potential impacts that could have led to the disappearance of your knee pain.

If you have pain in Utkatasana every time you do it without the block, I’d suggest you use the block regularly for a while, then try it without the block, but with the same alignment and muscle work that you feel when the block is in place. Hopefully this will resolve any pain in this pose, which is one of the original asana that Richard Rosen identifies in his book. He has other useful suggestions for Utkatasana in that book, which is a must-read for any yoga enthusiast!

See Featured Pose: Powerful Pose (Utkatasana) for our instructions on how to do this pose.

—Baxter

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Hyperextension of the Knees and Yoga

by Nina

Hyperextending!

Typically it’s not me who writes about anatomical aspects of the asana practice. After all, we’ve got both Baxter, an MD who teaches anatomy to yoga teachers and Shari, a physical therapist who teaches anatomy to yoga teachers, on our staff. But after reading Baxter’s post about The standing leg and knee in Warrior 3 pose (Vrbradrasana 3), I decided to write about hyperextension in the knee joints in general because, you see, I have it myself. And I have been working with it in one way or another for about fifteen years (after it was pointed out to me by a couple of my teachers). I decided that since I had a lot of knowledge about it, it would be good to get it down in writing. 

As Baxter said in his post, hyperextension of the knee joint means that your knee joint has a slightly greater range of motion in extension than the average person’s does. In other words, in people with hyperextension of the knees, when the knee is straight, instead of the femur bone on top and the shinbones on bottom forming one straight line, your knee joint bows slightly backwards. I’d like to add to what Baxter said by observing that when your knees are hyperextended, your kneecaps don’t face straightforward; instead, they turn in slightly, with the inner edges pressing back more than the outer edges (making you look a bit knock-kneed). Also, with hyperextended knees, you tend to bear more weight on your heels than on the balls of your feet and your thighs press back so they are not aligned directly over your shins. All this unevenness in your legs, knees and feet is the reason there is concern about hyperextension, with concern that it could lead to uneven wear and tear on the cushioning cartilage of your knee joint, which could result in dysfunction and pain down the road. 

Rather than simply avoiding poses where you tend to hyperextend your knees, I believe that by observing the unevenness in your legs, knees and feet, and making adjustments, you can bring your legs, knees and feet into a healthier alignment. And in this post, I’m going to share with you how I do that myself.

First I’ll recommend that you test yourself to see if you have hyperextension rather than knock knees, and then I’ll describe a few techniques for correcting your alignment, both as you move into and out of poses and while you are practicing them.

Testing Yourself

1. Start by standing in front of a mirror in Mountain pose (Tadasana), with your feet together (yes, together). Now look at your knees. Are they turning slightly in toward each other and coming closer together than the rest of your legs? This could be either a result of hyperextension or knock knees.

2. Next, bend both knees by moving your shins forward and shift some of your weight from your heels to the balls of your feet. Then straighten your knees by lifting from your thighs, while keeping some of your weight in the balls of your feet.

3. Look at your knees again. Are they now facing straightforward with more space between them? If so, you have corrected your hyperextended knees. If there is no change, you may have knock knees. But try the adjustment once more just in case.

Moving into Straight Leg Poses

The technique you just used to correct your hyperextended knees in Mountain pose test is one that you can use as you move into any straight-legged standing pose. For example, if you are moving into Warrior 3 (Vrbradrasana 3) or Half Moon Pose (Arda Chandrasana), where you bend your knee first and then straighten it, you will bend your knee by moving your shin forward and shifting some weight onto the ball of your foot. Then, as you straighten your leg to come in the pose, you would lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. (As you come out of the pose, use the same techniques to bend and then straighten your knee.)

Warrior 3

For poses such as Triangle pose (Trikonasana) and Pyramid pose (Parsvottanasana) where you normally move into the pose with a straight leg, you can try changing the way you move into the pose, as it is the front knee in these poses that you tend to hyperextend. Using Triangle as an example, you would take the foot position for the pose and raise your arms out the sides. Then, bend your knee by moving your shin and shift some weight onto the ball of your foot. Next, as you come into Triangle pose, lift from your thigh to straighten your knee as you keep some weight in the ball of your foot. Does it feel different to you?

Triangle Pose

Working in Straight Leg Poses

When you’re already in a pose, you can make adjustments to bring your legs into healthier alignment. 

First, in any pose with a straight leg, even balancing poses such as Tree pose (Vrksasana), you can slightly bend your knee and then straighten it again using the technique I described above. One week I tested this technique with every single standing pose in Light on Yoga, and found benefits in almost every single pose. In many poses, such as Dancer’s pose (Natarjasana), this adjustment brought me deeper into the pose!

Second, without bending your knee, you can try softening your front thigh muscles (quadriceps) and allow your thighbone (femur) to move slightly forward so it aligned more directly over your shinbone and more weight moves onto the ball of your foot. This will bring your leg into a straighter alignment. I just learn this one recently, and it works well in Half Moon pose (Arda Chandrasana).

Working in Seated Poses

In seated poses with one or more straight legs, including forward bends and twists, people with hyperextension of the knees tend to press the knee of their straight leg down toward the floor when their foot is fully flexed (vertical), hyperextending the knee. So, instead of flexing your foot in these poses, try pushing the ball of your foot a bit past your heel (without pointing your toes). I call this the “Barbie foot,” as it looks like the doll’s feet without her high heels on, and I’ve noticed Iyengar uses this foot position. The result is that your knee no longer hyperextends and—additional bonus!—your hamstrings soften a bit because pressing your front foot forward loosens the tug on the calf muscle, which then loosens the tug on the hamstrings, allowing you to come more deeply into forward bends. 

Moving into Bent Leg Poses

Remember that people who hyperextend tend to have knees that turn in slightly. So in weight-bearing poses with bent knees such as Warrior 1 and 2 (Vrbradrasana 1 and 2) or Extended Side Angle pose (Utthita Parsvakonasana), it’s a good idea to try to ensure that you’re bearing the weight evenly on your bent knee. Use the same technique of entering the pose by bending from your shin and moving some weight onto the ball of your foot. And, as you bend, pay attention to your inner back knee, deepening it as much as your outer back knee. This will help align your kneecap directly over your second and third toes and distribute your weight more evenly.

Extended Side Angle Pose

As you come out of the pose, use the same technique to straighten your leg as I described above, lifting from your thigh while keeping some weight on the ball of your foot. 

Thanks, Donald!

Whew! That’s it for now. I’d like to end by saying that I learned almost all of this from my teacher Donald Moyer, both while I was training with him to become a yoga teacher and in his ongoing classes. I'm very grateful for all that and more....

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