Our knees hold us up and allow us to propel forward, yet we often give them very little thought until they start to tell us that strain is taking its toll. When we consider that they can bear 5-12 times our weight when we break into a run, we can see how understanding their function is crucial for how we support ourselves up from gravity. They are the largest joints in the body because they need to be.
Our knees are essentially hinge joints, with a back-and-forth motion between extending the lower leg to straight and flexing it back in, our natural walking motion. They also have some rotating capacity inwards and outwards, allowing them to have flexibility, but can make them prone to injury. With modern tendencies to sit on chairs rather than on the floor as our skeleton evolved, we often have reduced range of motion (ROM) in the hips – which are ball and socket joints with a wider ROM – and the knees take up more rotation than their design allows. This ‘torquing’ across the knees can create pull that we feel as stiffness or pain and has shown to contribute to rheumatoid and osteoarthritis (OA) there as tissue inflammation results.
As our knees bear 1.5 times our weight when we walk, we can also find them suffering if we put on more pounds. Population studies have consistently shown links between obesity and OA (Am.J.Epidemiol., 1988;128:179-189), with obese women having nearly 4 times the risk of knee OA compared with non-obese women and for obese men, the risk was nearly 5 times greater (Am.J.Epidemiol., 1988;128:179-189). This is not simply about weight on the joint though, the adipose (fat) tissue stored in overweight and obesity is also inflammatory in nature, a known trigger for all types of arthritis (Curr Opin Rheumatol., 2010; 22(5): 533–537).
Ironically for many, knee issues can mean less ability to move and more likelihood of putting on weight, so attending to our knees in ways that allow our basic daily walking needs – without weight-bearing to start – is crucial for our overall health.
How our core affects our knees
Many modern postural issues have a short, tight psoas muscle at their core. This word is appropriate as this muscle complex is deep in the centre of our pelvis, linking the legs to the spine and allowing us to stand upright.
A short psoas tips the pelvic bowl forwards, which minimises the space between the crest of the pelvis and the leg, which in turn compresses the hip socket, preventing the leg from moving separately from the trunk. Normal rotation, instead of occurring in the ball and socket of the hip joint, begins to manifest as twists in the knees and torques in the lumbar spine. Lower back pain and knee pain go hand-in hand, with some research even suggesting that knee arthritis has a nerve pain origin, tracing back to compression in the lumbar spine nerves, such as sciatica (Arthritis Rheum.,2010;62(10):2995-3005).
The answer is not simple to lengthen the psoas (as we come to in the lunges), but to allow it to neutralise and let the lower back broaden. Doing this lying means we can take this ease into stacking up through the knees from the ground.
Lying for 15 minutes in Constructive Rest Position here (CRP), with balls of the feet and heels equally weighted on the ground, can allow this deep channel to soften and release. You can place your hands on your belly to connect into your breath there and if this feels tight in the lower back, you can walk your feet out wider, turn your toes in and drop your knees in towards each other. Check your head is supported to feel your chin dropping to your throat for full softening potential.
Massaging the backs of the knees
Tight or tense hamstrings can be at the heart of many knee issues. The meniscus in the knee is a thickened crescent-shaped cartilage pad between the two joints formed by the femur (the thigh bone) and the tibia (the shin bone). This acts as a smooth surface for the joint to move on. Those with smaller hamstring muscles (less used) compared to the size of their quadriceps (thigh muscles) have shown to have more signs of cartilage and meniscus swelling and degeneration of the knee (J Orthop Sports Phys Ther.,2013;43(12):881-90). Those with strong quads and tight hamstrings may have this muscular imbalance that
Fig 1 – From CRP draw each leg into the chest in turn, so that you can bring both hands around the backs of your knees and move your fingers into your ‘knee pits’ to fully massage from here and then anywhere into the backs of the thighs that feels tight. Go softly if there is soreness and build up over time.
Fig 2 – lift up each leg in turn to lengthen up through the knee without bearing your weight onto it. Spend some time rotating each ankle and pointing and flexing the foot before holding and breathing release in the backs of the legs.
The knees take what the hips cannot
Our knees are happiest when we can walk with feet pretty much parallel, where the one of our major hip rotator muscles – the piriformis – is at its most balanced. Most people turn their feet out to some degree and this can show that this muscle is either weak or tight. When we do the kind of hip openers here, we can feel if this is too tight when the pose feels very caught or painful in and around the buttock (of the leg closest to the face) or if we simply flop in and cannot feel a thing, then it may be too weak.
Fig 1 – bring the left foot against a wall with the knee at a right angle and turn out the right leg to bring the outer shin across the left thigh. Try to keep the hips level so that the rotation outwards is in the right thigh bone and not distorting the pelvis. Stay with any strog sensations with full exhalations to allow release in the hips.
Fig 2 – coming in deeper, you can take hold of the front of the left shin (or back of that thigh), supporting the head if need be, so you stay long at the back of the neck.
If the pose feels strong, simply stay in the version where you can feel the potential for opening, along with full, releasing exhalations. If simply very easy, hold back from your furthest degree and rather feel the muscles in your hip having to hold you there are create some containment.
Myofascial massage up from the foot
One way we can begin to support the knees is from the platform below of the feet. When our feet harden through lack of natural use, or weakness around the ankles pronates or supinates them (they collapse in as flat feet or outwards, respectively), this imbalance between the inside and outside of the foot is transferred upwards, where the knees and pelvis may compensate.
Myofascial release in the feet can help to open out the instep and ball of the foot and help movement through when walking to balance out. You will need a soft, small spiky ball (about 9-10cm in diameter) for this exercise.
Stand to feel how you lift up from the ground and then walk to feel your rhythm and where that is easy or less so, up through the legs and into the top body. Do this before each foot, between and after to feel the effects of fascial release up through the foot and knee, especially how you place them when walking.
Standing on one leg, holding onto a chair or to a wall if you need, roll one foot at a time over a spiky ball to fully explore every part of your foot for a good few minutes. Explore the different sensations and different pressures, even pushing down strongly into any region (and particularly the instep) to create a deeper intensity and then easing off to feel flooding of fluids through the tissues as you release. When you walk and stand you may then feel that your legs seem longer as the fascial lines have more freedom up from the lower body into the torso.
Standing up through your knees
From there, when you stand feet shoulder-width apart, you can feel your body organise itself upwards and find the place where we most easefully stack up on the platform of the knees, with the pelvis sitting directly on top of the femur heads – ears above shoulders, shoulders above tops of the thigh bones, above the ankles. The softening the psoas is CRP also helps to avoid shunting the pelvis forward that can cause so much extra pressure on the knees.
Strengthening the inner thighs
Good knee alignment relies on strength within the adductor muscles; those at the insides of the knees that draw our legs out and away from the centre line. There is not much call for these in average daily life and so it is quite usual for them to feel weak or pull strongly from the knees when we come into positions where the legs are wide and straightened. Once we have softened the fascial lines up through the knees, intelligently strengthening the inner thighs can aid how we support ourselves up through our knees:
Fig 1 – a wide-legged standing forward bend can firstly be done to a chair, so that the hips have more room and we can focus on how we lift up through the inner legs. Foot position determines the relationship of the inner and outer knees, so ensure your feet are parallel, even a little turned in if your hamstrings are tight. Then lift and spread the toes to gather up the instep, good contact with the ball of the foot on the big toe side. Drawing in the outer shins and lifting up through the inner knees. Breathe fully to hold this engagement of the legs without tension.
Fig 2 – if you have more hip movement and as the hamstrings release, you can come into a deeper forward bend with the same focus on intelligent feet lifting up through the knees.
Fig 3 – coming into poses like warrior 2 in yoga here or a lunge, where the front leg is bent towards a right angle, we need to pay attention to the position of the knee in relation to the foot. In this pose, the back foot is turned in (as is that hip) to allow the inner front thigh to lengthen and the knee to point towards the middle toes and not torque forward. The knee does not travel forward of the ankle or it can become strained, rather it receives beneficial weight-bearing for health of the bone and joint.
Alternatives to child pose
If you’re a yogi and coming into child pose is less restful and more knee-upsetting for you, this variation offers and increased angle at the back of the knee that can relieve problematic weight and compression there. Lifting the hips above the thighs means that the thigh bone can stack up from gravity and there is room to breathe space in the ‘knee pit’ as the spine decompresses in this inversion.
You can also increase the space behind the knee when sitting or kneeling by placing a small (child’s or sports) rolled up sock into the knee pit, just enough to open without feeling you are jamming there.
Always spend time relaxing after any session to allow tissues moved and strengthened to come to rest and rebuild in new patterns.
Join Charlotte at one of her next yoga classes, workshops, courses or retreats. More information here.