I’m getting a lot of inquiries about knee problems and here are some basic guidelines on knee health. 15 years ago I seriously blew out both of my knees (shifting furniture and landscaping) and have subsequently healed them with yoga. I took 1.5 years of work to get 95% of quality back and another 5 years for the remaining 5%. I believe that my knees are now healthier than they would have been in the case of using surgery. However, surgery may be the way to go in some cases.
I have given a lot of information pertaining the knee health in my first book Ashtanga Yoga Practice and Philosophy but here a few details:
Daily before your asana practice sit in Virasana with a pile of blankets under your sit bones so that you feel a mild tension in your knees and quads but nothing painful. Slowly day-by-day, week-by-week and month-by-month reduce the height of your blanket and thus the stretch of your quadriceps until you can completely flex the knee joint. In order to perform lotus and half-lotus postures safely you need to be able to move the femur (thighbone) and tibia (shinbone) as close together as possible and then move them as a unity on the way in and out of the posture. Transiting in and out of lotus and half-lotus postures tibia and femur should not move relative towards each other at all. It took me nine months of daily practice to arrive with my sit bones on the floor in Virasana. Continue to use the posture daily until your knees are completely healed and even beyond that point you may use it as a safety precaution. Knee problems are sometimes caused or exacerbated by wrong articulation of tibia, femur or patella towards each other. Virasana goes a long way in correcting it but only then when your feet and toes point straight backwards and never out to the side.
In standing asanas, never ever let the inner arch of your feet collapse. This will weaken the inner menisci. Again there is a correlation between collapsed arches and/or knocked knees and knee problems. Knocked knees are contributed to by fallen inner arches of the feet but also by tight adductors and weak abductors.
In all standing postures such as Trikonasana, micro-bend (2 degrees) the front leg and make a swiping movement with your front foot towards the back foot. Never ever push out through the knee down to the floor in an attempt to hyperextend the leg. This would weaken and stretch your cruciate ligaments. The vast majority of knee injuries shows an involvement of ligamentous laxity of the cruciates prior to the actual meniscus tear.
In standing postures be precise in placement of the feet, i.e. turn out of 85 degrees means 85 degrees and not 84. This will make a big difference.
In postures such as Downward Dog, Padangushtasana, etc the centreline of the feet going through the second toe and the centre of the heel need to be parallel to each other. Do not turn the feet out.
If you are in the habit of turning the feet out while you are walking you need to gradually and cautiously correct that. This otherwise will also weaken the inner meniscus.
Bring femur and tibia closely together before you go into half-lotus and precisely follow the stages in and out of lotus and half-lotus postures as I have described it in Ashtanga Yoga Yoga Practice and Philosophy (see the photos of Ardha Baddha Padmottanasana). Both transitions need to be pedantically and tediously broken down into their respective phases of movement.
Completely master the rotation pattern of the femur in the Primary Series (Ardha Baddha Padma Pashimottanasana to Janushirshasana C) as described in Ashtanga Yoga Practice and Philosophy. Again be precise and pedantic like a taxation officer, or the like.
Be sensitive, listen to your body and correct your mistakes as fast as possible. That’s really important. Do not, I repeat, do not re-injure yourself. In order to be able to interprete your bodies signals change every day only one thing in your practice. If your knee gets sore again this one thing that you changed needs to get eliminated. Most people change to many things around how they work in the postures and for that reason can never clearly allocate the effects.
Be gentle and never ever force the knee into position and never strain it. If necessary leave out postures, modify them as needed and ask your teacher to not adjust you in postures where you feel discomfort. Contrary to what’s believed in the contemporary Ashtanga-cult, you do not get browny points in heaven for sticking to a particular series despite obvious detriment.
Consider placing a ferrite magnet on your knee using sports tape. Change the location slightly and study the impact of the change. It seems to be helpful to use magnets but its important to find the right spot.
Consider using MSM Chondroiten, Glucosamine and Vitamin C with Bioflavonoids daily for at least 9 months. Helpful in many cases.
Place both hands on your knees. Visualize the Divine in whatever form you worship It in your heart. Become aware of the healing potential of the Divine. Breathe that healing energy from your heart, through your arms and hands into your knee.
If you are a seasoned pranayama practitioner then visualize extracting life force from air during internal kumbhaka and absorbing it into Manipura chakra. During the exhalation visualize distribution of prana into your knee or other area that needs healing.
I sometimes get a pins and needle pain at the bottom of my knee cap…..any thoughts?
It could be a million of things. You probably have some imbalance there which is likely to be cause by pelvic obliquity. In this case it may be worth to see a musculo-skeletal therapist. For the time being I would lay of being adjusted in things like Baddhakonasana. Was the onset of this sensation linked to you doing a new posture? In any case you need to be really careful with taking your leg in and out of half-lotus. The daily practice of Virasana may be helpful with your sensation but proceed cautiously in the way I have described it in my various books.
What does tightness and pain in the shin bone when doing virasana mean?
I get a feeling of tightness in the lower leg, just below the knee cap, that eventually grows into pain when I do Virasana. How might I adjust the Virasana pose to account for that?
Sorry about the delay. Two things. Firstly the pain could be caused by the fact that you slightly externally rotate the tibia when sitting in the posture. To prevent that make sure that the the front edge of the tibia slices straight down into the floor and that the feet and toes are pointing straight backwards. That also means that the heels and soles of the feet must face straight up to the ceiling and not even a few degrees facing inwards towards each other.
Secondly, when starting the posture you are likely to have a short quadriceps. The quadriceps being the biggest and most powerful muscle in the body does not stretch easily. If it is too hard the extra stretch will go into the soft tissue of the knee hence the pain. You need to first fold a blanket (or two or three) and place it between your heels so that your sit bones rest on the blanket. Every five minutes or so you can gradually unfold the blanket that your sit bones come incrementally closer to the floor. This process is likely to take years. When I start meditating early in the morning I still at first use a blanket although I do the posture since decades. After about 10 minutes or so of warm-up I discard the blanket.
Hope that helps
I’ve problem with pose like siddhasana or padmasana half, ardha padma pattchimottasana…
It seems that I’ve pes anserinus from the doctor, I thought for years it was meniscus. So in this pose I can’t sur properly even in easy pose After 20min it’s inconfortable but no pain, in the poses I said it’s just for 1min.
I feel it in the inner knee, my foot can’t reach perineum in siddhasana or Close to hip in half lotus.
Thé pain from pes anserinus Come and go, can feel it in this poses, long squat, not when I’m running.
How to heal it once and for all.
When it’ll be healed or okay, which exercices or posés could help me to reach this poses because I can’t meditate seriously as I can’t sit for long Time. Except in a chair but tends to sleep or put my back.
The pain you are experiencing is from the bursa (fluid-filled sac) that lies beneath the apes ancerinus called pes ancerinus bursitis. The bursa is there to protect the three tendons that meet here. When our pelvis is imbalanced there is often a pull in one or more of these muscles and this irritates the bursa. It can be very challenging to correct this pelvic torsion yourself. I would recommend finding a muscle-skeletal professional, eg a chiropractor or osteopath that has a holistic approach. After the pelvis is balanced, the best way to maintain it is with good core activation and having strong gluteals.
I hope that helps…
In the post comments, you mention: “the pain could be caused by the fact that you slightly externally rotate the tibia when sitting in the posture. To prevent that make sure that the the front edge of the tibia slices straight down into the floor and that the feet and toes are pointing straight backwards. That also means that the heels and soles of the feet must face straight up to the ceiling and not even a few degrees facing inwards towards each other.” Is this version with the feet and toes pointing straight backwards considered to be what most yoga studios call as Vajrasana? I tend to do Vajrasana myself every day like this with my sit bones on top of my feet.
Also, when doing vajrasana with parallel feet and toes (with blankets) every morning, I find that after a few minutes, it begins to feel a little uncomfortable in the area of the front side of the ankle, as the weight of my sit bones are making the natural arch in front of the ankle area very flat and close to the ground. I hope that makes sense. Is this normal or should I adjust the posture?
Vajrasana is a similar but different posture to Virasana. In Vajrasana you sit on the feet. The problem is, as you noticed, that the top of the feet may get hyperextended from the sheer weight bearing down on them. For that reason it is good to change, after a couple of minutes, to Virasana. The difference is that in Virasana you sit between the feet, not on them. But all the safety precautions in my last post must be applied. I have described Virasana, including photos, in my books Ashtanga Yoga Practice and Philosophy, Pranayama The Breath of Yoga, and Yoga Meditation, respectively.
I am writing to thank you for your post. Following your instructions I managed to heal my knee significantly during the last 10 months. Today I could do padmasana again after 10 months with no pain and much much better than before, with both knees on the floor and the feet facing upwards as you described. Thank you so much.
I’m glad I could be of help and thanks for letting me know. Take your time and don’t stress your knees too early. With patience and subtle work they can repair completely but time is needed. I think it took me about 12 months to return my knees to 80-90% of function and the rest took almost 5 years.
All the best and warm regards