Some students experience knee pain because their knees are sensitive, their hips are tight, or their legs are weak from sitting most of the day. Pain and swelling can also occur because the cartilage in the knee has worn away in time. These generalized adaptations are not a catch all solution to working with a knee injury, rather launch points for personal exploration and discovery. Caution to be gentle and go slowly whenever possible.
How you experience knee pain or discomfort will be unique to your situation, injury history, and practice. It is best to talk to your doctor, physical therapist, and/or yoga teacher to find the individualized modifications that best fit your practice.
Adaptation #1: Make space for your knees
This can be applied to every single aspect of your life on and off your mat. Make space for your knees to breathe and enjoy movement. Take time to notice your knees and truly value the support they provide in your life. Respect your knees and recognize when you are asking them to move too far.
It is especially important to make breathing space when putting your knees in extreme flexion. For example, Balasana (Child’s Pose) places your knees in a great deal of flexion. Put a rolled up blanket in-between your thighs and calves to give your knees space to breathe.
Adaptation #2: Invite a soft bend into your knees
One of the more common knee related injuries stems from hypermobile joints which translates to hyperextended knees. A soft bend in every asana will remind you to engage the muscles of the legs rather than dump weight into your knee joint. Bend to keep your knees feeling happy throughout your practice.
Trikonasana (Triangle Pose) is a culprit for hyperextended front knees. Place a block under your front calf to prevent hyperextension if it is difficult to remember or you are unsure how to softly bend your knee.
Adaptation #3: Check your knee alignment
In general, the inner thighs are weaker than our outer thighs. For this reason, people often walk with their toes pointed outward in external rotation. In asana, this is seen when the front knee in Virabhadrasana II (Warrior 2) falls medially rather than stacking over the front ankle. Mindful knee alignment in asana will help keep your knees safe.
At first, it will be a challenge to remember proper alignment and you may be unaware that you are not in alignment. Rather than focusing on a mirror to constantly correct your form which can take you out of your practice, film your practice from different angles and study your alignment. Take one correction after every practice to focus for the next practice and watch your practive evolve!
Adaptation #4: Strengthening your leg muscles
While the knee joint is the largest and most superficial joint in the body, it is mechanically weak and highly dependent on the strength of the surrounding muscles, tendons, and ligaments.
Working on the overall strengthen in the legs is one of the best ways to take care of your knees. As noted earlier, the inner thighs are generally weaker for most of us so practicing Utkatasana (Chair Pose) with a block between the legs is a helpful reminder to engage the inner thighs while working the muscles of the legs.
Adaptation #5: Swap out some asana
Some asana will create too much tension and pain in the knees. In these cases, swap out poses. For example, one of the more painful asana for the knees is Eka Pada Kapotasana (Pigeon Pose). While EPK can feel like a fantastic hip opener and overall glute stretch, it can be incredibly painful and hard on the knees. Modifying with Supta Kapotasana (Supine Figure 4 Pose) can feel better for many people. However, this may still be too intense and you should work with your teacher, doctor, or phyiscal therapist for a modification that best fits you.
Living with a knee injury requires you to be more aware and mindful in your movements. These adaptations will not always be easy to implement, start by trying one at a time. Learn about your knees as you go. The most painful points often inspire the largest areas of growth. Wherever you are, remember to practice for you and listen to your knees!