What Are the Best Ways to Prevent Yoga-Related Knee Injuries?

If you indulge me for a couple of paragraphs, I’d like to share a brief history of yoga, my knees, and yoga-related injuries. As a flexible body type, I could always achieve deep hip-opening poses in yoga. Then, after about ten years of practice, my knees started to feel the impact.

The first time was pretty dramatic. I attended an advanced yoga retreat with my teacher and about 30 senior students. We were practicing Root Lock Pose (Mulabandhasana). As you can see in this photo, it’s a pose that takes the knee into full flexion combined with extreme external rotation of the leg, i.e., bent and turned out.

As I moved into the pose, I felt the dreaded “pop” in my outer right knee. It was the tibia, the shinbone, that forms part of the knee joint. It had slid out of place and got stuck there. For a few seconds, I couldn’t straighten my leg until it popped back in, and the knee joint started moving again.

This was terrifying, to say the least. I can still feel the wave of fear that hit me. But even more disturbing, perhaps, was that I felt ashamed and embarrassed about it.

Learning Our Limits Through Healing Yoga-Related Knee Injuries

I don’t even remember telling my teacher or asking for help. As soon as it went back in, I went back to practice trying to pretend nothing had happened. The pain didn’t last, and I continued working more slowly and carefully. Fortunately, I hadn’t torn a ligament; I just really stretched it. For the next few months, I was treated by an osteopath, and over time, I learned (on my own and with teachers) how to stabilize my outer shin, knee, and leg to compensate for the laxity there. Yet, for years every time I took my leg into that same position, I felt scared.

The other knee had a different story, a dull pain in the inner knee that showed up occasionally at first and then more often when the leg was in external rotation like the front leg in Triangle Pose (Trikonasana) or in Wide-Legged Seated Pose (Upavista Konasana).

It was diagnosed as a mildly torn meniscus. I was told that it could heal by itself, but it meant not bending that knee past 90 degrees in any pose, that’s a square shape, like the front leg in Warrior II Pose (Virabhadrasana II). I backed off and listened to this advice. For six months, there was no Hero Pose (Virasana) (shown below and also at the top-using props), Bound Angle Pose (Baddha Konasana) (top image), and definitely none of the deep hip openers that I loved. I took it super easy. It healed.

I share the stories of my knees to illustrate some important things about yoga-related injuries. They are physical, and they are more than physical. How we work with them will teach us a tremendous amount about our bodies and our own unique biomechanical vulnerabilities. And just as important, working with injuries in yoga is a precious opportunity to examine our inner dialogue and the larger cultural and psycho-social dynamics at play in our practice environment.

3 Common Causes of Yoga-Related Knee Injuries

The most common musculoskeletal injuries that occur in yoga happen because of doing too much, too often, too fast, or some combination of these.

Too much: Too much is when you stretch beyond a healthy range of motion for your joints. Repeatedly moving into deep ranges of motion without creating proper stability can lead to injury. We can also overdo it by simply doing too much intense practice or holding poses longer than we can sustain healthy alignment and muscular action.

Too often: Repetitive movements done with misalignment, over time, create stress on the tendons and ligaments, resulting in overuse injuries like tendonitis, muscle strain, and tears.

Too fast: Moving too quickly to hold healthy alignment through moving into, holding, and coming out of a pose.

Obvious and Not-So-Obvious Yoga-Related Knee Injuries

In my experience, injuries in yoga can be of the quick and obvious variety, the muscle pull or the sharp, burning pain, my tibia moving out of the knee joint. These types of injuries are easy to recognize because they appear suddenly. There’s no mistaking that something is wrong.

Other yoga-related injuries are harder to pinpoint. These are the dull aches like my meniscus. They can come from vulnerabilities left by old injuries, joint instabilities that gradually start to bug us more over time, or repeatedly pushing beyond where our body is ready to go. We often may not feel this kind of injury while practicing. The pain might show up later on or the day after. Over time, pain or referred symptoms gradually increase because we are unknowingly making the situation worse by the way we’re practicing.

Both types of injuries require us to observe, listen, and come into a deeper relationship with our bodies and our practice.

How Can We Adapt Our Yoga Practice To Prevent Knee Injuries?

The good news is that too much, too often, and too fast, with too little awareness and sensitivity, often leads to injury. There is much we can do to prevent injuries from happening simply by doing the opposite. Slowing down, doing less, and backing off. Of course, increasing sensitivity, awareness, curiosity, and a willingness to explore and shift what you are doing are also essential.

Here are some reminders about avoiding yoga-relate knee injuries in practice:

• Use your breath to soften effort, calm your nervous system, and sustain focus when working deeply.
• Move slowly and mindfully when going into and especially when coming out of a pose.
• Always balance stability with flexibility, and prioritize stability over flexibility.
• Choose to maintain the integrity of good alignment over moving deeper into the form of a pose. This includes using props and the appropriate pose modifications for your body.
• Learn to differentiate between sensation and pain by observing your experience during and especially after practice. Discomfort in postures is not necessarily a sign of injury, but it’s important to learn to distinguish between the two. In general, a sharp, burning sensation localized in a joint or at a muscle attachment is a red flag to immediately back off.
• Sequence your practice to include enough warm-up to prepare your body for more challenging poses and ample warm-down, including Relaxation Pose (Savasana).
• Communicate with your teacher about anything that doesn’t feel good in your body.