When you stand in your ‘normal’ posture, do your feet rotate in, out, one in, one out or are they parallel? Another way to ask the question is, are you duck toed or pigeon toed? Stand, look, and answer. Go ahead, I’ll wait…so… which is it? In either case the issue of rotation is not in your feet or your ankle. You need to head uptown. Rotation in the lower leg originates at the hip joint.
A student of mine started classes about 6 months ago and told me had knee issues. Meniscus issues in one knee and also pain and mobility issues from lower thigh to just below the knee on the inside of both legs – but there had never been a trauma. I should mention here that he also had massive external rotation and foot supination when standing. We started with simply trying to find a new ‘normal’ in Tadasana. As his body awareness increased, his foot position changed drastically, and so did his posture.
After a month or so he was having less knee pain generally but still felt unstable at the medial knee. He then mentioned he rode a recumbent bicycle for exercise. Woah! Brakes on! What? New information! I asked him about his foot position when he clipped or strapped in. Did he put his feet in a parallel position or did he just strap in? He answered he just strapped his feet in, no correction. There it was. He was externally rotating his femurs at the hip while riding the recumbent. As a result, instead of using the muscles of flexion and extension (quads, hamstrings, glutes and gastrocnemius/soleus)he was recruiting his external rotators and abductors while stretching(weakening) his adductors. One of those external rotators is the sartorius (also a strong abductor) which originates at the iliac spine and inserts at the tibia, just below the inside of the knee. The exact spot of his pain. I asked him to make his feet parallel on the recumbent machine and focus on flexion and extension of the hip and knee, no side to side movement.
Three weeks later the knee pain was totally gone and we got to strengthening those weakened abductors and adductors. One of my favorite Yoga Tune Up® moves for this is Prasarita Lunges. You fire the outer thigh muscles to push you, the inner thighs to pull yourself from side to side or use the muscle groups equally. One great dynamic movement, two muscle groups, three ways to create balance in the hip. Talk about bang for the buck. Check it out!
Learn about our Quickfix Rx: KneeHab DVD.
Read the Scenic Route of Knee Pain.
Just love when you have one movement that can so easily shift the dominant muscle creating the movement. Get the client or class member to feel the difference of movement using opposing muscles. They can hopefully feel their imbalance and where their weakness and strength lie.
Wonderful strengthener for the midline. Thank you!
Thanks for sharing. I recently had a student who tore her meniscus. She didn’t believe me or the PT the standing posture would so dramatically affect the knee. After 3 weeks of making a conscious effort to stop the external hip rotation and spread weight spread evening over both feet she noticed a big difference in the amount of pain she was feeling. Thanks for the validation!
Thanks for describing the difference between adductors/push and abductors/pull as the innitiators of the movemnt side to side.
I don’t splay my feet but I do have weak adductors and externally rotate hips. i think it might be causing my knee issues (like his). no matter how much you become aware of the body there is always more.
its a universe
After studying ballet for several years, I am definitely duck toed. I have on and off again knee pain, but it is most excruciating when I hike. I will experiment the next time I hike with parallel feet, and see if my knees enjoys it better. Thanks!
Thanks for this share. I started to realise more and more that by activate certain muscle you can control more you allignement and posture in my dance class or yoga but I also havo to take a look at my everyday habits to understand the bigger problem. It took more time and patient to change bones than to changes muscles.
Another great article on what is behind the scene of the epidemic of duck feet!
Great article and example,this also happens to people using elliptical the foot pads are so wide and allow you to externally rotate.i love the prasarita lunges because as a runner I do not move in a lateral plane enough.
Standing with parallel feet is also the raddest way to wait for and ride the subway! #asyourfootgoessogoesyourhip
Really appreciate this article. Both timely and appropriate, as I am a fitness instructor (cycling no less), yoga teacher and long-distance runner. Thank you for the real life illustration; this could happen to any of the students in having incorrect foot placement. I will share the contents of your article with my students. Thank you.
After tearing the meniscus ( lateral tear, almost through) I have battled knee issues for a long time, and had to stop running which was something i loved to do. MRI showed the bad news. One of the things that really helped me was to constantly check out my stance and stop the external hip rotation!! Feet parallel, toes pointing forward, weight spread evening over both feet really helped. But I have to check myself all the time, very easy to slip into the “spinless slouch” where we get the hip depression, and lean over, feet all akimbo. Notice how people stand when you are in the grocery lineup, no wonder we are all in pain.
I have an external rotation of my right foot for a long time, but I do not have a knee problem. I practice running and I had a pain in the groin radiating down front of the thigh and interior knee within the last few months. I also have pain in the tensor fascia lata and piriformis, many links are forming in my head ! Practice this exercise yesterday during YTU level 1 training was a revelation for me and made me feel good and I would have benefit to integrate to my regular practice !
Thank you !!
This has been a favorite of mine for recovering from knee surgery! I definitely have more external rotation on my surgery side right now…
My adductors and abductors are weak so I’ve incorporated parasite lunges to my knee rehab routine after rolling out my quadriceps and hamstrings. I’m on the road to recovery thanks to the Level 1 training and all the blog posts on the website!
I love the way your story shows the link between knee issues and the position of the foot that is ultimately related to the strength of the hip region! Prasarita Lunge is a great exercise to strengthened the entire hip region ( the hip flexors, the adductors and abductors as well as the glutes), reinforcing this region is essential to gain greater stability in the pelvic region which then allows you to walk better.
I am loving this pose. But I have an issue with keeping my hips leveled. Jill suggested a weight lifting disc but I tried with a large heavy text book. It worked to use a prop to ensure the integrity of my hips. Thank u.
Thanks – really enjoyed. It’s always so interesting that we tend to dissociate action with reaction, i.e. position of foot during a regular movement activity! One of my teachers calls the knees “the middle children” because they’re stuck between the feet and the hips.
Very interesting article on awareness of our body during daily activities. Thank you for sharing, our body interconnection & stacking of our joints or not, as the case maybe creates excessive wear & tear, especially in repetitive activities. Great investigative work on your behalf for your student – dealing with the source of weakness rather than the patching up of pain with orthotics solution or worse surgery. Inspiring to read.
I was looking for a post on pigeon pose and came across this gem. My husband has been lifting weights a lot recently and complaining of knee and feet pain. He also complains about tight hips. I will have to work on his tadasana and make sure he isn’t internally or externally rotating his hips and then teach him prasarita lunges. Hopefully this gets to the root of the problem!
I am fascinated by how much awareness and retraining is needed to stand and walk with hips in the proper parallel position. My dancer days lead me to favor external rotation and I am shocked to discover how much that impacts the knee – especially when driving long distances in a car. If my hip is externally rotated when pressing on the gas pedal it only takes about 1 hour for me to experience pain on the medial side of the knee.
Thanks for all the feedback guys! and Deepa…next time you’re on the bike, watch out to see if you’re “chopping wood” while pedaling. It’s a common issue with cyclists. It’s when you’re knee throws outside of medial alignment just before and at the top of the pedal stroke. Creates lax adductors, tight abductors and possibly IT band dysfunction. Shims in the shoe or under a cleat may be in order. Keep an eye out!
Thanks for this post! I have a long history of injury in my left knee from years of playing soccer that has left me with a reconstructed ACL and no medial meniscus, so I have become very aware of how my posture can affect my knees. It is good to be reminded, thought, that all of the elements that build a solid foundation in Tadasana when we are on the yoga mat should be carried with us when we step out of the studio and into the street–or onto a bike or into a spinning class, as the case may be.
SInce I do not hear too much about the sartorius, I liked to hear about it. It is interesting because when I do Setu bandhasana, bridge pose, and activate my adductors, the above & outside of my left knee pops….things that make you go mmmm.
Prasarita lunges are my favourite warm up for the hips! They have been especially helpful prepration for retreiving the cat from under the trampoline… One blogger mentioned doing the lunges every morning after getting out of bed. What a wonderful idea! Thank you for this informative post!
Thank you Thank you Thank you !!!!.. I have exact same situation you described. .right knee pain on the inner side.. Tendency to hang on the external rotator muscles. I biked yesterday and felt the knee pain.. read this block and tried biking again today with focus on right foot parallel.. No knee pain..
Sounds like you’ve learned to see your students quite well. Long-term knee problems can take a long time to correct and require considerable body awareness from the feet up. Thank you for your insights. Great article.
Many of my students in non-Yoga Tune Up classes have basic structural alignment issues. Changing deeply ingrained habits, especially for my older students is possible, but patience is mandatory. Of course when they stand in tadasana I stress neutral hips, parallel feet, etc. More often than not, though, when they do other normal everyday activities, they’ll often resort back to external hip rotation and other imbalances. This blog pointed out how weaker muscles will continue to weaken as the stronger muscles take over. And, of course, the knees get affected – not a surprise! Watching people on stationary bikes at the gym reminded me how easy it is to have unconscious external hip rotation.
This article brings be back to my college Field Hockey Days. I spent years dealing with ongoing knee pain while playing and it got to the point where it was excruciating to even run and walk. I an effort to maintain some aerobic activity, the team and trainers suggested I begin on the bike. This was great I thought, however the knee pain didn’t go away. I learned many months later during PT following surgery that I was externally rotating my upper thighs therefore also my knees and legs to avoid the knee pain and rotation I felt was mimicking that of running. However what I didn’t realize is that I wasn’t avoiding it at all. I was only forcing my knee to move in ways it wasn’t use to ultimately creating flare ups in my fascia and excess tissues surrounding my knee. This article emphasizes the importance of alignment and being able to recognize pain in the body.
Thanks for asking Rie Katagiri,
His knee has greatly improved over the course of 18 months. Less medial pain and greater range of movement in both flexion and external rotation. And yes! He rides the recumbent in the winter for cardio work, no more discomfort on the machine.
I read that 90% of people toe out, and 10% toe in. This seems to be true when I look at a class of students. Your article very clearly illustrates the importance of finding the best point of correction or adjustment. Thank you for the illuminating case study.
I have a similar situation going on as your friend. Working with YTU and reading about other case studies gives me so much inspiration and hope to correct this! Thank you for sharing your knowledge with us. How is your friend’s knee feeling now and is he still riding the recumbent bike?
Thank you Heidi . I have ridden 4 Ride to Conquer Cancer 200k fund raisers .It seems that there are a number of people who complain of knee pain. I am grateful for this post as I now can suggest they check out to see if their pedals are parallel and also try the Prasarita lunges to strengthen their adductors and abductor stabilizing their hips in true north tadasana. Who’d a thought ? Cheers !
Great article. I broke both main bones in my right leg when I was kid…skiing accident. I broke the tibia just below the knee and fibula just above the ankle. When the doctor set my leg my right foot was externally rotated. I have always carried this with me and it was until I seriously started my yoga practice that I became aware of the tightness and tension in my right hip. I don’t feel the pain as much in my knee as my hip but I can appreciate how this might translate for others down to the knee. One of my goals is to completely right the wrong that has taken place with my right foot placement. I therefore work on strengthening my adductors and to use the muscles of flexion and extension. I was just doing some Prasarita lunges today:)
Thanks for posting about posture, Heidi! I’m halfway through my Yoga Tune Up teacher training and have already learned a world about my own posture. While my feet are in the proper stance, my instructors have noticed a few times that I tend to hyperextend my knees while I stand. I experience knee pain in most poses that require deep knee flexion (IE: warrior II, side angle) and I often can’t hold the pose for long. Hopefully, practicing a different stance will decrease pressure on my knee joints. It’s profound how little adjustments can go a long way.
I really like Prasrita Lunges for strengthening the hip flexors, adductors and glutes. We have a similar exercise in Classical Pilates called Side Plies and in contemporary or what I call adapted Pilates, something called skating, which as Jill mentions in her video works just like it sounds but is done on the Reformer with the added resistance of the springs. I like the hands coming all the way to the ground and the really deep knee bends in the Yoga Tune-up version however as I think it engages the glutes more directly. Doing this has really helped internally rotate the hips of my clients who came to me with duck feet and sore hips/lower back.
Tadasana used to establish a new normal. Brilliant!
As a novice Yogi, I’m learning how beneficial poses like Tadasana can potentially be.
Learning to re-align my pelvis in relation to my spine is something I’ve been working on for a few weeks, and Tadasana is absolutely part of my “new” everyday.
Prasarita Lunges is another fantastic YTU exercise that I use to promote the re-creation of my “new normal” of how my feet, knees, and hips align.
Now if I can only develop a little patience, then I’m set for success.
This article is thorough useful for anyone with legs!!! Often students come with injuries and concerns and that arise in their yoga practice but the reality is that is only an hour or so of their movement on any given day. The real tell tale signs are what they are doing in their life off the mat. This article was a great case in point. Also loved Roxanne’s mention of the YTU exercise of marching forward and back to give students a clear picture of where their biases and blindspots are in relation to the most basic movement of walking.
Thanks for the article and story. As an advid biker, I have never thought about the importance of my feet position when I’m spending hours on the bike. I think these lunges would also be great for swimmers who do a lot of breastroke and also stand with their feet “like duck feet”, as you mentioned.
In observing seniors -most people seem to have more external rotation and feel that is “normal” but many complain of a painful sensation in the knees. I challenge them to stand with their feet parallel so see if the pain subsides- old habits are hard to break -but worth the effort if pain free.)
This is an extremely helpful post – I do the prasarita lunges every morning when I get out of bed. I noticed that Jill is aligned with her toes pointing inward (avoiding daffy duck feet) which is also important for knee joint integrity. Often in class, students want to go deep into a squat and will sacrifice stability in the knee and point their toes outward.
Another keen issue person here who found excellent instruction in these comments. Before YTU the only thing I heard was that any knee problem was an issue with the hip and or the feet. That was as far as it went no one ever suggested what to do about it. learning these beginner-ish like movements and discovering more about the anatomy of issue makes a lot of sense.
Great article. We just learned Parasarita lunges today in YTU teacher training. A fabulous minivini for strengthen the adductors if you put the emphasis there. Or as you say the emphasis can be switched to the abductors if needed. The external rotation of the femor seems to be such a common issue and I can gladly say that if Jill see anyone doing this she immediately instructs us to parallel our feet.
Extremely helpful for me as a dance fitness instructor! Always looking at students positioning of feet and then heading north to see where issues occur as well. I think going back to basic movements to re-educate their bodies has this article in my folder!
Heidi – Thanks for this enlightening article! I am in my mid 40ies, have been teaching yoga for over 10 years now and have been virtually pain free … until recently. Discomfort in my knees has popped up, it seems, almost out of the blue. Being a teacher, I know better than to think it has just appeared. I have been try to find the source examining my body from every angle to see where the issue is emanating from. Last night I started Level I YTU Training and today we did Adductor Slides. I was very surprised to discover how weak my adductor muscles are. Your article along with knowing the important job these muscles have in keeping the hips aligned I can now see where I need to begin my work and thanks to YTU I have a few tools to use to help me heal.
I recall that Jill seemed to be down on biking. I didn’t understand why. But after reading this blog it makes a lot of sense. Sure, thinking of outer hip rotation affecting the knees makes sense and I correct my students in tadasana all the time. But I’ve rarely mentioned other activities, such as biking, that could be offsetting the value they’re receiving in the yoga class.
Thanks so much for posting. Couldn’t agree more. As a yoga teacher, runner, and bike commuter, this is constantly on my mind. I’m looking down at my feet while I ride every now and then just to check in on the external rotation of the hip and connect with the adductors as necessary just to slide the heel out a bit and everything back into neutral. Watching this video and trying this still made me realize how week my adductors are…
[…] – If you’re interested in the Myofascial work on the knees or have any type of knee issues, I highly recommend the YTU Quickfix Rx: KneeHab DVD, there are great routines in here the will […]
While in TT, we spent some time learning about Therapeutics, and learning how interconnected our feet, knees, hips and back are. Of course, it makes perfect since, now that I’ve been taught it. One of the things I am most excited to get out and teach people, is how to properly stand on your feet with weight distributed evenly between your big toe mound, the base of the 5th metatarsal bone, and the center of your heel. I have so many friends, especially in NYC where we all live on our feet, who complain feet, knees, and back pains, and I’m convinced, as explained in this article, that teaching proper weight distribution, will help immensely!
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I tore my meniscus while being a serious ballet student and standing in a constant turned out position. I am glad I now pay attention to the way I stand and where my weight is on my feet and to not rotate out. Though it is very difficult on a day to day basis to stay aware, I am happy I have the knowledge and time to think about it while on my yoga mat.
Thank you for this! I tend to tense up sometimes when I come into locked knees or spreading my feet wide. The lunges are excellent for loosening up my knees and not getting so tense&nervous when going into practice. Thank you!
It just goes to show that going back to the basics (Tadasana) and foundation can really bring awareness our bodies.
My hip abductors are much stronger and tighter than my adductors at this joint. Since I started doing Yoga Tune Up I’ve found that prasarita lunges are really helpful in developing my awareness of this imbalance and of the fact that certain movements can be accomplished with either my ad- or ab-ductors. This has become one of my favorite exercises too!
Another way to test it out is to get your class to shut their eyes, and to march on the spot for a few seconds. As they remain their eyes closed, ask them to take 3 steps back then 3 steps forward and to stop. When they are done, the position of their feet will tell them something about the rotation in the hip socket. Todd makes us do this in his YTU classes lately and I find it’s a good way to capt your students’ attention and to keep them interested as to how are they going to fix that.
Great article, thank you! I coach cyclists and a big problem that I see in their pedaling mechanic is their knee dropping outward on the push of the pedal stroke. In our strength training classes I usually work single leg at a time, but tried and love the idea of the Prasarita lunges. They help to replicate the transfer of power of the legs and adduction, even if it’s a lateral movement. Will def incorporate these in our program.
Thanks for all your responses, insights and ideas!
Mike: Plenty of thoughts of high heels…the first and most important is, “Wear them as little as possible”.
Here is a great resource for not just foot pain but how it relates to overall body issues. It’s by Katy Bowman, and you can find it at http://www.footpainbook.com. While it is woman-specific, the alignment principles are universal. Enjoy!
Though I never have had knee problems, this is something to watch out for in students. Watching how some ones feet rotate never hit me that it might lead knee issue. I am just going to take a shot in the dark and say shoes like high heel’s might in the long run lead to knee problems. I don’t know never wore them, any thought’s on this?
Thank you for this article! This exercise sure is a bang for your buck! And also a great quick way to wake up your hips and legs in the morning or before yoga practice, which is one thing I definitely have to by mindful of.
We learned to do prasarita lunges in YTU this past weekend and they are my new favorite warm up. My feet tend to externally rotate in squat, so I’m hoping these lunges will help that posture as well!
This article is truly brilliant! First off, I have to say that I’m so relieved to finally know what causes the outsides of my shoes to have more wear on them than the insides, and that it’s not just me! I noticed this a few years ago and was so curious to know what caused it. When I run or do a lot of walking, I experience pain in my upper outside calf, in my knee and in the last three toes, of mainly my right side. Not only that, my balance is terrible, terrible, terrible! I never once thought that the way I land, or stand, on my feet could be connected to the pain I feel or my balance. I’m currently training to teach yoga, but I’ve wanted to be a yoga teacher for many years and used to think how could I possibly be a teacher when I can’t even balance in certain postures?! This piece really shed a lot of light on me in many different ways. Suddenly, I’m not so fearful. Instead, I feel extremely inspired and eager to get back on the mat and keep practicing!
Thanks for this, I have a bad habit of turning one or both of my feet inward sometimes, so I tried the Prasarita lunges. They were great for the feet; but unexpectedly dynamite for my inner thighs! That really helped loosen my movement. Thanks again.
As someone who naturally has more external rotation and feel that that is my “normal” it was definitely creating an unstable and sometimes painful sensation in my knees. It wasn’t until i learned to find a new normal for my body and my own language of how to cue myself for my body that the pain went away and I began feeling more stable in my practice. Consequently, feeling more stable in my physical body has made me feel more confident and willing to try new postures 🙂
This is such a great exercise! I’ve had knee issues on both knees, but mostly on the left, and I think it’s possibly due to being a dancer and years of ballet. I was always turning my legs out to create the ideal ballerina positioning by first externally rotating my feet and placing them into position and hoping that the rest of the leg would just fall into place in the hip joint. I think my hips and hip joint accepted this, but my knees didn’t. Also, a lot of choreography is set for a right-handed/right oriented person, and it means a lot of high battements and developes with the right leg and lots of pirouettes on the right… All of these movements put strain on the knee, so I think that would explain my left knee having more pain that the right. Yoga has been a huge help to me by asking for a lot of internal rotation in the legs and the hips and always working symmetrically. This exercise in particular looks great for working that internal rotation and muscles around the knee.
My son rides one of these bicycles. I will immediately share this important information with him because he was beginning to complain about knee pain. We can be proprioceptive and consciously adduct the inner thighs, Adductor muscles, including the and knees while riding a bicycle.
GREAT piece! I also love the prasarita lunges. What I notice is that so many of the YTU moves are a lot of bang for the buck. We are so lucky to be learning how to tune up ourselves and in turn, tune up others. I really enjoyed this piece.