Medial knee pain and Yoga practice
How to manage and heal medial knee pain in your Yoga practice.
Inner knee pain can be a common occurrence in general but it can come up from time to time with Yoga practitioners. Especially if you are working on half lotus for example.
Occasionally it can be something serious if there has been some kind of sudden impact or rotation, but usually in my experience is it related to an old injury and more often than not, it is from an imbalance in the hips and muscular tension.
Let’s start with assesing the knee and how we can understand how it moves and what we are looking at.
The knee is a hinge joint. Meaning that it primarliy has one plane of motion associated to it and that is to move forwards and backwards. As we do when we walk for example. It isn’t designed to rotate but there is some rotation in the lower leg ( Tibia ) with regards to the upper leg ( Fibula ). A good example of this would be Janusirsasana C.
Most serious knee injuries i have come acrosss have been from practitioners applying too much rotation around the knee joint which has compressed the joint in some way leading to an injury, ranging from small tears to ruptures. The knee is unlike other joints in the sense that the sensory feedback ( pain ) does not gradually build like other joints. For example, the elbow, or shoulder when applying too much pressure to the joint, there is more of a progressive feedback system that builds letting you know something is not quite right, warning you to back off.
With the knee it can go from feeling ok, to feeling ok to feeling a little sore to pop. I’m not saying this to be an alarmist in anyway but it’s something to be aware of and to be mindul of when practicing.
Back in my younger years practicing grapping martial arts i witnessed this often and built up this sensory feedback myself. Submissions to joints such as the shoulder, arm, ankle were very progressive in nature. The knee not so much.
What we are looking for when assesing the knee is if the ‘pain’ is actually on the joint line or not. When feeling the medial side of the knee we want to asses exactly where the pain is. If it is exacly on the joint line, which you can feel for yourself using your fingers or thumb, gently press and gauge where the painful sensation is coming from. If it is on the joint line and is a sharp pain, this in my experience may need further investigation and potentially an examination of some kind to rule out any type of meniscus tear. Usually if the knee ‘locks’ when full straightening or fully bending then this could be a sign of this.
If this is the case for you, don’t think the worse. I have guided and have known many sutdents and practitioners over the years who have successfully healed all types of serious knee injuries with patient practice. The body is a highly intelligent organism and fantastic at healing with the right input. If you are unsure, seek out a skilled teacher to help you asses this.
In my experience, more often than not, the pain is not from a cartiledge tear, or any kind of tear for that matter, but from some kind of imbalance in hips of the practitioner.
In yoga, and especially Ashtanga yoga we are changing the structure of the body over time. We are working through potentially old injuries, with scar tissue and long term, deep seeded muscular / skeletal imabalances which creates tension at the hip and other parts of the body, thus leaving us with the experience of pain around the knee.
As the body stablises itself through regular yoga practice that is brining about more symmetry to the body, tension changes around the hip and specifically the muscles that cross and attatch at the knee. What is often felt is this tension change which feels painful at the inner knee, usually just below the joint line. The three muscles that attatch to this area we call in England the 'Goose Foot', or pes anserine, due to the shape. It consists of the sartorius, gracilis and semitendinosus muscles.
Under the attachment of these muscles is a fluid filled sack 'bursa', that sits underneath these attachments. If irritated or inflamed it can be quite painful and sore and can give similar feelings as ligament or cartilage damage. During my years of practice I've experienced knee pain at different times which was due to my body reorganizing itself from the changes made in practice. Usually the painful sensation would shift around, often moving from one side to another and coming and going as the weeks / months go by.
My way of managing this has always been the same. Observe, back off where and when I needed to and over time my body stabilize itself and the pain went away.
Our mind can want to achieve asanas or movement patterns the body isn't ready for. We just have to listen more carefully. Our bodies are amazingly intelligent.
A good way to think about muscular tension changes in the body is to picture a circus tent.
Like the body, a circus tent’s shape is held together with tension. If tension changes in one area the circus tent will lose it’s shape. To maintain it’s shape you would have to ratchet or shorten / lengthen a rope or weight in another part of the tent so it doesn’t collapse, or lose it’s shape. The bodies amazing intelligence is similar in that sense. Shortening a hamstring slightly, fascia around a particular part of the hip may tighten or some fibres along the lower back may shift slightly to create stability in the body. Your body is doing these changes consistently on the fly as a way to protect you.
Your body will always look for stability and a previous pattern that reinforces that.
What we are doing with yoga is changing that pattern slowly to create a new shape. But the process can be uncomfotable at times. A bit like having your teeth straightened at the dentist.
Steady and consistent yoga practice eventually creates a new shape in the mind / body that is stable, with less pain and better mobility.
For more of a complete guide to assesing knee pain and how to work with the hips, heal knee pain, check out my Better Mobility Guide using the link below where i go into this in more detail.
