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.

Heidi Broecking

I've been a yoga practitioner for 13 years and took my 200-hour certification in 2010. I received my Level 1 YTU certification with Jill Miller in March of 2011 at the Kripalu Center. When I'm not with my husband and son, I love to geek out on anatomy and ride a road bike, really fast. Providing a science based system of total body fitness, Yoga Tune Up® has provided me a seamless bridge between enhancing my performance and recovery as an athlete. Yoga Tune Up® has also given me greater understanding of mobility and biomechanics as it relates to the practice of Yogasana. YTU inspires curiosity for me as both a teacher and student of Yoga.

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Anne

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.

Eileen Riordan O'Sullivan

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.

Susan

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!

Isabelle Barter

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.

heidi

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!

Daniella Wittern Bush

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… Read more »

Heather

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.

Cindy Runzer

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!

Deepa Dravid

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..

Beverly N.

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.

Matt

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… Read more »

Courtney K

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… Read more »

Heidi

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.
Cheers!
Heidi

Nancy

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.

rie katagiri

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?

Nancy

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 !

Bev Hotchkiss

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… Read more »

Clare Chura

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.

Barbara Treves

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… Read more »

Steeve

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.

Kristine Tom

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.

Megan

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.

rebecca

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.)

Jenn

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.

Thanks –

Gary Carlisle

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.

Cynthia Bunt-Gardner

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.

Helen McAvoy

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!

Michelle Dalbec

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… Read more »

Matt Nadler

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.

Matt Sharpe

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…

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Kelsea

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.

Chelsea

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!

Natalie Miller

It just goes to show that going back to the basics (Tadasana) and foundation can really bring awareness our bodies.

Jen G.

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!

Roxanne

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… Read more »

Theresa van Vugt

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.

Heidi Broecking

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!

Mike

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?

Jane

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.

Natasha

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!

Kate

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… Read more »

Simone

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.

Lauren Goodwin

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 🙂

KC

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… Read more »

Silvia Marisol Harms

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.

Terry Littlefield

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.