Knee pain, ranging from general discomfort to consequences of traumatic injury, is one of the most common reasons people seek medical attention. Treatment often includes physical therapy and sometimes includes surgery (according to the American Academy of Orthopaedic Surgeons, 600,000 knee replacements are performed every year in the United States alone). But people are also increasingly looking to yoga to relieve knee pain. A recent Yoga Journal survey suggests over 15 million people currently practice yoga and at least that many more are very interested in beginning a practice. These populations will likely collide. If you do not have a client with knee issues in class now, chances are you will. And soon.
As a yoga teacher you are uniquely capable of helping your students address the pain, fear and frustration associated with injury, surgery and recovery. You can be even more effective, however, if you understand knee anatomy and mechanics. There’s a lot going on in that hinge between the thigh and shin. Let me introduce you to knee knowledge for yoga teachers…
Four bones, the femur, tibia, fibula and the patella are all held together by a few ligaments. The collateral ligaments hug the knee joint from thigh to shin to stabilize the side-to-side movement. Two cruciate ligaments cross under the kneecap like an “X” to stabilize the knee’s forward and back movement. Two crescent-shaped cartilage discs (aka meniscus) sit between the tibia and femur to distribute weight. Eleven muscles act upon the knee joint. The quadriceps lift the kneecap, extend the knee and converge above the kneecap to become the quadriceps tendon. The quad tendon flows over the kneecap and becomes the patella tendon (like when street names change across an intersection), which attaches the kneecap to the tibia. The three hamstrings flex the knee, run down the back of the thigh from the sit bone and attach at different points on the tibia. Two adductors (gracillis and sartorius), the popliteus (a small muscle behind the knee that runs to the ankle) and the gastrocnemius (your prominent calf muscle) are also knee flexors. All of the flexors except the gastroc medially and laterally rotate the knee a little–only when it is bent–if you can rotate your knee when it’s straight, get thee to a doctor. Now.
In short, the muscles on the front of your knee straighten it, the muscles on the back of your knee bend it; muscles that attach on the sides of the knee move your shin side to side. The entire structure is held together by a few ligaments and padded with a few discs.
Injuries you might see as a yoga teacher include cartilage tears caused by poor alignment, ligament tears due to side impact when the knees are bent, or joint replacements to relieve arthritis and long term degeneration.
Whether your clients are turning to yoga to “pre-hab” as a way of avoiding surgery, or have gotten the green light to resume yoga after surgery, consider what poses and exercises will be complimentary to their healing process. Knee rehabilitation often includes stabilizing the knee by strengthening and tightening the quads and hamstrings, but it is equally important to stretch those muscles as well as attend to the adductors so the knee doesn’t become imbalanced by being overly tight on one side and slack on the other. In addition, breaking up scar tissue and improving circulation in the knee will help the recovery process.
The Yoga Tune Up® KneeHab video is a great place to start! You can also check out my video below and use your Yoga Tune Up® Therapy Balls to help break up your scar tissue.
Read our post about knee pain.
Learn more about our Therapy Balls for knee pain.
Check out more of our Yoga Tune Up videos on YouTube.
Thanks Christine, this is very helpful and the video is very useful.
Thanks so much for this! I have zero patellar cartilage in one of my knees, and after the flare that sent me to get an x-ray, my trainer helped me to turn on the back chain of my legs. I built substantial hamstring and glute strength in a short time. Add in rolling, particularly of the anterior tibialus and sartorius attachments, and now I am pain-free. Trying to put off surgery as long as possible!
Thank you Christine for your post. I’m a marathoner, as well as a marathon coach, so this information was very helpful! It’s great to know you can roll out your knees with the YTU balls!
Thank you for your succinct explanation of the knee joint! I am searching for information to help my client with arthritis in the knee and wondering if surgery can be avoided. I will check out the knee hab video, thank you and if you think of anything else, that would be great.
Yea! It is nice to find someone like you with similar problems. After 4 knee surgeries, I am constantly do something to mess up my knee. I realize I really need someone who truly understand the body. After the last yoga restorative class, I attended I was in a lot of pain. I just bought some balls and will try them with your video. Can you recommend anyone in Denver that could safely help me build strength and protect that knee joint?
This was great! I just learned about skin rolling on my wrist and this will be great for my husband since he has chronic knee issues. Thanks!
Thank you for this! I work with a lot of pre- and post- knee replacement clients. I frequently use foam rollers in my practice, but have only recently discovered the Yoga Tune Up balls. I’m excited to see a technique that I can use with my elderly clients for whom compression is too aggressive.
Thank you for this post- it’s so succinct and clear. I’ve been approached to work with someone who has had knee surgery and this post backs up what I was thinking and also details simply the complexity of the knee joint
Thanks for the article and video clip.
I just did the skin rolling technique you demonstrated and now my knee feels all tingly and refreshed.
What a great and easy way to help re-balance my knee function.
I have Rheumatoid Arthritis and my knees are always tender when I try to get in any kneeling position. Oh how I wish I could do Child’s Pose or just get on my hands and knees!!! The only recommendations I have received is that I should use a cushion-ier mat and work on my “edge”. Any other techniques to try?
Christine – Thank you for the info. I had reconstructive foot surgery and I still find that I have range of motion issues and stiffness. I can’t wait to try out the skin rolling techniques on my foot!
This was a really helpful organization of the knee all in one place. I especially loved the simplification of the muscles on the front of the knee extend it and the muscles on the back flex it. That makes it relatively easy to remember! I also loved the context you used when you referenced the street changing across the intersection for the quadriceps tendon. That was always so confusing when I lived in Arizona! Thanks for the great summary.
I love the trick with the fingers for when I don’t have my therapy balls handy. The kneehab DVD has been a staple in my surgery recovery process! Super happy with the results I’m getting from it. Thank you.
Knee anatomy simplified. Thanks for the clarity.
Thank you for this clear and easy-to-follow reminder of the anatomy of the knee. I especially appreciate that you offered the ability to help one’s knee health without the use of the therapy balls. Don’t get me wrong – I love the balls – but it’s nice to have another option for when you don’t have balls handy or when you don’t have the privacy and space to get down on the floor and roll around.
As I was cueing breathe in my vinyasa class, a student came up to my and told me her husband on the mat next to her just had knee replacement surgery. I was taken completely off guard as my stomach dropped. Unfortunately there was little I could do because my full class had already started. This was a huge learning experience for me because I now know to ALWAYS inquire about any knee injuries that students have. This article allowed me to become so much more knowledgable about knees so if that happens I again I know how to respond! Thank you.
A great kneecap- recap!! Loved reminding myself of the structure of the knee, as well as re igniting the importance of prehab. I have spent so much time in my body full of imbalances and in rehab mode, it is great to not only know I can help relieve some of those ailments, but prevent others that may creep up due to poor alignment.
After a friend recommended the Knee Hab video, I got and have been using it every day. I cannot say enough about how much Knee Hab has helped my recovery. I have had the meniscus in each of my knees trimmed, a bit of each removed. I am wondering if I will ever be able to go into a deep squat ever again? Thanks so much!
Thank you for this post and video! I had knee surgery a few years ago and still experience lots of pain and discomfort. I am now adding skin rolling into my daily routine for some extra rehab before being physically active.
[…] Relieving Knee Pain: Get Knee Deep in Knee Knowledge […]
Thank you so much for this break down of what is happening in the knee! I have very funky misbehaving divas for knees, and it has become my mission as of late to uncover what is fueling the pain I’m experiecing and how I can relieve it. Coming from a family with crazy knee problems I think understanding the anatomy of the knee is an essential step in potentially preventing injury. My father has had both of his knees replaced…twice, My grandparents have had their knees replaced and my mom (a yogi herself) has suffered multiple meniscus tears. As a current Yoga teacher I am determined to better understand the the forces that effect the knee, and I appreciate you highlighting how relevant this is the yoga community in general.
Thanks for such a thorough article! As a new YTU trainee, but an instructor for several years I find that a deep degree of knee flexion is often problematic for a majority of the population. I’ve learned modifications from many of my teachers that I offer to students in class which typically alleviates some of their pain and concerns. However, my very first teacher had us sit in Virasana in every class for at least a minute or two and framed this pose as being extremely helpful in order to prevent future knee injuries. Would love to see an article discussing deep degree of knee flexion in many yoga poses and the related benefits, detriments or contraindications to this.
Great to know more about the way the knee is constructed. I am trying to figure out how to work on my knees with the yoga tune up balls and am wondering if there is any part of knee I should stay away from. Your advice on focusing on the quads, hamstrings, and adductors is very helpful though!
Excellent description of the anatomy of the knee. It is amazing to think of all of the possible impacts on the joint in terms of tightness or slack in the muscles that surround the knee and that is BEFORE we subject it to dynamic movement. Thank you for bringing my attention to the need for both strength and stretch in these muscles and ways to target that necessity. I want to make sure I stay in “pre-hab” NOT “rehab” if at all possible!
What great detail on the anatomy! Last fall, I fell of my bike and suffered from sever knee pain. Thanks to the Yoga Tune Up® KneeHab video and help from my teacher Todd Lavectoire, I avoided painful injection shots AND possibly severe allergic reactions!
Awesome kneehab video! I love that you gave options with or without the Yoga tune up balls. I had no idea that in the US there are a staggering 600 000 knee replacements every year. Thank you for relating the relationship with that stat and the number of individuals practicing yoga (suggested by yoga journal). As yoga teachers we will no doubt see students who have knee issues and some time or another. For that reason it is our responsibility for being aware of knee anatomy mechanics. Also being prepared with modifications and techniques before you see a knee issue is a must! I will certainly be forwarding the technique you have recorded to a friend tonight! Thank you for sharing such great information!
Great blog on basic knee anatomy and all the tissues surrounding this joint. Your points are all valid and true for sure, But I submit that it’s equally, if not more so, important to address any hip weakness/imbalance especially gluteus medius integrity. The inability of many to hold knee alignment in standing poses can often be traced up the chain to the poor neglected hip.
Great blog entry! It’s so important to know the structures and mechanics of the knee joint when assessing students, helping someone modify their postures, or creating a practice to help rehabilitate an injury or assist post-operative recovery. As you mentioned, it is inevitable that we will encounter students with knee pain or injuries in class, and having the relevant anatomical and kinesthetic knowledge will help us help them on a profound level. We must be able to offer posture variations, modifications and exercises that address their individual needs and requirements. Your article is a great launch-pad to build from or add to a tool-box of resources. Thank you!
I had 3 knee surgeries in a calendar year: a lateral meniscus resection, a medial meniscus resection and an OATS procedure (osteochondral autograft transfer system). The last one was by far the worst. I wish I had known about this way to break up scar tissue back then, but I’m sure there’s still plenty there to work with. Thanks for breaking it down! (Um, no pun intended.)
*tune up balls, not bowls! 🙂
Loved the skin rolling tip and how to use tune up bowls… would love if you could elaborate on the best yoga asanas to strengthen and stretch an injured/ recovering knee.
informative! thank you!
Knees support our body and play and important role in balancing and stabilization.
Yoga is an interesting approach because legs are the principal actors in standing poses and in case of recovery it is necessary to built a strong foundation. This includes working the muscles around the knee in many ways. I find it interesting to include yoga to the recovery process because it gives you latitude to explore and the possibility to find a space where it is safe to be, an inner state where pain brings less discomfort. This if course with the assistance of a compassionnate teacher that can suggest a variety of safe postures.
What an informative article! As a person with periodic knee pain (and a consistent yoga practice), I was interested in the way Christine presented the anatomy of the knee and how specific target areas for stabilization and stretching others can help maintain the health of your knees. Frequently, I have heard about the need to “stabilize” your knee by addressing the quads and hamstrings, but I have often forgot that we also need to stretch the area, so we will not be off balance. I’m definitely looking forward to mindfully applying these concepts and seeing how they change the way I practice yoga.
My Mother suffered from a torn meniscus a few years ago. After a long healing period and post surgery infection she suffered another injury to her other knee from overcompensation. This article was very helpful in understanding the anatomy of the knee and I was so happy to share it with her.
Christine – awesome article. I’ve been through 2 ACL replacements on the same knee, and yet I’m still learning how my knee joints really work. The anatomical breakdown above is very helpful, thank you! Something I’ve also noticed is how helpful it can be to engage the muscles below the knee as well – especially in positions such as pigeon – I think it’s the anterior tibialis and peroneus?
Thanks for the insight!
Great article on helping a teacher who does not have any knee issues herself, become more informed about how to help students in class with knee problems. Thank you
As a beginner teacher trainee, this is really helpful on how you broke it down. I also suffer from a knee injury and know many that complain about their knee pains and/or have had knee replacement surgery. Knowing and understanding this information is definitely value added to your teaching practice.
As soon as I began to practice, I noticed that my trick knee began to heal. That said, a daily practice offers plenty of opportunities for injury. Occasionally, I’ll find that a specific pose triggers a pang and I’ll have to back off a day or two. My structural awareness of the knee is limited but increasing. Articles like this are very helpful- the more I know about the knee, the more likely I can prevent anything wacky happening in the future.
Knee problems are very common, whether you’re young, middle aged, or a senior citizen. Yoga can benefit anyone from any of the aforementioned categories through stretching and strengthening. Two recommended poses would a head to knee yoga pose and a half lotus pose. Both would be useful in preventing and or treating current injuries. I can speak personally about the benefits of yoga with regards to my knees, I used to have problems with my knees while running, but after practicing yoga and in particular these poses, i know longer have problems.
i always like this kind of information anyways, but with my wife looking at a total knee replacement on one knee, this is very very timely and useful –
thank you much!
Great article. It was mentioned that if someone can rotate their knee when the leg is straight, the individual should see a doctor now. I have had this ability in my knees my whole life and it has not really caused problems. I do have to be careful with alignment in yogasanas like half lotus, and in situations where the knee joint is anyhere between closed or open to 90 degrees and the foot is grounded taking weight. The human body is so complicated, it would probably take hundreds of pages to document the knees potential problems alone!