Where does knee pain come from?
Knee pain is a common complaint in yoga classes and beyond, but you might be surprised to discover that quite often, the culprit is, in fact, not the knees at all, but instead, your hips and your bum.
Everyone’s anatomy and physiology is individual, so while a lucky few will never have any problems at all, the vast majority of us will experience differing levels of support from our hip abductors (gluteus medius), the tensor fascia latae, and the better known gluteus maximus (your bum muscles).
So how does this happen? It’s all to do with how you move, sometimes known as ‘the biomechanics of walking’, and the work of your abductors and adductors.
What is abduction and adduction?
Abduction and adduction are all about the relationship of your hips to the centre of the body.
Abduction is related to your hip abductors, which support you in walking, standing, balancing and stepping sideways. It’s about moving your legs away from the centre of the body
Adduction is the opposite. It’s the action of bringing your legs together. Your adductor muscles pull your thighs closer to the midline of the body.
When you place your heel down and up when walking, shifting weight or bending over, your pelvis and hip should be stable. If they’re not (you might not notice this, as it’s not often an obvious weakness), or if other muscles are compensating, your knee can roll inward as you move. This is when you often get the pang of knee pain, as the kneecap is compressed. If this happens to you repeatedly (it does to me), chronic pain or regular pain becomes a constant companion.
As a personal example, I often experience this myself. It has happened at all kinds of random times - while standing in the shower, walking up the stairs, while practicing yoga… The reason? I have a lot of turnout in my hips. If you’ve met me, you might notice my legs/feet turn out rather than face forward when I’m standing naturally. The way I’m built anatomically unfortunately means that my hips don’t support my knees or ankles. This is why I’m always spraining my foot and ankle. Lucky me!
What can help?
There are lots of things that can improve the situation, whether you practice yoga or not, and I’ve described them in full below.
Firstly, for general strengthening, I’d particularly recommend some Pilates movements like clamshells and side-leg raises.
Secondly, consider how you move within your practice. Often, when we’re simply standing or squatting, bending or folding, we aren’t aware of this gait issue, and as such our knee rolls inwards. To compensate for this, imagine your hands are pressing your knees outwards, or, if you’re twisting, you might place the back of the opposite hand on the outside of the leg and use oppositional forces. You might be surprised at how much you notice the difference.
Below I’ve listed out some ideas for postures within your yoga practice that can support improving this. You might find you experience knee pain in, say, a standing balance - this isn’t about doing those postures differently, it’s about what could help build strength outside of that. When doing those postures, you then want to bring the awareness of abduction and adduction in and start doing that as part of the whole movement.
How to guide
First, warm up before attempting these exercises. Take some non-weight bearing positions and warm up the full range of motion (e.g. rocking on the back with knees drawn, supine twists etc).
Clamshells:
Rest on your side, bend your knees a little, and place one leg on top of the other. Make sure your hip is firmly on the ground, rather than your body rolling backwards
Keep your heels together, and lift your top knee, then release it back until the legs are parallel
Repeat as much as you like, and then take it on the other side
Side-leg raises:
Rest on your side, and stretch your bottom leg out in a straight line (as with everything, make sure you’re not locking the knee).
Place your elbow on the floor to support the upper body. Squeeze the glutes, and lift the top leg up into the air until you reach the end of your natural range of motion
Release and relax your leg back to the starting position. Repeat and then take on the other side
You can also do this standing, but it might be a good idea to use a resistance band in this position
Setu bandha sarvangasana (bridge):
Lie on your back, and bring your feet towards your bottom. Keep the legs parallel at about hip distance
Press down through the feet, forward and up through the knees, and lift to a diagonal. Squeeze the glutes, and imagine your knees being pressed outwards
Release down, and take a few more times. To strengthen further, try placing a resistance band above or below the knee when you do this, or placing a yoga brick just above the knees
Supta padangusthasana (reclining hand-to-big-toe):
Lying on your back, grab a strap and place the ends round the ball of one of your feet. With control, keeping the knee bent and a sensation of connectivity between the ball and socket of the hip joint, press the foot up to the ceiling, ensuring the knee doesn’t lock
Similarly to your side-leg raises, you can mobilise the hip outwards, but do so with control, noticing any point of change
Repeat as much as you like, and then take on the other side
Virabhadrasana II (Warrior II)
Turn your hips to the long side of the mat. Point one foot towards the top of the mat, and turn the other foot in 45 degrees. You don’t have to have the feet in line. Bend the front knee
As you bend the front knee, abduct, imagining you’re pressing it outwards from the inside
Make this dynamic or static. Keep the feet planted, and place your hands wherever you prefer